Pharmacotherapy - Tufts OpenCourseWare - Tufts University

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Pharmacotherapy: opioids, NSAIDs, adjuvants, and analgesic e... 2. Pharmacotherapy of Pain. Tufts OpenCourseWare. © 2007 Tufts University.
Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

1.

Pharmacotherapy: opioids, NSAIDs, adjuvants, and analgesic e...

2.

Pharmacotherapy of Pain

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 1

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

3.

Mechanisms of Pain and Medication Activity Sites

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Classes of analgesics

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

5.

Severity: WHO analgesic ladder

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Pain Source

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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© 2007 Tufts University

Pharmacotherapy

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Acute vs. chronic therapy

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Acute vs. chronic therapy

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

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Elderly Patients

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Opioids

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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Pharmacotherapy

11.

Positioning Opioid Therapy

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Opioids: Mode of action

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 6

Tufts OpenCourseWare

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Pharmacotherapy

13.

Guidelines for Management of Opioid Therapy

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Opioid Agents

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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© 2007 Tufts University

Pharmacotherapy

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Morphine

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When to consider alternatives to morphine?

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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© 2007 Tufts University

Pharmacotherapy

17.

When to consider alternatives to morphine?

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When to consider alternatives to morphine?

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 9

Tufts OpenCourseWare

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Pharmacotherapy

19.

When to consider alternatives to morphine?

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When to consider alternatives to morphine?

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 10

Tufts OpenCourseWare

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Pharmacotherapy

21.

When to consider alternatives to morphine?

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Transdermal Fentanyl

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 11

Tufts OpenCourseWare

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Pharmacotherapy

23.

Mixed Agonist-Antagonists/Partial agonists

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Antagonists

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 12

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Pharmacotherapy

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Naloxone

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Medication Schedules

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 13

Tufts OpenCourseWare

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Pharmacotherapy

27.

Opioid Selection: Poor Choices for Chronic Pain

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Opioid-drug interactions

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 14

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

29.

Routes of Administration

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Opioid Therapy: Dosing Guidelines

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 15

Tufts OpenCourseWare

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Pharmacotherapy

31.

Opioid Therapy: Dosing Guidelines

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Poor Opioid Responsiveness

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 16

Tufts OpenCourseWare

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Pharmacotherapy

33.

Opioid Rotation

34.

How does this look?

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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Pharmacotherapy

35.

Equianalgesic Conversion

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Tolerance

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 18

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Pharmacotherapy

37.

Incomplete cross-tolerance

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Equianalgesic conversion

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 19

Tufts OpenCourseWare

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Pharmacotherapy

39.

Conversion Table

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Simple example

OCW: Introduction to Clinical Pain Problems (E. McNicol)

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Pharmacotherapy

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Simple example cont.

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Equianalgesic conversion example

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 21

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

43.

Equianalgesic conversion example

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Equianalgesic conversion example

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 22

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

45.

Equianalgesic conversion example

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Equianalgesic conversion example

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 23

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

47.

Equianalgesic conversion example

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Equianalgesic conversion example

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 24

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

49.

Nonopioid Analgesics

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NSAIDs: Properties

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 25

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

51.

Non-opioid analgesics

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Non-opioid analgesics: WHO ladder

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 26

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

53.

Positioning NSAID Therapy

54.

Guidelines for Management of NSAID Therapy

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 27

Tufts OpenCourseWare

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Pharmacotherapy

55.

NSAID with or without opioid?

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NSAID with or without opioid?

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 28

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

57.

NSAIDs - Adverse effects

58.

NSAIDs: drug interactions

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 29

Tufts OpenCourseWare

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Pharmacotherapy

59.

Which NSAID to choose?

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Which NSAID not to choose?

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 30

Tufts OpenCourseWare

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Pharmacotherapy

61.

NSAIDs: available agents

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NSAID Recommendations

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 31

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Pharmacotherapy

63.

Coxibs - place in therapy

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Adjuvant Analgesics

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 32

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

65.

Adjuvant Analgesics

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Adjuvant Analgesics - place in therapy

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 33

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Pharmacotherapy

67.

Adjuvant Analgesics

68.

Risk factors for herpes zoster

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 34

Tufts OpenCourseWare

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Pharmacotherapy

69.

Pharmacotherapy: Slide 69

70.

Anticonvulsants

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 35

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Pharmacotherapy

71.

Gabapentin/Pregabalin

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Gabapentin

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 36

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Pharmacotherapy

73.

Pregabalin

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Pregabalin

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 37

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Pharmacotherapy

75.

Pregabalin in neuropathic pain

76.

Antidepressants

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 38

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Pharmacotherapy

77.

Antidepressants

78.

Local anesthetics and oral analogues

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 39

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Pharmacotherapy

79.

Steroids

80.

Alpha-2 adrenergic agonists

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 40

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© 2007 Tufts University

Pharmacotherapy

81.

NMDA-receptor antagonists

82.

Topical Analgesics/Anesthetics

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 41

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Pharmacotherapy

83.

“Muscle relaxants”

84.

Miscellaneous drugs

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 42

Tufts OpenCourseWare

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Pharmacotherapy

85.

Adjuvant Analgesics for Cancer Pain

86.

First-line medications for neuropathic pain

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 43

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

87.

Add the following?

88.

Treatment Options

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 44

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

89.

Summary

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Summary

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 45

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

91.

NSAIDs: Summary

92.

Summary

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Page - 46

Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

93.

OCW: Introduction to Clinical Pain Problems (E. McNicol)

Pharmacotherapy: Slide 93

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