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