ANALGESICS SEDATIVES AND HYPNOTICS Dr Paul Donovan Analgesics

ANALGESICS, SEDATIVES AND HYPNOTICS Dr Paul Donovan

Analgesics, Sedatives and Hypnotics � � Mechanism: all 3 generally depress the Central Nervous System(CNS) Analgesics Relieve Pain Sedatives Produce Sedation Hypnotics Produce Sleep

Analgesics � � Pain is the most common reason patients seek Medical Care Pain has both Psychological and Physiological Components and Effects � � � Endorphins: Endogenous Analgesics produced in the body in response to pain or intense exercise Analgesics: Classified as Opioid and Non. Opioid Opium: The First Narcotic Analgesic

OPIOID ANALGESICS � � � Opioids: Morphine, Hydromorphone, Meperidine, Oxycodone, Hydrocodone, Fentanyl All are Full Agonists: alter the perception of pain All are FDA Controlled Substances � � Opioids can cause Physical and Psychological Dependence High Addiction Potential

OPIOID ANALGESICS � � Side Effects: Sedation, confusion, Hypotension, Bradycardia, Nausea, vomiting, constipation Addiction with long term use Interactions: Alcohol, Psychotropics, Antihistamines, Muscle relaxants Also Cause Tolerance � � � Administration: po, IM, IV, Transdermal List p 331 and 332 Po meds often combined with ASA or Acetaminophen

NON OPIOID ANALGESICS � � � Available OTC without a prescription Common: Acetaminophen, ASA, NSAIDs Acetaminophen: Commonly used Analgesic and Anti. Pyretic Less side effects than ASA and NSAIDs (Safer) List p 333 � Tramadol: In a category by itself since is a weak Opioid Agonist (is not a Controlled Substance), Less potential abuse and side effects than Opioids already mentioned

TREATMENT of OPIOID OVERDOSE � � Narcan(Naloxone): Given IV for OPIOID and HEROIN OD Heroin(Diamorphine) Patients often present Unconscious and not breathing Also given for respiratory depression in a Post-Operative Patient

ADJUVANT ANALGESICS � � � Mechanism: Enhance analgesic effects of Opioids and Nonopioids thereby lowering the need for Opioids and lessening risks of side effects Antidepressants (chapter 20) and Anticonvulsants(ch 22) List p 336 � � � Lidoderm: a Local Anesthetic, Applied as a Patch Dermally Absorbed through the skin Uses: Low Back pain, Osteoarthritis, Postherpetic Neuralgia

Lidoderm Patch

ANTIMIGRAINE DRUGS � � � Migraine Headaches: 1 type of headache caused by Vasodilation of Blood Vessels in the Brain(thought due to decreased Serotonin levels) Headache often accompanied with nausea and vomiting, light sensitivity Treatment: simple Analgesics � � � � Treatment: SRA Serotonin Receptor Agonists Reduces Vasodilation Sumatriptan(Imitrex): first one developed List p 341 Given po, intranasally, IM: self administered Given at the First Sign of a Migraine

Migraine Headaches � Mechanism of Migraine Headache: � Pills, Injection, Nasally

SEDATIVES AND HYPNOTICS � � � Uses: Promotes Sedation and Sleep (often dose dependent) Types: Benzodiazepines (BZDs) and Non. Benzodiazepines (Non. BZDs) � � � Benzodiazepines: common meds are Temazepam(Restoril) and Zolpidem(Ambiem) Short Acting BZDs Abuse potential and dependence can develop Side Effects: Confusion, drowsiness (hangover effect) Other Meds in this group discussed as Anxiolytics(chapter 20)

SEDATIVES AND HYPNOTICS � � Nonbenzodiazepines: Antihistamines Diphenhydramine: Benadryl, Unisom, Sominex Caution with use in Elderly(highly sensitive, Don’t Oversedate!)

MELATONIN RECEPTOR AGONIST � � � Melatonin triggers sleep onset OTC Melatonin New Drug Ramelton (Rozerem) prescribed for sleep Mechanism: Acts on Melatonin Receptors Do Not Use With Melatonin! � List p 344

SUMMARY � In general be cautious with OTC and Prescription Analgesics, Sedatives and Hypnotics due to potential side effects, abuse potential and drug interactions � � � Case Studies Quiz Next Tuesday April 16: chapter 25 Cardiovascular Drugs