9. CHOICE OF ANALGESICS
• For mild pain Non-narcotic analgesics or
NSAIDs are used such as:
Paracetamol.
Ibuprofen.
Diclofenac.
10. CHOICE OF ANALGESICS
• For moderate pain ,Narcotic (opiod)
analgesics, low –efficacy opiods are used such
as:
Codeine.
Dihydocodeine.
Dextropropoxyphene.
Pentazocine
11. CHOICE OF ANALGESICS
• For severe pain, high-efficacy opiod are used
such as:
Morphine
Diamorphine
Pethidine
Buprenorphine
An additional NSAID is useful if there's an
additional tissue injury component e.g. gout, bone
metastasis.
12. CHOICE OF ANALGESIC
• overwhelming acute pain
High-efficacy opiod plus a sedative/ anxiolytic
such as diazepam.
High –efficacy opiod plus a phenothiazine
tranquillizer such as chlorpromazine,
levomepromazine,
13. NONSTEROIDAL ABTI-INFLAMATORY
DRUGS
Mode of action
They work by blocking prostaglandin synthesis.
This is due to inhibition of the enzyme Cyclo-
oxygenase. Some NSAIDs are specific whereas
others are none specific.
15. USES
• Prolongation of gestation and labour.
• Patency of ductus arteriosus
• Primary dysmenorrhoea.
16. ADVERSE REACTIONS
• Gastric and intestinal mucosal damage
• Sodium and fluid retention
• Urticuria, rhinitis, and asthma occur in
susceptible individuals.
17. INTERACTIONS
• ACE inhibitors and angiotensin 11 antagonists
:there is risk of renal impairment and
hyperkalaemia.
• Quinolone antimicrobials: convulsions may
occur if NSAIDs are co administered.
• Anticoagulants and Antiplatelet agents reduce
platelet adhesiveness and GI tract damage by
NSAIDs increase risk of bleeding.
18. INTERACTIONS
• Fluconazole raises the plasma of Celecoxib
• Effect of antihypertensive drugs reduced due
to sodium and fluid retention.
• Ritonavir may raise the concentration of
piroxicam; NSAIDs may increase the
heamatological toxicity from Zidovudine.
21. ASPIRIN
INDICATIONS
• Mild to moderate pain
• Pyrexia
• Prophylaxis of cerebrovascular disease or
myocardial infarction
• Inflammatory condition
22. DOSE
Inflammatory /analgesia
• Adults: 300-900mg every 4-6 hours when
necessary, maximum 4g daily.
Secondary prevention of thrombotic
cerebrovascular disease or cardiovascular
• 75mg - 300mg daily. after myocardial
infarction 150mg daily. following bypass
surgery,75mg to 100mg daily.
23. ADVERSE EFFECTS
• Gastric irritation and bleeding.
• Asthmatic attacks and skin reactions.
• Reyes syndrome in some children with viral
infection.
• Salicylism-deafness, dizziness, tinnitus,
confusion, vomiting and hyperventilation.
• Metabolic acidosis
25. CONTRAINDICATIONS
• Gastro-intestinal ulceration
• Children under 12 years of age ( except for
juvenile arthritis) due to association with
Reyes syndrome
• Breastfeeding
• Heamophilia and other bleeding disorders
• History of hypersensitivity to aspirin
• Concurrent anticoagulant therapy.
26. DRUG INTERACTIONS
•
• ALCOHOL-likely to cause gastritis
• ANTICOAGULANTS-Increases bleeding
• ANTACIDS-excretion of aspirin increased in
alkaline urine
• ANTIEPILEPTICS-Phenytoin, valproate effect
enhanced.
• COTICOSTEROIDS-increased risk of bleeding and
peptic ulceration.
36. Dose
Adult:1.2- 1.8g in 3-4 divided doses preferably
after meals increased to a aximum of 2.4g
daily
Maintenance dose of 0.6 – 1.2g daily may be
adequate
Children:20mg/kg body weight daily in divided
doses. Not recommended for children under
75kg.
