this lecture was presented at the school for Enrolled Nurses and Midwives- The Gambia.

1. MR. ABDOU MARAM PANNEH
(RM ,FWACN,NT, RN)

2. INTRDUCTION
 Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described
in terms of such damage. (Intl. Association for the study of
pain).
 It occurs as result of stimulation of peripheral receptors which
transmit impulse through pain pathways to the brain.
 These group of drugs can be broadly divided into three
categories:-
 Analgesics
 Anti-inflammatory drugs
 Antimigraine drugs
 Antigout Drugs

3. THE ANALGESICS:
 These are drugs that relief moderate to severe pain. They
include the following:-
 Narcotics (Opiates)
 Non-narcotics (Non-opiates)
I) NARCOTICS (OPIATES) ANALGESICS:-
 These drugs suppress the CNS, thereby relieving pain and
promoting sleep.
 Narcotics are derieved from the juice of Opium poppy.
Opoids are synthetic substitutes that have opium-like
properties. Most narcotics are Schedule II drugs and
cannot be sold without a medical prescription. (DDA)

4. THE ANALGESICS Cont’d:
 The frequent and prolonged use of Narcotics may result
in drug tolerance, drug dependence and drug addiction.
 Sudden withdrawal from Narcotics may also lead to
paradoxical effect, nausea, vomiting, anorexia,
intestinal cramps, fever and lightheadedness.
 ADR:- respiratory depression, inhibition of cough
reflex, postural hypotension, constipation.
 INTERACTIONS:- Metochlopramide & Domperidone-
their effects is antagonized.
 - Beta blockers – increases their plasma concentration.

5. THE ANALGESICS Cont’d:
 COMMON NARCOTICS DRUGS USED:-
 Morphine (Sevredol, Zomorph) 10mg, 20mg, 3omg
tabs/inj
 Codeine phosphate 15mg tabs
 Diamorphine 5mg, 10mg tabs/inj
 Dihydrocodeine (DF118) 30mg tabs
 Dextromoramide (Palfium) 5mg tabs
 Meptazinol (Meptid) 100mg, 200mg tabs/inj
 Papaveretum 10mg
 Pentazocine (Talwin)30mg, 50mg tabs/inj
 Pethidine Hydrochloride 50mg tabs/inj
 Tramadol Hydrchloride (zamadol, Zydol) 50mg, 100mg
tabs/inj.

6. THE ANALGESICS Cont’d:
NARCOTI ANTAGONISTS:
These drugs compete with narcotics for receptor sites,
which then block the effects of narcotics. They are also
used to diagnose opoid toxicity, reverse CNS and
respiratory depression and to treat babies born with
addicted mothers.
 ADR:- Withdrawal symptoms, Nausea, vomiting,
hypertension, headache.
 COMMON NARCOTIC ANTAGONISTS DRUGS
USED:-
 Naloxone (nacan) 400mcgs/ml
 Nalmefene hydrochloride (Revex)

7. THE ANALGESICS Cont’d:
II) NON-NARCOTICS (NON-OPIATES) ANALGESICS:-
 These drugs inhibit the formation of prostaglandins in
inflamed tissues, thereby preventing stimulation of pain
receptors. They lower temperature by resetting the
hypothalamus
 ADR:- hepatic failure, renal failure, rash and urticaria in
high doses.
 COMMON NON-NARCOTICS DRUGS USED:-
 Paracetamol (Panadol, Dollipran) 120mg, 250mg, 500mg tabs
 Aspirin 300mg
 Acetamophine (Tylenol, Datril, Panadol )
 Tylox
 Nefopam (Acupan) 30mg tabs

8. ANTI-INFLAMMATORY/ANTIPYRETIC DRUGS,
ACETYLSALICYLIC ACID AND NONSTERIODAL
ANTI-INFLAMATORY DRUGS:-
 These drugs also act by inhibiting prostaglandin
formation.
 In the inflammatory process, prostaglandins
potentiate the pain and oedema caused by the release
of bradykinin, histamine, and other substances into
areas of tissue damage.
 Prostaglandins regulate many functions.( refer to
previous notes).

9. 2. ANTI-INFLAMMATORY/ANTIPYRETIC DRUGS,
ACETYLSALICYLIC ACID AND NONSTERIODAL
ANTI-INFLAMATORY DRUGS Cont’d:-
 Salicylates and NSAIDs do not produce tolerance or
physical or psychological dependence. They do not
alter the course of the disease for which they are
prescribed.
 Antipyretics act by inhibiting thr formation of
pyrogens, which reset the hypothalamic thermostat,
thereby lowering temperature, and reducing fever.
 Antipyretics do not cure but induce comfort.

10. 2. ANTI-INFLAMMATORY/ANTIPYRETIC DRUGS,
ACETYLSALICYLIC ACID AND NONSTERIODAL
ANTI-INFLAMATORY DRUGS Cont’d:-
 CLINICAL USES :- Mild to moderate pain,
inflammatory process, Arthritis, Dysmenorrhea, Fever,
Cardiovascular disorder(stroke, deep vein thrombosis),
during catherizations, etc..
 ADR:- Nausea, vomiting, gastritis, GIT bleeding, ulcer
formation, bone marrow depression, anemia,
hypersensitivity reactions, etc

11. 2. ANTI-INFLAMMATORY/ANTIPYRETIC DRUGS,
ACETYLSALICYLIC ACID AND NONSTERIODAL
ANTI-INFLAMATORY DRUGS Cont’d:-
 COMMON DRUGS USED:-
 Acetylsalicylic acid (Asa) 300mg tabs
 Ibuprofen (Advil, Motrin) 200mg, 400mg tabs
 Naproxen 250mg, 500mg tabs
 Piroxicam (Feldene) 10mg,20mg tabs/inj
 Flurbiprofen 50mg, 100mg tabs
 Indomethacin 25mg caps
 Mefenamic acid 250mg, 500mg
 Ketoprofen(Oruvail) 50mg, 500mg tabs,
 Diclofenac (Voltarene,) 50mg, 100mg tabs

12. 2. ANTI-INFLAMMATORY/ANTIPYRETIC DRUGS,
ACETYLSALICYLIC ACID AND NONSTERIODAL
ANTI-INFLAMATORY DRUGS Cont’d:-
ANTI-INFLAMATORY CORTICOSTERIODS
 These drugs are produced by the adrenal cortex. These drugs
help to reduce inflamation of the joints associated with
rheumatoid arthritis and he inflammatory process in other
disease.
 CLINICAL USES:- Rheumatoid arthritis, tendonitis,
dermatitis, nephritic syndrome, pericarditis, myocarditis,
hypersensitivity reactions, allergies, asthma, etc
 ADR:- Burning and dryness, increased hair growth, loss of
pigmentation, muscle weakness,
 Increased risk of infection, abnormal fat distribution, fluid &
electrolyte imbalances, mood swings, increased blood glucose
level, decreased gastric mucus & blood flow, etc

13. 2. ANTI-INFLAMMATORY/ANTIPYRETIC DRUGS,
ACETYLSALICYLIC ACID AND NONSTERIODAL
ANTI-INFLAMATORY DRUGS Cont’d:-
COMMON ANTI-INFLAMATORY
CORTICOSTERIODS DRUGS USED:-
 Prednisolone (Deltasone) 5mg tabs
 Betamethasone (Celestone) 500mcgs tabs
 Hydrocortisone 10mg
 Dexamethasone (Dexanil) 4mg tabs
 Beclomethasone

14. 3. ANTIMIGRAINE DRUGS:-
 Migraine is associated with dilatation of arteries of the
scalp and face.
 Antimigraine drugs are used to prevent attacks by
inhibiting vascular dilatation, or to terminate attacks
by constricting the dilated vessels.
 CLINICAL USES:- To treat mild to moderate pain
caused by migraine.
 ADR:- Nausea, vomiting, abdominal cramps,
constipation, coldness & numbness of fingers,
 Angina, malaise, palpitations, dry mouth, dizziness.

15. 3. ANTIMIGRAINE DRUGS Cont’d:-
 COMMON DRUGS USED:-
 Ergot Alkaloids:- they are vasoconstrictors
 Ergotamine tartrate (Ergotstat), Ergotamine+caffeine
(Cafegot)
 Triptans:- prevents vascular headaches.
 Sumatriptan (Imitrex), Zolmitriptan (Zomig),
Rizatriptan (Maxalt)
 Serotinin Antagonists:- supresses vascular
headaches.
 Methysergide (Sansert),

16. 4. ANTI GOUT DRUGS:
 Gout is a type of arthritis that is characterized by joint
inflammation. It is caused by a metabolic disturbance
of purine metabolism that results in hyperuricemia.
The symptoms develop when the serum uric acid leve
is >6mg/dl.
 Anti gout drugs are used act to prevent and treat
attacks of gouty arthritis.
 CLINICAL USES:- to reduce inflammation in the
joints, decrease the production of uric acid and
increase the excretion of uric acid by the kidneys.
 ADR:- GIT symptoms, kidney stones, renal failure,
hypotension, bone marrow suppression, anemia, etc.

17. 4. ANTI GOUT DRUGS Cont’d:..
COMMON ANTIGOUT DRUGS USED:-
 Colchicine 1mg, 2mg tabs
 Allopurinol (Zyloric, Zyloprim) 100mg, 300mg tabs
 Probenecid (Benemid)
 Ibuprofen, Indomethacin, Naproxin, Diclofenac, etc.

18. QUESTIONS,
CONTRIBUTIONS,
CLARIFICATIONS &
CONSTRUCTIVE
CRITICISMS?????