Analgesics

OBJEKT
IF
1. Memberi definisi ‘Analgesics’.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian
ubat.
1. Menyatakan tindakan ubat.
2. Menerangkan kesan sampingan
dan kontraindikasi ubat.
3. Memberikan nasihat spesifik
dalam pengambilan ubat.
 Analgesics

• Adalah ubat yang

digunakan untuk
mengurangkan
kesakitan
(management of pain).
 Analgesics
Non-narcotic Narcotic
Analgesics Analgesics

Salicylates NSAIDs
Non-
Salicylates
Non-Narcotic
Analgesics
 Definition
• Juga dikenali sebagai “non-
opioid analgesics”
• Kumpulan ubat ‘analgesic’
yang digunakan untuk
mengurangkan kesakitan
tanpa menyebabkan
ketagihan.
 Mekanisma Kesakitan
• Bila tisu tercedera, ia akan
membebaskan
prostaglandin.
• Prostaglandin adalah
sekumpulan asid lemak
semulajadi yang bertindak
dalam badan.
• Prostaglandin boleh
merangsang reseptor sakit
(nociceptors).
• Maka reseptor sakit akan
menghasilkan impulse yang
akan dihantar ke otak.
• Kemudian otak akan interpret
impulse tersebut sebagai
kesakitan “pain”.
 Tindakan Analgesics

• Menghalang penghasilan/
pembebasan prostaglandin.
• Maka prostaglandin tidak
boleh merangsang reseptor
sakit.
• Seterusnya reseptor tidak
dapat menghasilkan
impulse.
• Tiada impulse dan otak tidak
ada impulse untuk interpret
sebagai kesakitan “pain”.
• Maka pengurangan
prostaglandin boleh
mengurangkan kesakitan.
Prostaglandin: One of a number of hormone-like
substances that participate in a wide range of body
functions such as the contraction and relaxation of
smooth muscle, the dilation and constriction of blood
vessels, control of blood pressure, and modulation of
inflammation. Prostaglandins are derived from a
chemical called arachidonic acid.
• Prostaglandin also:
• Regulate acid secretion in
stomach
• Regulate body temperature
• Regulate platelet
aggregation
• Control inflammation
• Maka dengan pengurangan
prostaglandin, Non-narcotic
analgesics menghasilkan
kesan:
• Analgesics
• Anti-Inflammatory
• Antipyretics
 Jenis-jenis
Non-narcotic analgesics

• Salicylates
• Non-Salicylates
• NSAIDs (Non Steroidal Anti-
Inflammatory Drugs)
Salicylates
 Contoh ubat

• Acetylsalicylic
acid / Aspirin
(Empirin)
1. Acetylsalicylic Acid
(Aspirin)

Category: C
 Indication
• Mild to moderate pain
• Reduce elevated body
temperature
• Treatment of inflammmatory
conditions (Arthritis
disorders)
• Anti-platelet
 Dose
• Adult:
• 300-900mg tiq/qid (divided
dose)
• Max: 4g/day
• Peads:
• Not recommended for child
< 12 yrs

Note: Take this medicine after food

 Kesan Sampingan
• Irritation (lapisan mucosa
gaster)
• Epigastric distress
• GI bleeding
• Increase bleeding time
• Allergic reactions
 Contraindication

• Allergic to Aspirin
• Bleeding ulcers
• Hemorrhagic status
• Child < 12 yrs
• Pregnancy
 Cautious

• Impaired renal function

• Lactation
• G6PD deficiency
• Peptic ulcer
• Vitamin K deficiency
 Interactions

• Activated charcoal
– Kurangkan penyerapan
salicylates
• Antacids
– Kurangkan kesan salicylates
• Carbonic anhydrase
inhibitors
– Tingkatkan kesan sampingan
salicylates
• Heparin
– Tingkatkan risiko pendarahan
• NSAIDs
– Tingkatkan serum NSAIDs
Non-Salicylates
 Contoh ubat

• Paracetamol/ Acetaminophen
(Panadol)
1. Paracetamol/
Acetaminophen
(Panadol)
Category: C
 Indication

• Mild to moderate pain

• Reduce elevated body
temperature
 Dose

• Adult:
• 500-1000mg tiq/qid PO
• Max: 4g/day
• Peads:
• 1 yr: 60-120mg tid-qid PO
• 1-5 yr: 120-240mg tid-qid PO
• 6-12 yr: 240-480mg tid-qid PO
• Max: 4 doses/day
 Kesan Sampingan
• Hepatotoxicity
• Jaundice
• Hemolytic anemia
• Urticaria (allergic)
• Pancytopenia(kur
ang sel-sel darah)
 Contraindication
• Allergic to Paracetamol
 Cautious
• Impaired hepatic & renal
function
• Pregnancy
• Lactation
• Chronic alcoholism
 Interactions
• Anti-coagulants
• Alcohol
• Aspirin
• Chloramphenicol
• Phenobarbitone
 C. NSAIDs
(Non Steroidal Anti-Inflammatory
Drugs)
 NSAIDs
• Tidak tergolong dalam
kumpulan ubat steroid.
• Maka tidak menghasilkan
kesan sampingan berkaitan
steroid.
 • Tindakan:
• Analgesics
• Anti-inflammatory
• Antipyretics

• Rujuk Nota NSAIDs

 Narcotic
Analgesics
 Definition
• Juga dikenali sebagai
“Opioid analgesics”.
• Obtained from opium poppy
plant.
• Controlled substance.
• Boleh menyebabkan
ketagihan.
 Tindakan

• Bertindak terhadap reseptor

opioid yang terletak pada
otak.
• Maka tindakan reseptor
disekat dan kemasukkan
impulse ke otak dihalang.
• Maka impulse tidak boleh
ditafsir sebagai kesakitan
‘pain’.
 Contoh ubat
• Morphine sulphate (MST
Continus)
• Morphine sulphate (Statex)
• Methadone (Dolophine)
• Fentanyl Citrate (Fentanyl)
• Pethidine HCl
1. Morphine sulphate (MST
Continus)
Indication
• Analgesics (moderate to severe)
• Post-operative sedation
• Adjunct(J.pendek) to
anesthesia
• Pain associated with MI
1(a). Morphine sulphate
10mg/30mg/60mg controlled
release tablet
(MST Continus)
Category: A
 Dose
• 10-60mg q 12 hr (depends
on the severity of the pain)
1(b). Morphine sulphate
10mg/ml Inj

Category: B
 Dose
• Adult:
• 10-20mg/kg SC/ IM q 4 hr
• Peads:
• < 1 mo: 0.15mg/kg
• 1-12 mo: 0.2mg/kg
• 1-5 yrs: 2.5-5mg
• 6-12 yrs: 5-10mg
• All doses are given q 4 hr
2. Morphine sulphate
(Statex)

Indication
• Chronic pain in cancer
patient
2(a). Morphine sulphate
5mg/ 10mg immediate release
tablet
(Statex)
Category: A*
 Dose
• 5mg q 4 hr or
• 10mg q 4 hr
 2(b). Morphine sulphate
10mg/ 20mg/ 30mg suppositories
(Statex)

Category: A*
 Dose
• 15-30mg q 4 hr
3. Methadone 5mg/ml syrup
(Dolophine)
Category: A

Indication
• Analgesics
• Methadone replacement
therapy
 Dose
• Analgesics:
• 2.5-10mg q 4 hr (PRN)
• Methadone replacement
therapy:
• 10-40mg/ day
4. Fentanyl Citrate
50mcg/ml Inj
(Fentanyl)
Category: A
 Indication
• Analgesics (during surgery)
• Adjunct to anesthesia
 Dose
• Adult:
• Spontaneous respiration:
50-200mcg then 50mcg q 20-
30 min
• Assisted respiration: 300-
350mcg then 100-200mcg
(up to 600mcg)
• Peads:
• Spontaneous respiration:
3-5mcg/kg then 1mcg/kg q
20-30 min
• Assisted respiration: 10-
15mcg/kg then 1-3mcg/kg
5. Pethidine HCl 50mg/ml Inj or
100mg/2ml Inj

Category: B

Indication
• Analgesics
• Pre-operative analgesics
 Dose
• Adult:
• 0.5-2mg/kg SC/ IM q 2-
4hr (if necessary)
• Peads < 1yr:
• 1-2mg/d IM
• Peads 1-5 yr:
• 12.5-25mg/d IM
• Peads 6-12 yr:
• 25-50mg/d IM
 Kesan sampingan

• CNS:
– Sedation
– Headache
– Dizziness
– Confusion
– Gangguan mental
• GI:
– Nausea
– Vomiting
– Dry mouth

• Cardiovascular:
– Tachycardia or bradycardia
– Flushing (face)
– palpitation
• Genitourinary:
– Spasm of ureters &
bladder
– Urinary retention

• Allergic:
– Pruritis
– Rash
– Urticaria
• Others:
– Physical dependency
– Pain at injection site
 Contraindication

• Allergic to Narcotics
• Respiratory tract
obstruction
• Increased intra cranial
pressure
• Convulsion disorders
• Severe Renal & hepatic
dysfunction
• Pregnancy
• Labor
 Cautious

• Impaired hearing
• Cardiovascular disease
• GI condition
• Hypertension
• Allergic
• Elderly
• Liver disease
• History of drug addiction
• Prostatic hypertrophy
• Renal/ hepatic impairment
• Lactation
 Interactions

• Additive CNS depression

– Alcohol
– Anti-histamine
– Anti-depressants
– Sedatives
– MAOIs
• General Anesthesia
(barbiturates)
– Respiratory depression
– Hypotension
– Sedation
WHO Analgesic Ladder

Se
ve
re
i n
Pa M
od “Strong” Opioid
e ra
te

“Weak” Opioid
M
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Non-Opioid
 Soalan
1. Berikan definisi ubat analgesics?
2. Senaraikan jenis-jenis
analgesics & terangkan cara
tindakannya?
3. Senaraikan contoh ubat
analgesics?
4. Nyatakan kesan sampingan dan
kontraindikasi ubat analgesics?