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Non-anti-inflammatory Analgesics. Acetaminophen / Tylenol Only OTC in this category Analgesic Antipyretic Effective for mild to moderate pain Rx or OTC.

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Presentation on theme: "Non-anti-inflammatory Analgesics. Acetaminophen / Tylenol Only OTC in this category Analgesic Antipyretic Effective for mild to moderate pain Rx or OTC."— Presentation transcript:

1 Non-anti-inflammatory Analgesics

2 Acetaminophen / Tylenol Only OTC in this category Analgesic Antipyretic Effective for mild to moderate pain Rx or OTC No GI effects No interaction with insulin / gout medications Safe for aspirin intolerance

3 Acetaminophen Administered Orally: tablets, caplets, liquid (30 – 60) Suppositories: (20-30)

4 Acetaminophen Dosages – 325 mg. Tablets 2 every 4 hrs. – 500 mg. Tablets 2 every 6 hrs. – Not to exceed 4000 mg. / 24 hrs. – Childrens doses

5 Acetaminophen Side Effects and Reactions Extremely safe Liver effects with: Long term use High doses Alcohol abuse fasting Overdose symptoms Nausea, vomiting, sweating, abdominal pain, loss of appetite

6 Considerations for ATC Acetaminophens hepatoxicity - watch use with females that exhibit signs of eating disorders - wrestlers trying to make weight - post surgical, too sick to eat

7 Opiate Agonists Only by RX Narcotics that alter the sense of pain & induce sleep – Inhibits neurotransmitters or stimulates opiate receptors – cause release of endorphins & enkephalins – Depresses CNS Controlled substances Pure = Schedule II Combinations = Schedule III Different levels for degree of pain Levels correlate with dependency

8 Opiate Agonists Characteristics - – Similar to opium; morphine extracted from dried poppy seeds – Relieves moderate to severe pain - illness, surgery, trauma, chronic pain – Treatment for severe diarrhea

9 Opiate Agonists Mild to Moderate Pain Codeine – + acetaminophen = Roxane – Cough suppressant Hydrocodone – + aspirin = Percocet, Roxicet, Panasal – + acetaminophen = Hydrocet, Lortab, Vicodin, Lorcet, Panacet

10 Mild to moderate pain Oxycodone – + aspirin = Percodan, Roxiprin – + acetaminophen = Percocet, Roxicodone, Tylox Propoxyphene – + acetaminophen = Darvocet

11 Opiate Agonists Moderate to Severe Pain Meperidine – moderate to sever pain – (ex) Demerol Morphine for severe pain – Often used with cancer and other debilitating conditions

12 Opiate Agonists Administered Orally (30-60) Intravenously (< 30) Intramuscularly (< 30) Dosages depend on specific drug but usually taken every 4-6 hrs.

13 Opiate Agonists Side Effects and Reactions Relatively safe when used for limited time Reactions: Drymouth, drowsiness, nausea, constipation, urination problems (Severe) depressed breathing, rashes, decreased HR/BP, nausea, stomach pain, vomiting Tolerance Withdrawal = runny nose, fever, diarrhea, pupil dilation, goose flesh, irritability, rapid HR Should never be used if hx of opiate addiction May induce seizures if taken with anti-depressants or if there is head trauma

14 Other Systemic Analgesic Tramadol (Ultram) For moderate to severe pain Less addictive? Weak agonist for opiate receptors and prevents the re-uptake of norepinephrine and serotonin

15 Considerations for ATCs NCAA bans heroin USOC bans opiates with some exceptions Will decrease performance because of CNS effects Not to be used by athletes throwing, catching, shooting Overuse Add on effect of opiates if combined with alcohol

16 Corticosteroids Anti-inflammatory Drugs

17 Corticosteroids Steroid hormones that are lipid soluble – Produced in adrenal cortex – Synthetic versions also made in laboratory Not Anabolic Steroids 4 types – Mineralcorticoids (acts on salt metabolism) – Glucocorticoids (cortisol & derivatives) – Androgens – estrogens

18 Indications Powerful Systemic – affect more than the affected area Available only by prescription except for topical hydrocortisone Used in sports for inflamed joints, brochiospasm w/ EIA, allergic rhinitis, and topical itch relief

19 Mechanism of Action React with receptors in the cytoplasm (RNA) of affected cells Anti-inflammatory action due to suppression of chemical mediator reaction to inflammation Also inhibit collagen formation, thus prolonging the healing process Lipid soluble = longer effects – Effects may last for days to weeks

20 Topical Applications Skin infections and disorders Used to treat the skin irritation and itching – Hydrocortisone & hydrocortisone acetate – Does not treat the fungal or yeast infection – Not effective with ringworm

21 Nasal Inhalants & Sprays Used to treat nasal inflammation & rhinitis – Beclomethosone (Beclovent, Vanceril) – Budesonide (Rhinocort) – Dexamethasone (Decadron, Turbinaire) – Flunisolide (Nasalide) – Triamcinolone (Nasacort) – Watch for irritation

22 Oral Inhalation Treatment of asthma and respiratory problems – Beclomethasone (Beclovent, Vanceril) – Dexamethasone (Decadron Respihaler) – Flunisolide (Aerobid) – Triamcinolone (Azmacort) – Watch for coughing, dysphonia

23 Injection Used to treat itiss – Betamethasone (Celestone) – Dexamethasone (Decadron) – Hydrocortisone (Solu-Cortef) – Methylprednisolone (Depo-Medrol) – Prednisolone (Hydeltrasol) – Tramcinolone (Aristospan, Kenalog-10) – Rest and reduced stress to soft tissue must be part of treatment plan – DO NOT INJECT Patellar / Achilles Tendons

24 Oral Ingestion Systemic inflammatory conditions such as arthritis, Crohns disease, colitis Prednisone (Deltasone)

25 Adverse Reactions Numerous Topical – Increase the rash like symptoms Systemic – Nausea – Restlessness / sleeplessness – Skin color changes – Unusual hair growth

26 Serious Side Effects Eye pain / blurred vision Stomach pain, nausea, tarry stools, vomiting General fluid retention and swelling of extremities Hives, rashes, acne, skin eruptions

27 Menstrual irregularities Suppression of immune system = symptoms of infection Softening of cartilage in joints / local tissue atrophy More Side Effects….

28 Even More Side Effects … Prolonged use leads to Birth defects Osteoporosis Cataracts Glaucoma Cushings syndrome Diabetes Osteonecrosis

29 Contraindicated for… Heart Disease Hypertension Diabetes Diverticulitis Gastritis / peptic ulcer Glaucoma / cataracts Liver / Kidney disease TB Lupus Infections such as cold / flu HIV/AIDS

30 Athletic Considerations Inhaled corticosteroids have no effect on natural testosterone Oral ingested over long period can reduce plasma concentration of testosterone by up to 33% = masking agent Effectiveness of oral ingested agents can be decreased by exercise but not inhaled or injected

31 More Considerations for the ATC Athletes with an inhaler should take a dose before exercise (MDs orders) Wound healing may be slower Do not stop using suddenly – gradual withdrawal helps avoid serious side effects Combining w/ alcohol or NSAIDS can cause stomach ulcers

32 Banned Substance Lists NCAA has no restrictions on use USOC bans – Intravenous – Intramuscular – Rectal – Oral USOC allows with prior permission – Intra-articular – Inhaled – local

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