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HA standard drugs 4.

7 ANALGESICS ASPIRIN BUPRENORPHINE CAFERGOT (OR EQUIV) CODEINE PHOSPHATE DEXTROPROPOXYPHENE HCL DIHYDROCODEINE DOLOGESIC (OR EQUIV) DOLOXENE CO (OR EQUIV) METHADONE MORPHINE NORGESIC (OR EQUIV) PARACETAMOL PARACETAMOL (SUPP) PENTAZOCINE PETHIDINE PIZOTIFEN TRAMADOL TRAMADOL (SUPP) Special drugs FENTANYL (PATCH) GABAPENTIN (TEVA) MORPHINE SUMATRIPTAN ZOLMITRIPTAN

Analgesics 1. Non-opioid analgesics X 2 2. Opioid analgesics X 8 3. NSAIDs = non-steroidal anti-inflammatory drugs X 3 1. Non-opioid analgesics X2 ( Aspirin + Paracetamol ) a) Aspirin = acetyl-sali-cylic acid = ASA ( mild moderate pain ) - anti-inflammatory drug + analgesic + anti-pyretic + anti-coagulant * Action : inhibit prostaglandins synthesis & anti-coagulant * Dose : PO : 300-900 mg Q4-6H + Max 4g = 4000mg daily * S/E : GI disturbance / bleeding + constipation + loss of appetite * Caution : with-hold for GI ulcer b) Paracetamol = panodol = acetaminophen = APAP ( mild moderate pain ) - non-narotic analgesic + anti-pyretic * Action : inhibit prostaglandins synthesis * Dose : PO : 0.5-1g Q4-6H + Max 4g daily * S/E : hepatotoxic + X G6PD * Caution : check temperature before given ** Anti-dote : N-acetylcysteine 2. Opioid analgesics X8 ( Codeine Phosphate + Dihydrocodenine Tartrate(DF 118) + Morphine + Pethidine + Dextro-propoxyphene + Fentanyl + Methadone Hydrochloride + Tramadol Hydrochloride ) a) Codeine Phosphate ( ) ( mild moderate pain )

- narcotic analgesic * Combine w/ aspirin / paracetmol / doloxene to enhance analgesia * Dose : 30-60mg Q4H + Max 240mg daily * S/E : Orthostatic hypotension + tachycardia * Caution : combination w/ chlordiazepoxide may induce coma b-d) Dihydrocodeine Tartrate ( DF 118 ) ( moderate to severe pain ) Morphine (DD) ** anti-dote : Naloxone Pethidine - narcotic analgesic * Action : 1) depress pain impulse transmission at the spinal cord level by interaction with opioid receptors 2) produce CNS depression 3) decrease cough reflex 4) respiratory suppress * S/E : GI disturbance + respiratory suppress + constipation + dryness of mouth * Caution : Dependence + monitor respiratory depression!!!

e) Dextro-propoxyphene = dologesic = doloxene ( mild pain ) - narcotic analgesic * Action : agonist at specific opioid receptors in CNS * S/E : GI disturbance + drowsiness + dizziness + fatigue f) Fentanyl use only in cancer patient ( moderate to severe pain ) - narcotic analgesic * Action : Similar to morphine, may have profound effects on respiration * Caution : Fever / external heat will increase absorption g) Methodone Hydrochloride (DD) ( severe pain ) - narcotic analgesic + adjunct in tx of opioid dependence = detoxification tx of opioid addition * S/E: CNS depression + dizziness + GI upset f) Tramadol Hydrochloride ( moderate to severe pain ) - narcotic analgesic * S/E : Dizziness + headache + CNS stimulation + vertigo + constipation + nausea + ataxia 3. NSAIDs = non-steroidal anti-inflammatory drugs 1st generation X 4 : ( Diclofenac Sodium = Voltaren + Diclofenac Potassium = Cataflam + Ibuprofen = Advil + Indomethacin = Indocid ) 2 generation X 1 : ( Celecoxib = Celebrex )
nd

1st generation X 4 a) Diclofenac Sodium = Voltaren Diclofenac Potassium = Caraflam for pain + arthritis + dys-menorrheal + inflammation * Action : Inhibit prostaglandins synthesis * Caution : Withhold for GI ulcer b) Ibuprofen = Advil ( mild to moderate pain ) pain & inflammation in rheumatic disease + migraine () + dental pain * Action : Inhibition of cyclo-oxygenase decrease prostaglandin synthesis but increase peripheral blood flow, heat loss increase sweating *S/E : Dizziness, rash, nausea, heartburn, epigastric / GI pain c) Iodomethacin = Indocid for inflammation of joint + acute gout + dysmenorrhoea + muscle pain + arthritis * Action : Inhibit the prostanglandin synthesis * S/E : GI disturbance + N&V + headache + rash + oedema * Caution : Withhold for GI ulcer

2nd generation X 1 a) Celecoxib = Celebrex pain + inflammation in osteoarthritis + arthritis + ankylosing spondylitis + dysmenorrhea * Action : 1) Inhibit prostaglandin synthesis 2) Inhibiting COX-2 decrease inflammation * S/E : Abdominal pain / cramps + diarrhea + nausea + dyspepsia / indigestion + URTI

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