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ANALGASIC slides for all medical students
1.
2. All those drugs which are used to reduce pain
sensation are called analgesic
Pain
Pain is unpleasant sensation OR emotional
behavior to the body due to actual or
potential tissue damage
3. Nociception is the mechanism whereby noxious
peripheral stimuli are transmitted to the central
nervous system.
Analgesia – absence of pain
Pain receptors in our bodies are nerves that
transmit pain. These are located in various body
tissues that respond to thermal, mechanical and
chemical stimuli. When stimulated, these pain
receptors generate an impulse which is carried to
the CNS. Called nociceptors
4. Nociceptive pain: it results from activation of
nociceptors (Pain receptors)
Neuropathic pain: it results from direct injury to
nerves in the peripheral nervous system.
Somatic pain
Superficial: stimulation of receptors in skin
Deep: stimulation of receptors in muscles, joints and
tendons
5. Visceral pain
Stimulation of receptors in internal organs, abdomen
and skeleton
Referred Pain: Pain experienced at a point distant to
its point of origin
Somatogenic pain is a pain originating from an actual
physical cause e.g. trauma, ischaemia etc
Psychogenic pain is pain for which there is no physical
cause
7. The term opioids refers to all those drugs
(natural or synthetic) which acts on opioids
receptors produce analgesia and narcosis
(drowsiness)
Opioids derived from poppy (opium)
papaver somniferous
15. Opioids receptor belong to glycoprotein
coupled family with seven transmembrane
extracellular N-terminal and intracellular
C-terminal
16. Receptor Place where present Response to
stimulation
μ (MPO) Receptor
OP3
Peripheral
inflammation pre and
post synaptic neuron of
spinal cord
pre aqueduct gray
matter
limbic system
caudate putamen
thalamus
cerebral cortex
Analgesia
Sedation
Euphoria
Respiratory
depression
Constipation
17. RECEPTORS PLACE WHERE
PRESENT
RESPONSE TO
STIMULATION
k receptor (KOP)
OP1
KAPA
MID brain
Hypothalamus
Spinal cord
Nucleus raphe
Magnus
Spinal analgesia
Sedation
Miosis
δ(delta) receptor (DOP)
OP2
NOP FQ receptor
Nociceptive orphanin
OLFACTORY CENTERS
CEREBRAL CORTEX
CAUDATE PUTAMEN
SPINAL CORD
Nucleus raphe
Magnus
Spinal cord
Afferent neuron
Cardiac stimulation
Analgesia
Dysphoria
18. Natural Painkillers OR opiopeptides
Endorphins and Enkephalins are the natural
opiates found in the part of the brain and the spinal
cord. They are able to bind to neuro-receptors in
the brain and produce relief from pain. The
temporary loss of pain immediately after an injury
is associated with the production of these
chemicals.
19. Acts on specific opioids receptor
Exogenous opioids mimic the action of
endogenous opioids
Block the adenylete cyclase which further
inhabit the neurotransmitter (substance P
and glutamate) from the neural cell which
caring painful stimulus
20.
21.
22. Absorption
All opioids are week base and highly ionized
state
Rapid absorption from GIT
Many opioids undergoes first pass effect
Parentally 100% bioavailability IM, IV,
sublingual, subcutaneous, nasal mucosa,
Highly lipid soluble absorbed from skin e.g.
alfentanyle pitch
23. Lipid soluble distribution depend upon
Lipid solubility
Concentration gradient
Binding to glycoprotein
Only a small amount enter in to the brain
24. Metabolism take place in the liver by phase I
and Phase II reaction converted to
glucoronides and water solvable metabolites
Excretion
Execrate through kidney in urine
Bile excretion
26. Lead to cerebral vasodilatation increase
blood flow to brain which increase ICP
(THIS EFFECT ALSO DUE CO2)
REPIRATORY DEPRESSION
Activate chemoreceptor trigger zone
produce nausea and vomiting
Stimulation of endanger westphal nucleus
produce Miosis (Occulumoter nerve III
CN)
27. Produce spasm of GIT muscle
Reduce peristalsis causing constipation
Decrease the secretion of stomach
Decrease the motility of sphincters and
produce contraction of sphinctors
28. In Normo volumic patient have no effect
Orthostatic hypotension
Depress the vasomotor center which depress
the vasomotor tone lead to vasodilatation it
is also due to histamine release produce
hypotension
29. Produce constriction of bronchial smooth
muscle
Decrease secretion of bronchioles
Decrease respiratory rate due to central
depression
Increased the rigidity of trunk muscle
(alfentanyle) child and old are more effected
Decrease sensitivity of respiratory center to
CO2
30. Decrease blood flow to the kidney which
increase the secretion of ADH which lead to
Oliguria
Produce spasm of urinary system retention of
urine
Causes relaxation of uterus delay labour
Decrease sexual activity in mail
Libido in addict patient
Delayed ejaculation
31. Decrease thyroid hormones
Decrease BMR
Decrease the level of LH, FSH, Testosterone
and cortisol
Increase ADH
32. Long Bone Fracture
Myocardial Infarction
Terminal stages of cancer
Burn patients
Postoperative patients
Visceral pains
Biliary colic and renal colic
Intraoperative & premedication
TIVA
34. Drug tolerance means reduced response to
a drug following its repeated use. Increasing its
dosage may re-amplify the drug's effect
35. Dependence develops when the neurons adapt to
the repeated drug exposure and only function
normally in the presence of the drug. When the
drug is withdrawn, several physiologic reactions
occur. Morphine act on specific areas of the brain
known as the limbic system, which controls
emotions, to create feelings of pleasure or
relaxation. Opiates work to reduce pain by
affecting the spinal cord, which sends messages
from the brain to the rest of the body, and vice
versa
