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Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
Analgesics
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Analgesics

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  • 1.  
  • 2. بسماللهالرحمنالرحيم صدق الله العظيم ( قَالُواْ سُبْحَانَكَ لاَ عِلْمَ لَنَا إِلاَّ مَا عَلَّمْتَنَا إِنَّكَ أَنتَ الْعَلِيمُ الْحَكِيمُ )
  • 3. Mansoura University Faculty of Medicine
  • 4. Analgesic Drugs
  • 5. Drugs which relieve pain be central action . Certain drugs can relieve specific types of pain (not proper analgesic drugs) e.g., atropine in colics. Peripheral analgesic include : physical protectives, local and surface anaesthetics , obtundants , astringents and counterirritants
  • 6. Central Analgesics include:  No drug dependence  No euphoria or drowsiness.  Subcortical on thalamus  Relieve low intensity pain, e.g., headache , neuralgia, myalgia Analgesic antipyretics  Addictive  Produce euphoria and stupor  Act cortical and subcortical .  Can relieve any type (except itching ). Opioid (narcotic ) analgesic
  • 7. Opioid analgesics
  • 8. Opioid actions CNS: analgesia Respiratory and cough centre: depression Vomiting centre: Nausea Higher centres: Euphoria & dysphoria Bowel: relax. Uses: relief of pain ( ischemic-post operative- palliative Dirrhea (codeine)
  • 9. Contraindications :
  • 10. <ul><li>Very old, very young . liver disease and myxedema. </li></ul><ul><li>Acute abdominal pain (interfere with diagnosis). </li></ul><ul><li>Head injury , increased CSF pressure . </li></ul><ul><li>Respiratory disease. </li></ul><ul><li>Delivery and lactation. </li></ul><ul><li>Biliary colic. </li></ul><ul><li>Acute alcoholism. </li></ul><ul><li>Epilepsy </li></ul>
  • 11. Preparations : Morphine HCI or ulphate 10-15 mg S.C., I.M. or I.V. Adverse effects: Respiratory depression, nausea , dizziness, mental clouding, dysphoria , pruritus, constipation , increased biliary pressure, urine retention and hypotension.
  • 12. Non steroidal anti-inflammatory drugs (NSAIDs)
  • 13. Non steroidal anti-inflammatory drugs (NSAIDs)
  • 14. <ul><li>Analgesic and anti-inflammatory drugs especially </li></ul><ul><li>In chronic inflammation </li></ul><ul><ul><li>Rheumatoid arthritis </li></ul></ul><ul><ul><li>Sever osteoarthritis </li></ul></ul><ul><ul><li>Chronic back pain </li></ul></ul><ul><li>In acute injury with inflammation </li></ul><ul><li>Dysmenorrhoea </li></ul><ul><li>Pain from lytic bone metastases . </li></ul>Usese of NSAIDS
  • 15. Pyrazolone derivatives : rarely used due to bone marrow depression Adverse effects : GIT upset, salt and water retention, oedema, h7ypertension , bone marrow depression, liver and renal toxicity, skin rash, and bronchospasm. Indole derivatives : is potent Adverse effects: GIT disturbances , frontal headache , vertigo, confusion, psychosis , blood dyscrasias , liver and kidney toxicity, kin rash and asthma. Classification Of NSAIDS
  • 16. Sulindac : it is prodrug which is converted into active metabolite and ahs kess gastric irritation. Anthranilic acid derivatives : fenamates Central analgesic action (which is specific with mefenamic acid . Propionic acid derivatives (IBUPROFEN : Most safe Oxicams : Piroxicam (Feldene). It has enterohepatic cycle, so has long plasma half life
  • 17. Side Effects of Salicylate :
  • 18. Gastric irritation , increased occult blood in stools. Hypersensitivity reaction: asthma, rash, …… Idiosyncracy: In patient: with G-6-PD deficiency ->haemolytic anaemia Prolonged use may lead to hypoprothrombinaemia.
  • 19. Chronic use -> Salicylism: Headache , mental confusion, vertigo, ringing in ears (tinnitus), Sweating , nausea, vomiting. Acute salicylate poisoning : Restlessness, tremors , convulsions vomiting , dehydration, ↓ B.P., metabolic acidosis (in children), respiratory alkalosis (in adults), hyperglycemia , hyperpyrexia.
  • 20. 1- Epigastric distress, naused and v0omiting ( # PGS in GIT) 2- CVS & M.I.: with Cox-2 inhibitors (rofecoxib ) 3- Coagulation disorders (reversible ) 4- Renal toxicity (# Pgs). 5- Hypersensitivity N.B. Newer NSAIDS have lower incidence of gastric distribution but higher incidence of renal damage adverse effects of NSAIDs
  • 21. Kinetics Major Minor Conjugate with Toxic metabolite glucuronic and (N-acetyle Benzo quinone acid sulphate which is detoxificated by glutathione acetaminophen (paracetamol )
  • 22. <ul><li>Adverse effects: </li></ul><ul><li>It is well tolerated at therapeutic doses. </li></ul><ul><li>Skin rash and drug fever, blood dyscrasias (rare). </li></ul><ul><li>Hepatic necrosis and renal tubular necrosis and hypoglycemic coma. </li></ul><ul><li>Methemoglobinemia and haemolytic anaemia (with Phenacetin ). </li></ul><ul><li>Phenacetin may produce cyanosis , respiratory and cardiac arrest in lethal doses. </li></ul>acetaminophen (paracetamol )
  • 23. THANK YOU
  • 24. بحمد تم

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