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Analgesics & Muscle Relaxants

Analgesics Pain Killers (Decreases sensation of pain - sense of relief & well-being)
Pain unsatisfactory feeling that makes an emotional drive
Opiod receptors 5; Mu (2 subclasses), Kappa, Delta
Number of pain pathways from periphery to brain 50
Sedation Affects higher cortical function. (Lead to coma or general anesthesia)
Dextromethorphan SE suppresses cough reflex
Morphine Classification CII
Morphine is derived from... Opium Poppy
Opiods morphine-like substance
Narcotics Opiods & those that induce narcosis
Morphine(Avinza, Kadian, MSContin, Duramorph)site of action spinal cord, midbrain, thalamus, cortex (depresses nocioceptive spinal reflexes in dorsal horn)
Morphine (Avinza, Kadian, MSContin, Duramorph) neurotransmitters Cholinergic, adrenergic, serotonergic, dopaminergic
Morphine (Avinza, Kadian, MSContin, Duramorph) onset Quick: peaks 30-40 minutes after administration
Propoxyphene Darvocet, Darvon
Morphine Avinza, Kadian, MSContin, Duramorph
Propoxyphene (Darvocet, Darvon) pain use mild to mod
Propoxyphene (Darvocet, Darvon) Class CV
Propoxyphene (Darvocet, Darvon) SE Acute & chronic Toxicity, convulsions (difficult to treat)
Propoxyphene (Darvocet, Darvon) DI Increase toxic effects with muscle relaxants & CNS depressants
Propoxyphene (Darvocet, Darvon) overdose Most fatal OD in US b/c it extremely lowers the Sz. threshold. 2nd most common drug cause of death.
Meperidine Demerol
Meperidine (Demerol) pain use mod-severe; perioperative
Meperidine (Demerol) vs Morphine 1/6 potency. No pupillary constriction or cough suppression. Less smooth muscle effects
Meperidine (Demerol) metabolized by Liver
Meperidine (Demerol) SE CNS excitation - high doses (Tremor, muscle twitches, Szs.) & Respiratory suppression
Meperidine (Demerol) Class CII
Opiates SE Analgesia, Antianxiety, euphoria, sedation, respiratory depression, depression of cough reflex, pupillary constriction, N/V,endocrine effects (Increases ADH, corticotropin, PRL, GH, gonadotrophic hormones), edema, flushing, orthostasis, constipation,itch
Hydromorphone Dilaudid
Hydromorphone (Dilaudid) class CII
Hydromorphone (Dilaudid) Duration Short Acting
Hydromorphone (Dilaudid) SE Same as Morphine
Hydromorphone (Dilaudid) Potency High w/ IM
Fentanyl Actiq, Duragesic, Fentora
Fentanyl (Actiq, Duragesic, Fentora) Class CII
Fentanyl (Actiq, Duragesic, Fentora) Onset Rapid
Fentanyl (Actiq, Duragesic, Fentora) Duration Short
Fentanyl (Actiq, Duragesic, Fentora) Form No PO b/c doesnt go through the gut b/c its greater lipid soluble)
Fentanyl (Actiq, Duragesic, Fentora) SE Respiratory depression/Apnea (high risk), skeletal muscle rigidity, moderate bradycardia
Oxycodone Oxycontin, Roxicodone, Percocet, Roxicet, Percodan
Oxycodone (Oxycontin, Roxicodone, Percocet, Roxicet, Percodan) SE Fewer than Codeine - more tolerable
Oxycodone (Oxycontin, Roxicodone, Percocet, Roxicet, Percodan) vs morphine slightly higher potency than morphine
Oxycodone (Oxycontin, Roxicodone, Percocet, Roxicet, Percodan) Class CII
Oxymorphone Opana
Oxymorphone (Opana) class CII
Oxymorphone (Opana) efficacy Questionable
Oxymorphone (Opana) similar to... Oxycodone
Hydrocodone Lortab, Lorcet, Vicodin, Vicodin ES, Zydone, Norco
Hydrocodone (Lortab, Lorcet, Vicodin, Vicodin ES, Zydone, Norco) abuse Must abused drug in US
Hydrocodone (Lortab, Lorcet, Vicodin, Vicodin ES, Zydone, Norco) similarities Oxycodone except less euphoria
Hydrocodone (Lortab, Lorcet, Vicodin, Vicodin ES, Zydone, Norco) combination Combined with acetominophen (Be careful of acetominophen toxicity)
Hydrocodone (Lortab, Lorcet, Vicodin, Vicodin ES, Zydone, Norco) Class CIV
Codeine SE Same as morphine
Codeine Pain Use Mild to moderate
Codeine Combinations Aspirin/Acetominophen (CIV) & Pure (CII)
Codeine Class Pure-CII or Combined with Aspirin/Acetominophen (CIV)
Nalorphine type of drug First known morphine antagonist (proof that antagonist are analgesic with less abuse potential)
Pentazocin Talacen, Talwin, Talwin NX
Pentazocin (Talacen, Talwin, Talwin NX) Class CIV
Pentazocin (Talacen, Talwin, Talwin NX) type of drug Kappa receptor agonist & mu receptor antagonist
Pentazocin (Talacen, Talwin, Talwin NX) SE No ADH effect, less GI effects, lowers seizure threshhold, N/V, dysphoria, hallucinations & confusion
Nalbuphine Nubain
Nalbuphine (Nubain) class CII
Nalbuphine (Nubain) vs morphine Equal potency & duration of morphine
Nalbuphine (Nubain) type of drug Mu antagonist and kappa agonist
Nalbuphine (Nubain) SE Less respiratory suppression
Butorphanol Stadol
Butorphanol (Stadol) class CIV
Butorphanol (Stadol) type of drug Potent kappa agonist
Butorphanol (Stadol) onset quick in nasal form
Butorphanol (Stadol) abuse potential High abuse potential
Tramadol Ultram, Ultracet
Tramadol (Ultram, Ultracet) type of drug Mu antagonist, kappa agonist, 5HT-ag
Tramadol (Ultram, Ultracet) SE Sedation, less GI effects, abuse potential, seizures
Kertorolac Toradol
Kertorolac (Toradol) type of drug prostaglandin inhibitor (NSAID)
Kertorolac (Toradol) use Mild to moderate pain - short term
Kertorolac (Toradol) vs Codeine Similar potency
Kertorolac (Toradol) CI Perioperative and obstetrics (premature closure of the PAD in the baby)
Naloxone Narcan
Naloxone (Narcan) type of drug mu, delta, and kappa antagonist
Naloxone (Narcan) SE Opposite of opiates: euphoria, analgesia, mental clouding, respiratory depression, severe withdrawl Sx.
Naloxone (Narcan) Half-life Short (10 minutes)
Acetaminophen type of drug non-prostaglandin synthetase
Acetaminophen metabolized & excreted Liver & Kidney
Acetaminophen vs aspirin Analgesic activity equivalent to aspirin
Acetaminophen use Reduces opiate dose
Methadone Dolophine
Methadone (Dolophine) half-life Long; withdrawl lasts for months
Methadone (Dolophine) Class CII
Nucynta type of drug Dual-action pain inhibition (ascending; mu-opiate agonist. Descending; Inhibits NE reuptake)
Nucynta CI Patients at risk for respiratry depression and MAOIs
Tolerance phenomenon where an organism chronically exposed to a substance becomes progressively less sensitive to it (need higher dose to achieve equal effects)
Dependence Withdrawl syndrome upon cessation of a substance
Drugs that reduce opiate use Antidepressants, anticonvulsants, NSAIDs, Topical/local agents, Muscle relaxants & Antihistamines
Muscle spasticity UMN dz. which relates to the tone of the muscle
Muscle spasm Localized in1 muscle body
Dantrolene Dantrium
Dantrolene (Dantrium) Tx use CP, MNS, malignant hyperthermia
Dantrolene (Dantrium) SE Drowsiness, dizziness, weakness,liver toxicity (chronic), pleural effusion (Chronic)
Methocarbamole Robaxin
Methocarbamole (Robaxin) physiology Depresses muscle spindle affarent activity (spinal cord level)
Methocarbamole (Robaxin) Tx for... Acute muscle spasm, back pain, sprain/strains
Methocarbamole (Robaxin) SE Drowsiness, ataxia & coma (high doses)
Diazepam Valium
Diazepam (Valium) physiology Presynaptic inhibition of motor neuron in spinal cord (increases GABA)
Baclofen Lioresal
Baclofen (Lioresal) physiology Reduces excitatory synaptic influences of motor neuron at spinal and supraspinal level. (blocks asparate and glutamate)
Baclofen (Lioresal) Tx. Chronic muscle spasm, spasticity of MS & spinal cord injury
Baclofen (Lioresal) SE Hyperglycemia
Cyclobenzaprine Flexeril, Amrix
Cyclobenzaprine (Flexeril, Amrix) physiology Acts in midbrain & spinal cord level
Cyclobenzaprine (Flexeril, Amrix) Tx. Spinal cord damage due to ischemia
Cyclobenzaprine (Flexeril, Amrix) SE Very sedating, dry mouth, fatigue, mental confusion
Carisoprodol (SOMA) physiology Blocks interneuron action similar to methocarbamol (less selective); metabolized to sedative with little muscle relaxant.
Carisoprodol (SOMA) SE Very sedating
Tizanidine Zanaflex
Tizanidine (Zanaflex) physiology Alpha agonist; acts in spinal cord
Tizanidine (Zanaflex) Tx. for... Chronic muscular pain, spasticity or MS-related spasticity
Tizanidine (Zanaflex) monitor LFTs
Tizanidine (Zanaflex) SE Sedating (less with given food)
Orphenadrine Norflex
Orphenadrine (Norflex) physiology Acts supraspinally to decrease rigidty
Orphenadrine (Norflex) SE Anticholinergic SE
Orphenadrine (Norflex) Tx Strain, Spain, Low back injury
Cholpromazine Thorazine
Cholpromazine (Thorazine) physiology Depresses system btwn cerebellar & midbrain areas
Metaxalone Skelaxin
Metaxalone (Skelaxin) physiology Similar to methocarbamol
Metaxalone (Skelaxin) SE Least sedating
Chlorzoxazone Parafon Forte
Chlorzoxazone (Parafon Forte) physiology Smooth muscle relaxant
Created by: 147401391
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