Professional Documents
Culture Documents
Biomed
Pharmacology Department
Faculty of Medicine, UII
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Skin,integumentum,
Somatic pain
muscle, bone, joint
Incutaneusarea, which
Referral pain receives nerve supply from
the same spinal segment
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Central nervous system
Ex:Pethidine,Tramadol,
etc
Analgesic
Peripheral
≈
aspirin,paracetamol,NSAID
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• bindopioidspesificreceptor in CNS. (mu,
MOA kappa, delta receptor)
• Analgesic
• Anti-diarrhea (ex:loperamid)
Clinical • Coughsupressor(ex: codeine)
• Acute pulmonaryoedema vasodilatation
Application effect (ex: morphinei.v)
• Tolerance
• dependence
Important issue • Withdrawal
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• Avoid in respiratory insufficiency, ex: COPD
• In extreme age more susceptible to respiratory
depression
• In asthma patient asthma attack (morphine)
• Head injury increase CSF pressure, respiratory
Precaution depression,vomitting,miosismental clouding
• Hypovolemicshock decrease the BP
and contra • Potentiates the CNSdepressan
indication
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MIXED AGONIST-
ANTAGONISTS
STRONG MODERATE/LOW
AND ANTAGONISTS OTHER
AGONISTS AGONISTS
PARTIALAGONIS
TS
Alfentanyl
Pentazosine
Codeine
Fentanyl Naloxone
Buprenorphine
Meperidone
Oxycodone Tramadol
Methadone
Butorphanol
Heroine Naltrexone
propoxyphene
Nalbuphine
Morphine
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Non selective COX Inhibitor
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NON-SELECTIVE COX INHIBITOR
1. Para-aminophenol derivatives Paracetamol (asetaminofen)
2. Salicylic acid derivatives Aspirin, diflunisal, sulfasalazine
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Selective COX-2 Inhibitor
Diaryl substituted furanones Rofecoxib, celecoxib
Diaryl-substituted pyrazoles Celecoxib
Indol acetic acid Etodolac
Sulfonanilides Nimesulide
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• Inhibit cyclooxigenase irreversibly,
• inhibit prostaglandin and platelet
MOA aggregation
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PRECAUTION !!!
• Pregnancy
contraindicated cross the
placenta, may harm fetus. choose
paracetamol
• Lactation
Excreted in breastmilk in low
concent, but no adverse effect in
infant use in caution
• Children
Not recom Reye’s syndrome
• Renal dz
CKD, fluid retention
• Liver dz
Caution in impaired liver function,
preexisting hypoprothrombinemia,
vit. K def bleeding
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MOA
Indication
Side effect
ACETAMINOPHEN
Dosage
CI
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IBUPROFEN
Side effect
Contra
Indication
Dosage
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PIROXICAM
Dosage
Special use
interaction
Same with IBP
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Clinicaly, no clear guideline in
selecting appropriate NSAID for a
patient
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Thank You
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