ANALGESICS DRUGS

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ANALGESICS DRUGS FOR CHRONIC PAIN
Dr. M . Bercovitch
Hospice Tel HaShomer
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Mechanism of action INHIBITING THE SYNTHESIS OF
PGE2
Indications In PC MILD TO MODERATE PAIN ( STEP 1
OF THE WHO LADDER)
PANCREATIC AND HEAD NECK CANCERS
CI ULCER BLEEDING DYSCRASIAS, URTICARIA,
Caution in MULTIPLE MYELOMA AND RENAL FAILURE
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How supplies TB- 85mg, 100mg, 500mg
ENTERIC COATED TB325mg, 500mg
SUPPOSITORIES500mg
Dosage Administration 650mg- 1000mg q6h
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OTHER NSAIDs
Adverse side effects PERIPHERAL EDEMA, FLUID
RETENTION
DYSPEPSIA, NAUSEA, EPIGASTRIC PAIN, GI BLEEDING,
CONSTIPATION
PROLONGATION OF BLEEDING TIME
PRURITUS, RASH
Incompatibility with ANTICOAGULANTS
OTHER DRUGS THAT INHIBIT PLATELET AGGREGATION
CARBPENICILLINE, PIPERACILLINE, VALPORIC AC,
OTHER
NSAIDs
POTENTIATE THE ACTIVITY OF HYPOGLICEMIC AG
MAY DECREASE THE EFFECTIVENESS OF DIURETICS
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OTHER NSAIDs
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OTHER NSAIDs
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Indications in PC MODERATE TO SEVERE PAIN
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SEMISYNTHETIC NARCOTIC ANALGESIC
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How Supplied PATCHES CONTAINING 25mcg/h,
50mcg/h, 75mcg/h, 100mcg/h.
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FENTANYL
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ACTIQ
(LOLIPOP)

• Transcellular
• Lipophilic
• eg, fentanyl
• Un-ionized
• Molecules readily cross cellular membranes

• Paracellular
• Hydrophilic
• eg, morphine
• Ionized
• Molecules do not cross cellular membranes

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ATTRIBUTES OF ACTIQ

• Convenient route of administration
• Favorable safety features (eg, product
  identification, removal of unit)

• Short consumption time (15 minutes)
• Rapid absorption across buccal mucosa
• Noninvasive

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RELATIVE POTENCY CONSIDERATIONS ACTIQ TO ORAL
MORPHINE1,2
OT fentanyl
IV morphine
10-201
Oral morphine
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200 mcg OTFC 2-4 mg IV morphine
6-12 mg oral morph.
Adapted from Lu JK, Bailey PL. Poster
presentation Presented at the ASA Annual
Meeting, October 11-15, 2003, San Francisco, CA.
Sevarino FB, et al. Anesth Analg. 199784S330
Lichtor JL et al. Anesth Analg. 199989732-738.
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METHADONE
ADOLAN
Indication in PC ALTERNATIVE MEDICATION IN MO
UNRESPONSIVNESS
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Dr. A. WALLER Dr. M. BERCOVITCH
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ADJUVANTS ANALGESICS
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THANK YOU !