Transcript Chapter 20 Lesson 2 - ROP Pharmacology for Health Care

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
20
Analgesic Drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. When given the name of a well-known
analgesic generic drug, identify its trade
name.
2. When given the generic and trade names of
an analgesic drug, identify what drug
category it belongs to and what disease it is
used to treat.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
3. When given an analgesic drug category,
name several generic and trade name drugs
in that category.
4. When given an ending common to several
generic drugs, identify the related drug
category.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
• Analgesic effect because they inhibit
the production of prostaglandins
• Have less of a tendency than salicylate
drugs to cause stomach irritation and
ulcers
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
• Structurally similar enough to aspirin
that patients who are allergic to aspirin
should not take NSAIDs
• Used to treat mild-to-moderate pain
and inflammation
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
• Used to treat mild-to-moderate pain
and inflammation, particularly from:







Osteoarthritis
Rheumatoid arthritis
Bursitis
Tendinitis
Gout
Migraine headaches
Dysmenorrhea
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
•
•
•
•
•
•
•
•
Celecoxib (Celebrex)
Diclofenac (Cataflam, Flector, Voltaren)
Etodolac
Fenoprofen (Nalfon)
Ibuprofen (Advil, Motrin)
Indomethacin (Indocin)
Ketoprofen
Ketorolac
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 20–5 Celecoxib (Celebrex). Prescription celecoxib (Celebrex) is a COX-2
inhibitor type of NSAID. Celecoxib was the first in this drug category when COX-2
inhibitor drugs were introduced in 1998 to treat the pain and inflammation of
osteoarthritis. Other drugs in this category—rofecoxib (Vioxx) and valdecoxib (Bextra)—
were taken off the market because of an increased risk of heart attack and stroke. Now,
there is only one COX-2 inhibitor drug: celecoxib (Celebrex).
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 20–6 Ibuprofen (Advil). (a) Over-the-counter ibuprofen is a nonsteroidal
anti-inflammatory drug. Notice that the drug label states that this generic drug has the
same active ingredient (and therefore the same pain-relieving effect) as the familiar, but
more expensive, over-the-counter trade name drug Advil. (b) This drug bottle of Advil
contains gelatin capsules with a liquid drug inside (Liqui-Gels) to provide fast pain relief.
Generic ibuprofen is also available as the over-the-counter trade name drug Motrin IB
(the "IB" stands for "ibuprofen") and the prescription drug Motrin.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
•
•
•
•
•
•
•
Meclofenamate
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Naproxen (Aleve, Naprosyn)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Sulindac (Clinoril)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Naproxen Animation
Click on the screenshot to view an animation showing naproxen.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• NSAIDs are structurally similar enough
to aspirin that patients who are allergic
to aspirin should not take NSAIDs.
• Studies have shown that elderly people
who regularly take an NSAID or aspirin
are 55 percent less likely to develop
Alzheimer disease.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• All nonsteroidal anti-inflammatory
drugs can be given orally as a capsule
or tablet.
• However, only diclofenac can be given
in all of these drug forms and routes of
administration: orally as a tablet
(Cataflam, Voltaren), topically as a gel
(Voltaren Emulgel), or topically as a
transdermal patch (Flector).
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• The nonsteroidal anti-inflammatory
drug diclofenac (Voltaren) is now
available as a topical gel to treat the
pain of osteoarthritis.
• It is the first prescription topical skin
gel approved by the FDA for treating
the pain of osteoarthritis.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• When body tissue is damaged, the fluid
within the cells is released, and the
enzyme cyclooxygenase (COX) converts
this fluid to prostaglandins.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• The prostaglandins then stimulate pain
receptors in the area.
• The greater the amount of tissue
damage, the more prostaglandins that
are produced and the greater the pain
that is felt.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• There are two types of the
cyclooxygenase (COX) enzyme: COX-1
and COX-2.
• The COX-1 enzyme produces
prostaglandins that cause pain, but it is
also active in platelet aggregation, in
regulating blood flow, and in protecting
the mucous membranes of the stomach
from the irritating effect of gastric acid.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• The COX-2 enzyme's only action is to
produce prostaglandins that cause pain.
• Analgesic drugs, such as aspirin and
NSAIDs, inhibit the COX-1 enzyme.
• This blocks the production of the
prostaglandins that cause pain, but it
also disrupts the protective action that
prostaglandins have on the stomach.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• That is why aspirin and NSAIDs can
cause stomach upset and peptic ulcers.
• The COX-2 inhibitor drugs selectively
inhibit only the COX-2 enzyme and so
control pain without any adverse effects
on the stomach.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
• Synthetic prostaglandin drug that is
given to protect the gastric mucosa
when natural prostaglandins are
inhibited by aspirin or NSAIDs.
 Misoprostol (Cytotec)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Nonsteroidal Anti-Inflammatory
Drugs
• Proton pump inhibitor drugs decrease
the amount of acid in the stomach and
are used to treat ulcers caused by
NSAIDs
 Esomeprazole (Nexium)
 Lansoprazole (Prevacid)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Over-the-counter combination drug
containing a salicylate drug (aspirin)
and a stimulant drug (caffeine)
 Anacin
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Over-the-counter combination drugs
containing a salicylate drug and an
antacid drug to minimize stomach
irritation
 Alka-Seltzer with aspirin
• Aspirin, sodium bicarbonate
 Ascriptin
• Aspirin, aluminum, calcium, magnesium
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Over-the-counter combination drugs
containing a salicylate drug and an
antacid drug to minimize stomach
irritation
 Bayer Buffered Aspirin
• Aspirin, aluminum, calcium, magnesium
 Bufferin
• Aspirin, calcium, magnesium
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Over-the-counter drug containing a
salicylate analgesic drug (aspirin), a
nonsalicylate analgesic drug
(acetaminophen), and a stimulant drug
(caffeine)
 Excedrin Extra Strength
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Over-the-counter drug containing a
salicylate analgesic drug (aspirin), a
nonsalicylate analgesic drug
(acetaminophen), a stimulant drug
(caffeine), and two antacid drugs
(aluminum, magnesium)
 Vanquish
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Over-the-counter drug containing a
nonsalicylate analgesic drug
(acetaminophen) and a stimulant drug
(caffeine)
 Excedrin Aspirin Free
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Prescription drugs containing a
salicylate analgesic drug (aspirin) or a
nonsalicylate analgesic drug
(acetaminophen), a stimulant drug
(caffiene), and a barbiturate sedative
drug (butalbital)
 Fioricet
• Acetaminophen, caffeine, butalbital
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Combination Non-Narcotic
Analgesic Drugs
• Prescription drugs containing a
salicylate analgesic drug (aspirin) or a
nonsalicylate analgesic drug
(acetaminophen), a stimulant drug
(caffiene), and a barbiturate sedative
drug (butalbital)
 Fiorinal
• Aspirin, caffeine, butalbital
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• The sound-alike combination drugs
Fioricet and Fiorinol can be easily
confused.
• Fioricet ends in the suffix -cet, which
stands for acetaminophen—a way to
remember which is which.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved