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MSc A-D Analgesic Medication
Transcript of MSc A-D Analgesic Medication
Our patient with LBP
Actions: inhibits COX pathway, stopping formation of prostaglandins.
Particular affinity for synovial membrane of inflamed joints. ibuprofen reversible effects at binding sites; aspirin non-reversible for life of the platelet ie effective!
?contra-indicated with fracture
Side-effects: GI bleeding/ulceration; inc risk CV events
Maximum daily dose OTC: 1200mg
Maximum daily dose Rx: 2400mg
Actions: Acts in spinal cord & limbic system: Spinal cord: bind to potassium channels to prevent opening of Ca2+ channels ie prevents voltage gates from opening at synapses to prevent pain signals from ascending. Limbic system: binds to receptors to increase dopamine release, to promote feelings of euphoria & counteract pain - addiction!
Side-effects: addictive due to the up-regulation of the dopamine receptors. Needs larger & larger doses to get same effect. Constipation & dry mouth common side effects.
Dose: as codeine: 8/500 OTC. 15/500 or 30/500 Rx.
as tramadol: Rx only <400mg daily.
Actions: affects COX pathway, to a lesser extent & differently to NSAIDs. Does not compete for protein binding sites, therefore less GI issues.
Side-effects: Hepatotoxicity at fairly low levels. Care in pts with liver & kidney disease.
Maximum daily dose paracetamol: 4g daily.
What do you do?
Stop taking either co-codamol or paracetamol; alternate NSAID & co-codamol for incrased therapeutic effect