Your SlideShare is downloading. ×
0
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Pharmacology of pain medications /certified fixed orthodontic courses by Indian dental academy

1,755

Published on



The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

Published in: Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,755
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Pharmacology of Pain Medications INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. From: Bonica, “Thewww.indiandentalacademy.com 1990 Management of pain”
  • 3. Nerve Fibers Class Velocity Function AA- Fast Fast Motor AA- Intermediate Intermediate B C Small Small www.indiandentalacademy.com Touch, pressure Muscle tone Pain, temperature Motor Pain
  • 4. Pain Fibers •C • A• Changes in Awww.indiandentalacademy.com
  • 5. From: Dickinson & Fleetwood-Walker, Trends in Pharm. Sci. 20: 324, 1999. www.indiandentalacademy.com
  • 6. From: Yaksh, Trendswww.indiandentalacademy.com 1999. in Pharm. Sci. 20: 329,
  • 7. www.indiandentalacademy.com
  • 8. Temporomandibular Joint dysfunctions • Disorders of muscles of mastication(myofascial pain dysfunction) • Internal joint derangement • Degenerative joint disease • Fractures, infections, tumors www.indiandentalacademy.com
  • 9. Treatment of Myofascial Pain Dysfunction • Non-drug treatment • Drug treatment –NSAIDS, Opioids –Tricyclic antidepressants (amitriptyline) –Centrally-acting muscle relaxants –Glucocorticosteroids www.indiandentalacademy.com
  • 10. Diagnosis Drug Treatment Acute and chronic pain NSAIDS, Opioids, acetaminophen Myofascial pain dysfunction Analgesics, tricyclics, centrally-acting muscle relaxants, glucocorticoids Neuropathic pain, neuralgias Carbamazepine, phenytoin, baclofen, tricyclics, gabapentin, others? www.indiandentalacademy.com
  • 11. Aspirin • Analgesic • Antiinflammatory • Benefits in addition to analgesia • Inhibits COX • Irreversible inhibitor of COX • Nonselective inhibitor of COX (adverse effects) • Analgesic ceiling • Elimination kinetics • Drug-drug interactions • Reye’s syndrome www.indiandentalacademy.com
  • 12. Phospholipids Phospholipase A2 Arachidonic Acid COX Prostaglandins Lipoxygenase Leukotrienes Thromboxanes Prostacyclin www.indiandentalacademy.com
  • 13. Aspirin Usual dose Effect 80 – 160 mg Antiplatelet 325 – 1000 mg Analgesic, antipyretic 325 mg – 6 grams Antiinflammatory, tinnitus 6 – 10 grams Respiratory alkalosis 10 – 20 grams Fever, dehydration, acidosis > 20 grams Shock, coma www.indiandentalacademy.com
  • 14. Aspirin (rapid) Salicylate (slower) * Metabolites In urine www.indiandentalacademy.com ( * = http://www.hsc.wvu.edu/som/pcol_tox/pharm361/lectures/djs/nsaid.htm
  • 15. Ibuprofen and other NSAIDS • Analgesic • Antiinflammatory • Reversible inhibitors of COX • Nonselective inhibitor of COX (adverse effects) • Analgesic ceiling www.indiandentalacademy.com
  • 16. Acetaminophen • Analgesic • Low effect on peripheral COX • Few drug-drug interactions • Not antiinflammatory • Analgesic ceiling • Liver toxicity www.indiandentalacademy.com
  • 17. Acetaminophen • May inhibit COX selectively in central nervous system • Only weak inhibitor of peripheral COX (peroxide effects?) • Inhibits effects of substance P in CNS? • Inhibits effects of glutamate in CNS? www.indiandentalacademy.com
  • 18. Acetaminophen – Mechanisms of Action • Central effect at level of spinal cord ( Little effect on peripheral COX-1 or COX-2) • Spinal antinociceptive effect is amplified by acetaminophen in the brain.* • The brain effect is mediated by an opioid mechanism expressed at the level of spinal cord.* * Raffa et al., J. Pharm. Exp. Therap. 295: 291, 2000. www.indiandentalacademy.com
  • 19. Acetaminophen (conjugation) Non-toxic metabolites (oxidation) Toxic metabolites* www.indiandentalacademy.com (* = http://www.hsc.wvu.edu/som/pcol_tox/pharm361/lectures/djs/nsaid.htm
  • 20. Selectively For COX-1 and -2 • Most NSAIDS (COX-1 > COX-2) • Nabumetone (Relafen) and Etodolac (Lodine) (COX-1 = COX-2) • Celecoxib (Celebrex) and Rofecoxib (Vioxx) ( COX-2 > COX-1) www.indiandentalacademy.com
  • 21. Selective COX-2 inhibitors • Analgesic • Antiinflammatory • Fewer adverse effects • Less experience • More expensive • Blood • GI tract • Kidney www.indiandentalacademy.com
  • 22. Celecoxib (Celebrex) • Half life ~ 12 hours • Metabolized in liver • Has a sulfur atom – possible problem in patients with allergies to sulfonamides www.indiandentalacademy.com
  • 23. Rofecoxib (Vioxx) • Half life ~ 17 hours • Metabolized in the liver • Does not contain a sulfur atom www.indiandentalacademy.com
  • 24. Opioids • Much less ceiling effect • Work through opioid receptor mechanisms • Adverse effects • GI tract • CNS • Histamine release • cranial pressure www.indiandentalacademy.com
  • 25. Sites of Opioid Action (*) * Midbrain Medulla * Sensory Nerve Ascending Tract * • www.indiandentalacademy.com Spinal Cord
  • 26. Some Opioid – Nonopioid Combinations • • • • • • • Codeine + Aspirin (Empirin) Codeine + Acetaminophen (Tylenol#?) Dihydrocodeinec+ Aspirin + caffeine (DHC Plus) Hydrocodone + Acetaminophen (Lortab ?/?) Oxycodone + Acetaminophen (Percocet) Pentazocine + Aspirin (Talwin compound) Propoxyphene + Acetaminophen (Wygesic) www.indiandentalacademy.com
  • 27. Clinical Study (Diclofenac-100 mg [D]; Acetaminophen-1000 mg [A]; codeine-60 mg [C]) 50 45 40 35 30 25 20 15 10 5 0 *** *** ** * * Total Pain Relief D A A+C D+A D+A+C www.indiandentalacademy.com Breivik et al. Clin.Pharmacol. Ther. 66: 625, 1999
  • 28. NSAID +Acetaminophen • Greater analgesic effect than either alone • Avoids adverse effects of opioids • Similar half lives for many NSAIDS and acetaminophen • Over-the-counter • Each has analgesic ceiling. www.indiandentalacademy.com
  • 29. NSAID + Acetaminophen • Ibuprofen • 400-600 mg, q 4-6 hr • max of 2400 mg q 24 hr • Acetaminophen • 600-1000 mg, q 4-6 hr • max of 4000 mg q 24 hr www.indiandentalacademy.com
  • 30. NSAID + Acetaminophen • Ibuprofen (400 mg q 4 hr) + acetaminophen (600 mg q 4 hr) • Ibuprofen (600 mg q 6 hr) + Acetaminophen (1000 mg q 6 hr) www.indiandentalacademy.com
  • 31. Diagnosis Drug Treatment Acute inflammatory pain NSAIDS, Opioids Myofascial pain dysfunction Analgesics, tricyclics, centrally-acting muscle relaxants, glucocorticoids Carbamazepine, phenytoin, baclofen, tricyclics, gabapentin, others? Neuropathic pain, neuralgias www.indiandentalacademy.com
  • 32. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

×