Non opioids pain management Done by : Noor Alkhawaja

Introduction Pharmacological treatment of pain : Opioids non-opioids adjuvants >> not typically used for pain but may be helpful for its management 1. Antidepressants 2. Anticonvulsants 3. Local anesthetics / antiarrthymics 4. Corticosteroids 5. Botulinum toxin

Paracetamol (acetaminophen) Mechanism of action : The exact mechanism is not clear ,, it has potent antipyretic & analgesic actions but weak anti inflammatory action so it’s not true NSAID Appear to inhibit prostaglandins synthesis in CNS ,, but in peripheral tissue is poor inhibitor . Acetaminophen does not affect platelet function or increase bleeding time. It is not considered to be an NSAID.

Pharmacology Bioavailability >> 63-89% Half life >> 1-4 hrs Dose >> 3 or 4 grams. Onset of action >> Pain relief onset by route: By mouth – 37 min Buccal – 15 min Intravenous – 8 min

Therapeutic uses 1) used for the relief of mild to moderate pain. 2) fever (drug of choice as antipyretic for children (due to the risk of Reye syndrome with aspirin) Osteoarthritis ( + NSAID to reduce inflammation). Low back pain Headaches Post operative Dental pain

Adverse effects At normal therapeutic doses >> free of significant adverse effects Patients with hepatic disease >> at higher risk of acetaminophen-induced hepatotoxicity Paracetamol hepatotoxicity is the most common cause of acute liver failure N-acetylcysteine is an antidote in cases of overdose

NSAID effect: Antibiotic. Analgesic. Anti-inflammatory.

Diclofenac known as voultaren. It is phenyl-acetecic Acid derivated . It is non selective. COX inhibitor. Route of Administration: oral , IM , IV , rectal , topical. Indicated for management : mild to moderate pain.

Used to Common side effect: Contraindicated in: 1) Treat inflammatory disorders especially MSS (Arthritis , RA , OA , AK , Gout). 2) Acute Migraine. 3) Kidney stone , gallstone. 4) Chronic pain associated with cancer. Common side effect: Vascular and coronary risk as major cardiovascular events increased about third by it. GI adverse event ( bleeding , ulcer ). Acute Kidney failure. Contraindicated in: Acute peptic ulcer or GI bleeding , severe renal/liver insufficiency , caution in patient with fluid retention or Heart failure , third trimester pregnancy.

Ketorolac Brand name Toradol. Is used for short-term management of moderate to severe pain.It is usually not prescribed for longer than five days. Not for chronic or mild pain.  Effective when administered with paracetamol to control pain in neonates because it does not depress respiration as do opioids. Used during eye surgery help with pain. Ketorolac is effective in treating ocular itching.

Adverse effects: MI. GI bleeding. Stroke.

Analgesic ladder