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Opioid

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Binds with mu opioid receptors to mimic actions of naturally occurring opioids (endorphins, enkephalins)

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Severe pain
Moderate to severe pain

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respiratory depression
sedation, dizziness, lightheadedness, drowsiness
constipation
nausea, vomiting
orthostatic hypotension
urinary retention
cough suppression

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*Potential for abuse
*Tolerance with continued use and *cross tolerance with other opioids
*do not use in patients with respiratory issues (asthma), elevated intracranial pressure, slow bowel motility

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*Assess respiratory rate and depth prior to and after administration
*Have antidote (Naloxone, Narcan) available)
*Risk for falls
*Timing of dose (do not push an opioid too fast

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NSAID, Salicylate

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Inhibition of COX-1 and COX-2 that leads to reduced prostaglandin synthesis. The analgesic action of aspirin occurs peripherally with limited action in the CNS

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*Pain, mild to moderate
*Prevention for CV risk

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*Bleeding (more so than NSAIDS
*Tinnitus on overdose
*Same as other nonselective NSAIDS

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Renal function

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Bleeding precautions

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Opioid Antagonist

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*Competitive antagonist that knocks opioids out of the receptors
*Blocks opioid receptor

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Reversal of Opioid overdose

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Those with opioid dependence (careful administration wit help of provider if not an emergency

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Opioid withdrawl or opioid abstinence syndrome including SEVERE PAIN

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*Monitor blood pressure and vital signs
*Have emergency supplies ready for further resuscitation
*Watch after administration for continued effectiveness of Narcan if opioid is long acting

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Opioid Agonist-Antagonist

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Antagonist at Mu receptor, Agonist at Kappa

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*Moderate to Severe pain

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*Pentazocine causes less nausea, vomiting, and respiratory depression than morphine
*Drowsiness and dizziness are common

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*Can initiate withdrawal in Opioid dependent patients
*Asthma, COPD, respiratory disorders
*Do not administer with other CNS depressants (including alcohol)

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CNS depression system precautions (side rails up, etc)

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In a class of its own

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*Inhibits production of prostaglandins in the CNS through COX
*relieves pain
*reduces fever
*No peripheral inhibition (not out in the tissue like NSAIDS)
*No anti-inflammatory effects
*No anticoagulant effects

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*Mild Pain or moderate pain
*Drug of choice for mild/mod pain in older adults and peds
*Added to opioids to increase overall analgesia.

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*At safe doses, on of the best tolerated meds
*Drug of choice for peds and older adults with pain
*Liver damage with high doses

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*Excessive acetaminophen use is the number 1 cause of acute hepatic failure in  the US
*Do not drink alcohol with Aceta.
*Do not use in those with Liver disease

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*4000mg (4g) is max dose in 24 hours
*Antidote Acetylcysteine (Mucomyst) with overdose

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Serotonin (5-HT1) receptor agonist

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Binds to receptors on intracranial blood vessels and causes vasoconstriction, thus reducing headache pain

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Stop an an ongoing migraine attack

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*Often associated with vasoconstriction
*Heavy arms, chest pressure, angina, dizziness, tingling

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*interacts with other meds causing vasoconstriction, including some migraine meds
*Contraindicated in any condition where vasoconstriction could be dangerous (HTN)

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*Monitor vital signs, especially for those at cardiovascular
*If angina occurs, must rule out cardiac ischemia through EKG

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Non Steroidal Anti-Inflammatory (NSAID)

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Non-selectively prevents COX enzymes from releasing prostaglandins thus reducing pain, fever, and inflammation

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Gastric Irritation and bleeding
Kidney failure in those with kidney problems

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*Do not use in patients with kidney problems
*Do not use in patients needing to take aspirin for cardiac health

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*Watch for GI bleeding
*Monitor kidney function

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Mixed opioid-nonopioid analgesic
*Centrally acting analgesic
*Technically not an opioid

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*Binds to selected opioid receptors while also blocking reuptake of norepinephrine and serotonin in the CNS

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Moderate to moderately severe pain/ Chronic pain

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Dizziness, nausea, vomiting, constipation, lethargy respiratory depression (rarely)

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*Hx of substance abuse (alcohol and tramadol bad mix) or suicidal thoughts (risk of OD)
*Caution in renal hepatic impairment and increased intracranial pressure
*Don't take if hx of seizure (lowers seizure threshold
*Older adults

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Naloxone (Narcan) only moderately effective in reducing respiratory depression
*Seizure precaution

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COX 2 Inhibitor

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*Selectively prevents COX2 enzyme from releasing prostaglandins thus reducing pain, fever, and inflammation

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Patients with low cardiovascular risk who require NSAID therapy and are at increased risk for GI toxicity

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*Gastric irritation (but less than regualr NSAID
*Kidney problems
*Cardiovascular

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Do not use in patients with kidney problems

*Do mot use in those with cardiovascular risks

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Same as regular NSAID + Cardiovascular changes