Pharmacotherapy: opioids, NSAIDs, adjuvants, and analgesic equivalence
	Pharmacotherapy of Pain
	Mechanisms of Pain and Medication Activity Sites
	Classes of analgesics
	Severity: WHO analgesic ladder
	Pain Source
	Acute vs. chronic therapy
	Acute vs. chronic therapy
	Elderly Patients
	Opioids
	Positioning Opioid Therapy
	Opioids: Mode of action
	Guidelines for Management of Opioid Therapy
	Opioid Agents
	Morphine
	When to consider alternatives to morphine?
	When to consider alternatives to morphine?
	When to consider alternatives to morphine?
	When to consider alternatives to morphine?
	When to consider alternatives to morphine?
	When to consider alternatives to morphine?
	Transdermal Fentanyl
	Mixed Agonist-Antagonists/Partial agonists
	Antagonists
	Naloxone
	Medication Schedules
	Opioid Selection: Poor Choices for Chronic Pain
	Opioid-drug interactions
	Routes of Administration
	Opioid Therapy: Dosing Guidelines
	Opioid Therapy: Dosing Guidelines
	Poor Opioid Responsiveness
	Opioid Rotation
	How does this look?
	Equianalgesic Conversion
	Tolerance
	Incomplete cross-tolerance
	Equianalgesic conversion
	Conversion Table
	Simple example
	Simple example cont.
	Equianalgesic conversion example
	Equianalgesic conversion example
	Equianalgesic conversion example
	Equianalgesic conversion example
	Equianalgesic conversion example
	Equianalgesic conversion example
	Equianalgesic conversion example
	Nonopioid Analgesics
	NSAIDs: Properties
	Non-opioid analgesics
	Non-opioid analgesics: WHO ladder
	Positioning NSAID Therapy
	Guidelines for Management of NSAID Therapy
	NSAID with or without opioid?
	NSAID with or without opioid?
	NSAIDs - Adverse effects
	NSAIDs: drug interactions
	Which NSAID to choose?
	Which NSAID not to choose?
	NSAIDs: available agents
	NSAID Recommendations
	Coxibs - place in therapy
	Adjuvant Analgesics
	Adjuvant Analgesics
	Adjuvant Analgesics - place in therapy
	Adjuvant Analgesics
	Risk factors for herpes zoster
	Pharmacotherapy: Slide 69
	Anticonvulsants
	Gabapentin/Pregabalin
	Gabapentin
	Pregabalin
	Pregabalin
	Pregabalin in neuropathic pain
	Antidepressants
	Antidepressants
	Local anesthetics and oral analogues
	Steroids
	Alpha-2 adrenergic agonists
	NMDA-receptor antagonists
	Topical Analgesics/Anesthetics
	“Muscle relaxants”
	Miscellaneous drugs
	Adjuvant Analgesics for Cancer Pain
	First-line medications for neuropathic pain
	Add the following?
	Treatment Options
	Summary
	Summary
	NSAIDs: Summary
	Summary
	Pharmacotherapy: Slide 93

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