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Non-Opioid Pain Management
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Aspirin
Mechanism: Inhibits cyclooxygenase (COX) enzyme, decreasing prostaglandin synthesis. Indications: Mild to moderate pain, inflammation, and fever.
Ibuprofen
Mechanism: Nonselective inhibitor of COX-1 and COX-2, reducing prostaglandins. Indications: Mild to moderate pain, inflammation, fever.
Naproxen
Mechanism: Nonselective COX inhibitor, reduces prostaglandin synthesis. Indications: Pain, dysmenorrhea, inflammation, fever.
Acetaminophen (Paracetamol)
Mechanism: Inhibits prostaglandin synthesis in the CNS and peripherally blocks pain impulse generation. Indications: Mild to moderate pain, fever.
Celecoxib
Mechanism: Selective COX-2 inhibitor, reduces prostaglandin production. Indications: Pain, osteoarthritis, rheumatoid arthritis.
Tramadol
Mechanism: Weak opioid receptor agonist; inhibits reuptake of serotonin and norepinephrine. Indications: Moderate to severe pain.
Diclofenac
Mechanism: Nonselective COX inhibitor, decreases prostaglandins. Indications: Pain, inflammation, ankylosing spondylitis, migraine.
Meloxicam
Mechanism: Preferential COX-2 inhibitor, leading to reduced prostaglandin synthesis. Indications: Osteoarthritis, rheumatoid arthritis pain.
Ketorolac
Mechanism: Nonselective COX inhibitor to reduce prostaglandin synthesis. Indications: Short-term management of moderate to severe pain.
Gabapentin
Mechanism: Inhibits voltage-gated calcium channels, modulating excitatory neurotransmitter release. Indications: Neuropathic pain, postherpetic neuralgia.
Pregabalin
Mechanism: Binds to alpha-2-delta subunit of voltage-gated calcium channels. Indications: Neuropathic pain, fibromyalgia, and postherpetic neuralgia.
Tizanidine
Mechanism: Alpha-2 adrenergic agonist; decreases spasticity by presynaptic inhibition of motor neurons. Indications: Muscle spasticity.
Baclofen
Mechanism: GABA-B receptor agonist, inhibiting neurotransmission in the spinal cord. Indications: Muscle spasticity.
Cyclobenzaprine
Mechanism: Acts centrally at the brainstem to reduce muscle spasm. Indications: Muscle spasm.
Lidocaine (topical)
Mechanism: Sodium channel blocker, preventing propagation of pain signals. Indications: Local anesthetic, neuropathic pain.
Capsaicin (topical)
Mechanism: Activates and then desensitizes cutaneous nociceptors. Indications: Neuropathic pain, osteoarthritis pain.
Sumatriptan
Mechanism: Serotonin (5-HT) 1B/1D receptor agonist, resulting in vasoconstriction. Indications: Acute migraine attacks.
Topiramate
Mechanism: Blocks voltage-dependent sodium channels, enhances GABA activity. Indications: Migraine prevention, epilepsy.
Amitriptyline
Mechanism: Tricyclic antidepressant; inhibits serotonin and norepinephrine reuptake. Indications: Neuropathic pain, migraine prophylaxis.
Duloxetine
Mechanism: Serotonin and norepinephrine reuptake inhibitor (SNRI). Indications: Diabetic neuropathy, fibromyalgia, chronic musculoskeletal pain.
Venlafaxine
Mechanism: SNRI affecting serotonin and norepinephrine. Indications: Neuropathic pain, chronic pain syndromes.
Methocarbamol
Mechanism: Central muscle relaxant with unknown exact mechanism. Indications: Muscle spasm and tetanus.
Etoricoxib
Mechanism: Selective COX-2 inhibitor, reducing prostaglandin production. Indications: Acute and chronic pain, osteoarthritis, rheumatoid arthritis.
Nefopam
Mechanism: Non-opioid, non-NSAID analgesic; its action may involve NMDA receptor antagonism. Indications: Acute pain.
Indomethacin
Mechanism: Nonselective COX inhibitor, which decreases prostaglandin synthesis. Indications: Strong analgesic for gout, arthritis, and inflammatory disorders.
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