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dr. Putrya Hawa, M.

Biomed
Pharmacology Department
Faculty of Medicine, UII

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Skin,integumentum,
Somatic pain
muscle, bone, joint

Vague, dull-aching type,


Visceral pain difficult topinpointo a
Types of pain
pain site

Incutaneusarea, which
Referral pain receives nerve supply from
the same spinal segment

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Central nervous system

Opiod/ narcotic For severe pain

Ex:Pethidine,Tramadol,
etc

Analgesic

Peripheral

NonOpioid For mild and severe pain


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)

• Comatous, respiratory depression


• Vomitus, constipation
• Brochoconstriction
• Urinary retention
Side effect • Increase CSF pressure

• 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

• CNSdepressan, alcohol, antipsychotic


respiratory depression
• MAO inhibitor hyperpyrexia, coma,
hypertension
Drug Interaction

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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

Gastric bleeeding  COX-1 receptor inhibition, inhibit


platelet aggregation

Selective COX-2 Inhibitor

Lower GI effect and platelet dysfunction


Increase risk of myocardial infarction and stroke

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NON-SELECTIVE COX INHIBITOR
1. Para-aminophenol derivatives Paracetamol (asetaminofen)
2. Salicylic acid derivatives Aspirin, diflunisal, sulfasalazine

3. Indol acetic acid derivatives Indometasin, sulindac


4. Arylacetic acid derivatives Tolmetin, diclofenac, ketorolac
5. Propionic acid derivatives Ibuprofen, naproksen,
flurboprofen, ketoprofen
6. Fenamates (Anthranilic acid) Mefenamic acid, meclofenamic
acid
7. Enolic acid derivatives Piroxicam, Meloxicam
8. Pyrazolone derivatives Phenylbutazone, azapropazone

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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

Side effect ACETYL Indication


SALICYL ACID
Pain, fever, inflammatory
condition (RA,
OA,dysmenorrhea),
common cold, fever
Reducing risk of TIA, MIA
at low dose
Dosage Contraindication

Adult: 350-650mg/4h  mild pain


500-1000 mg/4-6 h  moderate &
severe pain
75-325 mg/day MI<TIA prevention

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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

It’s depends on clinical


experience, patient convenience,
side effect and cost

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Thank You

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