The resident's electronic handbook ...

ANALGESICS


NSAID

OPIOIDS


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02/16/96 kaufmannm@ubaclu.unibas.ch


Nonsteroidal Anti-inflammatory Drugs - Overview


               Salicylates   Paracetamol   Benzothiazin   Propionic    Mefenamin   Ketorolac                                                         acid         acid
Aspirin         Panadol        Felden      Brufen      Ponstan     Tora-Dol
                  Aspegic

Dose in
(mg) p.o.         25-1000       325-1000         20        200-800       500          ---

Dose interval
in hours           4-6           4-6           12-24        8-12         6-8         8-12

Dose in
mg i.v.            500                                                              10-30

Maximum intensity
in hours           2            0.5-1           2-4        1-2           2        0.5-0.75

Duration of analgesic
effect in hours   4-6            4-6            24         4-6          4-5         4-5

Analgesic effect  +++            +++            +++        +++           ++          ++

Anti-inflammatory
effect            +++            ---            +++        +++           ++          ++

Antipyretic
effect            +++            +++             +          +++           +          +



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Nonsteroidal Anti-inflammatory Drugs - Side effects


            Salicylates   Paracetamol   Benzothiazin   Propionic     Mefenamin   Ketorolac
                                                         acid         acid

Gastric
irritation       +++          ---             ++         ++           +++         +++

Gastric
ulceration       +++          ---              +          +            ++          ++

Platelet
dysfunction      +           ---              +          +

Hemolytic
anemia                                        ++          ++

Renal
dysfunction     +                            +          +            ++          ++

Hepatic
dysfunction    ++           +++              +          +             +          +

Allergic
reactions    +++           ---              +          +             +          +

CNS       tinnitus       ---           insomnia     headache     headache    headache
                                       dizziness    dizziness    confusion
                                       dysopia

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Opioid - Overview


         Morphine   Methadone    Pethidin    Alfentanil   Fentanyl  Nalbuphin

analgesic 
potency     1          1           0.1          30          125         1

dose i.v.
(mg/kg)    0.1        0.1          0.5       0.025-0.1   0.025-0.3   0.15-0.3

dose s.c.,
i.m.(mg)   5-20    0.1/kg KG     25-150

Repeat dose 
after      3-5h       3-5h        3-5h       5-10min     30-60min      5h

Peak analg.effect 
i.v. max 
after      30min     10-30min     90min       1min         3min        3min

Activity
time        3-5h       3-5h        3-5h       5-10min     30-60min      5h

Elimination 
half-time   3h       15-40h       4h          90min       3.5h         3h

Metabolism       liver/kidney   liver      liver       liver        liver       liver

Secretion           bile       bile       bile        bile         bile        bile
           kidney     kidney     kidney      kidney       kidney      kidney

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Opioid - Side effects (adults)



           Morphine  Methadone   Pethidin   Alfentanil  Fentanyl  Nalbuphin

Nausea/vomiting              ++       ++          ++         ++++         ++        +

Thoracic rigidity                             ++++         ++

Miosis        ++       ++                      ++          ++

Bradycardia                                    +           ++

Cardiovascular compensationdepressed by all opiods

Gastrointestinal              depressed motility

Biliary muscles tonus             ++       ++         ( + )        ++          ++        ++

Bronchial muscles tonus             ++       ++           +        ++          ++        ++

Histamine release             ++                   ++

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