1. D3 Analgesics By Cameron Precord and Quin Peek And edited by Ms. Smith By Cameron Precord and Quin Peek And edited by Ms. Smith

2. FPain-described as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage FPain receptors-free nerve endings located in various tissues that respond to thermal, mechanical or chemical stimuli FWhen stimulated, these pain receptors generate an impulse FPain results from interaction between more than one impulse arriving at the spinal cord and brain Pain

3. FWhen tissue is damaged, it releases chemicals known as prostaglandins and leukotrienes FThese sensitized receptors react to even slight stimuli, causing pain ( an injury being tender) FDifferent people feel pain differently FAnalgesics are drugs that relive pain without causing a loss of consciousness.

4. FMILD ANALGESICS  relieve “mild” pain and often fever  non-addictive  Examples include  Aspirin  Acetaminophen  Phenacetin  Ibuprofen  NSAIDS (Nonsteroidal anti-inflammatory drugs) F STRONG ANALGESICS (OPIATES)  relieve severe pain  controlled substances  addictive  Examples include  Morphine  Heroin  Codeine Two Types of Analgesics

5. FUsed in four different ways:  Mild analgesic for minor aches and pains, to relieve headaches, sunburn and arthritic pain  anti-pyretic to mitigate fever  anti-inflammatory agent (reducing swelling)  anti-platelet agent (decrease/prevent blood clotting) Aspirin – MILD ANALGESIC – a derivative of Salicylic Acid

6. Disadvantages of Using Aspirin  acidic; cause upset stomach, internal bleeding, ulcers  When taken with alcohol may produce gastrointestinal bleeding .5% of people are allergic to aspirin  develop skin rashes, respiratory issues, and may go into shock  frequent causes of poisoning among infants  May lead to REYES Syndrome a potentially fatal liver and brain disorder which may result in brain damage, coma, death

7. Alternatives to Aspirin FPhenacetin FAcetaminophen  Metabolic byproduct of phenacetic  AKA  Tylenol  Known as paracetamol in some countries  Properties - Advantages  Anti-pyretic  Mild analgesic  Does NOT upset stomach  does NOT cause internal bleeding  Properties - Disdvantages  Not anti-inflammatory  Side effects include blood disorders… damage to kidnes…  Not safe to take with alcohol  Overdose can cause liver damage, brain damage, coma, death

8. Strong Analgesics Faka Opiates or Narcotics FOpiate = any natural or synthetic drugs that produces morphine-like characteristics FNarcotic = drug that has both sedative and analgesic action FExamples include  Morphine – natural – opium poppy plant  Heroin - semi-sythetic  Codeine – natural – opium poppy plant FStructures are similar… but…  Heroin has the two OH groups in morphine replaced with ester groups.  Codeine replaces one OH group of Morphine with a OCH3 group. Faka Opiates or Narcotics FOpiate = any natural or synthetic drugs that produces morphine-like characteristics FNarcotic = drug that has both sedative and analgesic action FExamples include  Morphine – natural – opium poppy plant  Heroin - semi-sythetic  Codeine – natural – opium poppy plant FStructures are similar… but…  Heroin has the two OH groups in morphine replaced with ester groups.  Codeine replaces one OH group of Morphine with a OCH3 group.

9. Strong Analgesics Heroin is most potent, then morphine, then codeine

10. Advantages of Strong Analgesics FOpiates impact  Central nervous system  Pain relief due to injury, surgery, chronic disease (cancer)  Relieves coughing by relaxing the ‘cough center’ in the brain stem.  Digestive system  Produces a Constipating Effect – used for diarrhoea  Impact Psychological state  Relief from physical, emotional, and psychological pain. FOpiates impact  Central nervous system  Pain relief due to injury, surgery, chronic disease (cancer)  Relieves coughing by relaxing the ‘cough center’ in the brain stem.  Digestive system  Produces a Constipating Effect – used for diarrhoea  Impact Psychological state  Relief from physical, emotional, and psychological pain.

11.  Impact physical state  Constipation  Nausea  Vomiting  Sedation  Can lead to tolerance and physical dependence  Psychological state  Mood changes  metal clouding  Anxiety  Fear  lethargy  sedation,  ack of concern  inability to concentrate  Can lead to psychological dependence  Impact physical state  Constipation  Nausea  Vomiting  Sedation  Can lead to tolerance and physical dependence  Psychological state  Mood changes  metal clouding  Anxiety  Fear  lethargy  sedation,  ack of concern  inability to concentrate  Can lead to psychological dependence Disadvantages of Strong Analgesics

12. Common Short and Long Term Effects Short  sedation / stupor  pain relief  euphoria  impaired coordination  reduced tension and fear  suppressed coughing reflex  occasional deaths from overdose Short  sedation / stupor  pain relief  euphoria  impaired coordination  reduced tension and fear  suppressed coughing reflex  occasional deaths from overdose LONG  loss of appetite  constipation  risk of infections through shared needles  withdrawal  loss of job / income  crime  sterility  loss of energy LONG  loss of appetite  constipation  risk of infections through shared needles  withdrawal  loss of job / income  crime  sterility  loss of energy

13. Tolerance and Dependence FTolerance – body needs more of the drug to have the desired impact  Cross tolerance - Users who develop tolerance for one opiate will begin to tolerate all other opiates. FPhysical Dependence – inability to function normally without the drug  users experience withdrawal  Restlessness, sweating, fever, chills, vomiting, increased respiration, cramping, diarrhoea, aches, pains FTolerance – body needs more of the drug to have the desired impact  Cross tolerance - Users who develop tolerance for one opiate will begin to tolerate all other opiates. FPhysical Dependence – inability to function normally without the drug  users experience withdrawal  Restlessness, sweating, fever, chills, vomiting, increased respiration, cramping, diarrhoea, aches, pains

14. Synthetic Opiates Fdemerol Fmethadone  bocks euphoric high of heroin  used to break addiction to heroin F dextromethorphan  can replace codeine  non-narcotic  used in cough syrups Fdemerol Fmethadone  bocks euphoric high of heroin  used to break addiction to heroin F dextromethorphan  can replace codeine  non-narcotic  used in cough syrups

15. FLOCAL ANESTHETICS  Reversible loss of sensation (and pain) in a localized area  Maintain consciousness  Examples include  Lidocaine  Procaine used in dentistry FGENERALIZED ANESTHETICS  act on the brain  produce reversible unconsciousness and insensitivity to pain  Examples include  Inhalants: Isoflurane, Desflurane; sevoflurane; Nitrous oxide  IV : barbituates, benxodiazepines, ketamine Two Types of Anesthetics

16. Practice Problems Can Be Found on Page 434 of your Green and Damji Book