ANALGESIC DRUG 1.

PARACETAMOL Trade name : panadol Functional class : Nonopiods analgesic, antipyretic Chemical class : Nonsalicylate, paraaminophenol derivative Action : May block pain impulses peripheral that occur in response to inhibition of prostaglandin synthesis; does not possess anti-inflammatory properties; antipyretic action result from inhibition of prostaglandin in CNS (hypothalamic heat-regulating center) Uses : Mild to moderate pain or fever, arthralgia, dental pain, dysmenorrhea, headache, myalgia and osteoarthritis. Dosage : tab 1g, suppository 80,120, 125, 325, 600, 650 g Side effect : hepatotoxocity, hepatic fever, renal failure, cynosis, anemia, neutropenia, jaundice. Nursing consideration : Dont give exceed recommended dosage.. Not to use with alcohol, herbals, without approval of prescriber. To notify if pain or fever lasting over 3days. 2. KETOROLOC Trade name : Toradol Functional class : Nonsteroidal anti-inflammatory/nonopiod analgesic Chemical class : Acetic acid Action : Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, antiinflammatory and antipyretic effects Uses : Mild to moderate pain (short term) seosanal allergic conjunctivitis (ophthalmic) Dosage : 15/30 mg/ml, tab 10mg Side effects : CV trombotic events, MI, stroke, GI bleeding, perforation, nephrotoxicity, blood drscrasias. Nursing consideration: Patient with aspirin sensitivity, asthma, may be more .ikely to develop hypersentiviti to NSAIDs., monitor for hypersensitivity. Not to exceed 5 days. Avoid driving if dizziness or drowsiness occurs. Report any urine patern, weight increase, edema, pain increase in joint, fever, blood in urine. Avoid alcohol.

3. INDOMETHACIN Trade name : Novomethacin Functional class : Nonsteroidal anti-inflammatory product (NSAIDs), antirheumatic Chemical class : Propionic acid derivative Action : Inhibits prostaglandin synthesis by increasing enzyme needed for biosynthesis; analgesic, anti-inflammatory and antipyretic effects Uses : Rheumathoid arthritis, ankylosing spondylitis, osteoarthritis, bursitis, tendernitis, acute gouty arthritis, closure of patent ductus arteriosus in premature infants, ICU- dysmenorrheal, inflammatory disease. Dosage : 25-50 mg BD/QID, max 200mg/day Side effect : dizziness, drowsiness, fatigue, tachycardia, peripheral edema, palpitations, ulceration, perforation, nephrotoxicity. Nursing consideration : take with food to decrease GI symptom and perevent ulcerations. Shake suspension and do not mix with orther liquids. Avoid alcohol, NSAIDs, salicylates: bleeding may occur. 4. FENTANYL Functional class : Opiods analgesic Chemical class : synthetic phenylpiperidine Action : Inhibits ascending pain pathways in CNS, increase pain threshold, alters pain perception by binding to opiate receptors. Uses : Control moderate to severe pain, pre-op, post-op; adjunct to general anesthetic, adjunct to regional anesthesia. Fentanyl; anesthesia as premedication, conscious sedation. For treatment cancer and palliative care ( rheumathoid arthritis) Dosage : IV : 25-100mcg, IM /IV 0.1mg 30-60min before operation, 25mcg/hour (patch). Side effect : Dizziness, delirium, sedation, bradycardia,cardiac and respiratory arrest, respiratory depression, laryngospasam, lightheadedness, weakness and fatigue, dry mouth and constipation. Nursing consideration : CNS changes, allergic changes, respiratory dysfunction, give slowly to prevent rigidity (IM/IV)

5. LOCAL ANESTHETICS ( LIDOCANE, ROPIVACAINE, PROCAINE, TETRACAINE) Action : Inhibits conduction of nerve impulses from sensory nerve. Uses : Refer to individual product listing for indications. Side effect : dystonia, akathisia, flexion of arm, fine tremors, drowsiness, restlessness, and hypotension, chills, respiratory depression and laryngospasm. Precaution : Pregnancy 6. MORPHINE Functional class: Opiods analgesic Chemical class : Alkaloid Action : Depression pain impulse transmission at the spinal cord level by interacting with opioid receptors. Uses : Moderate to severe pain , left ventricular failure, analgesic for terminal care. Dosage : IM/IV/SC 0.5-50mg/ml, tab 15/30mg, liq 10,20mg/ml, Antidote : Naloxone Side effect : Hypotension, bradycardia, respiratory depression, drowsiness, nausea, vomiting, constipation, pruritis. Nursing consideration : CNS changes, allergic reaction, turn position slowly orthostatic and hypotension may occur, avoid use alcohol and CNS depressants. 7. CODEINE Functional class : Opiates analgesic, antitussive Chemical class : Opiates, phenathrene derivative Action : Depression pain impulse transmission at the spinal cord level by interacting with opioid receptors, decreases cough reflex, GI motility Uses : Moderate to severe pain, nonproductive cough Dosage : tab 15-30mg, inj 15,30mg/ml Antidote : Nalaxone Side effect : drowsiness, sedation, dizziness, agitation, seizures, bradycardia, palpitation, orthostatic, hypotension, tachycardia, respiratory depression, respiratory paralysis, anaphylaxis, circulatory prolapse. Nursing consideration: not to breastfeed, CNS changes, allergic reaction, avoid hazardous activity

8. METHADONE Functional class: Opioid analgesic Chemical class : Synthetic diphenylhapatane derivative Action : Depression pain impulse transmission at the apinal card level by interacting with opioid receptors, produce CNS depression. Uses : severe pain, opioid withdrawal Dosage : tab 5-10mg, inj 5-10mg/5ml Antidote : Nalaxone Side effect : drowsiness, dizziness, confusion, headache, seizures, respiratory depression or arrest,cardiac arrest, shock 9. TRAMADOL Trade name : Tramal Functional class : Analgesic Action : Not completely understood, binds to opioid receptors, inhibits reintake of norepinephrine, serotonin; does not cause histamine release or affect heart rate Dosage : tab 15mg Side effect : dizziness, headache, hallucination, sedation, vasodilation, orthostatic hypotension, tachycardia, hypertension, dry mouth, constipate, anorexia, anaphylaxis.