March 28, 2023

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Today i want to talk about the pain medications next few weeks i would like to talk about pain medications because pain is universal as you live in this world you will encounter pain in some form or the other a joint pain or a headache or some kind of billy pain or any organ in our body can cause pain so it’s important to know the basic medications about pain i would

Like to start with a stamina fen commonly known as paracetamol our acetaminophen and it is the most commonly administered ward the counter worrell analysis in the world but you see the mystery is even though it is the most commonly used analysis in the entire world the analysis mechanism of estimate often still is uncertain we have non-steroidal anti-inflammatory

Drugs let me say and as a ideas and zetz for the sake of liberty so in contrast to the nz h the monofin are paracetamol is not anti-inflammatory h stamina finish commonly combined with opioid medications to reduce the amount of whoopie i needed but such combination products may be difficult to titrate so we have hydrocodone with tylenol we have oxycodone with

Tylenol we have these combinations but you remember if you do not watch how much you are taking them you might end up with tylenol war dosing that’s why recently the amount of tylenol is set at 325 milligrams so even if take 10 vicodin tablets you’re still getting less than 3.5 grams of tylenol the estimate of him power does you all see you should always remember

That because people can lower those with a stamina film and can have severe hepatotoxicity you see what is the most common cause of acute liver failure in the world it is coming from acetaminophen our paracetamol so this concern with hepatotoxicity is important to remember especially people who drink alcohol but people who have never disease they should be careful

With how much tylenol they are taking a day and they should remember the dose how much they’re taking if you do a blood test you will see the hepatic a minor transferase concentration going up but just because their liver enzymes go up that doesn’t mean they’re going into acute liver failure so a constant watch is needed when they are taking a stamina friend

For long terms now what is the maximum safe dose the safety of long term hasta maana film is set at 4 grams per day but many people are questioning that they have da less the maximum dose of s time an event to be like 4 grams per day but many manufacturers are reducing that to tooth to 3 to 3.5 grams so i would personally say stay under 3 grams significant level

Disease or heavy alcohol those also should be considered if the patient has never desist then you need to be more careful with how much stamina film they are taking there are other adverse effects like chronic kidney disease hypertension and peptic ulcer disease so now let me talk about non-steroidal anti-inflammatory drugs and zets they are indicated for mild

Pain moderate pain particularly somatic origin and there are many different combinations they are commonly used for soft tissue injuries like after sports injuries strains sprains headaches arthritis i take ibuprofen almost every week whenever i have i have a headache or joint pain or back pain so these and sets they can be used with opioids to exert synergy

And the analysis of anzhi’s that derives from the peripheral action on the enzyme cyclooxygenase so cyclooxygenase it plays a central role in inflammatory conditions and it’s as well as on the central nervous system and all the pain states so you use an jets to block these enzymes that cause pain and they were definitely more effective than placebos so answers

Even though they are a blessing to combat pain unfortunately they come with lot of side effects we need to remember the side effects very careful because some of them are very very serious so if possible use as little as possible or even a topical ends up like diclofenac use diclofenac cream just for that area so some of these are selective they’re called borel

Cyclooxygenase two inhibitors cox-2 inhibitors so some of them are selective some of them are non selective so when you use them for example at a state celecoxib for patients with chronic and z treatments who are at risk for gas property celecoxib is a good medication so let me talk about these side effects of these medications now there are many and zets and you

Can always change one from the other if your patient says i cannot tolerate this you can change it to a different medication and you can improve the complaints by switching from one medication to the other medication or by changing the frequency liking to try to make it once a day it is easy to take once a day then three times a day and the main adverse effects of

An zetz they inhibit platelets in other words they promote bleeding they can also gastro intestinal injury they can cause heart problems that’s important to remember so if a patient comes with heart disease you need to be careful so the regular and said use should be avoided and if a patient is taking low-dose aspirin for cardiovascular protection you need to be

More careful because most anze’s interfere with platelet aggregation but there are some exceptions like choline magnesium price isolate and selective cox-2 inhibitors despite is short half-life aspirin irreversibly inhibits platelet aggregation for the lifetime of the platelets they inhibitory effect of other and zets lasts about two days and certs produce adverse

Gastrointestinal side effects like dyspepsia gastric ulceration patients who are deemed at high risk for peptic ulcer or it’s complications so if a patient says i have peptic ulcer you need to be careful because this answers whether it is a meloxicam or nap in our ibuprofen it can cause bleeding in these patients and with if you are using with prednisone the risk

Only increases so give it food or antacids to decrease the dyspepsia that come from these medications so some doctors actually prescribe proton pump inhibitors i went to a clinic and i was told by the nurse that the doctor every time he gives an nz he always prescribes a proton pump inhibitor and i thought let’s a good practice nephrotoxicity is our other problem

And nephrotoxicity can cause reversible renal insufficiency due to renal vasoconstriction acute interstitial nephritis and also a predisposition to acute tubular necrosis in patients with low renal perfusion so answers can lead to fluid retention and they can cause hypertension so you see all these side-effects coming from this unzips in patients with cardiovascular

Disease and zips interfere with cardio protective effect of aspirin and they potentially exacerbate heart failure they raise blood pressure and yet they also can cause pro trom bartek effects that’s why it’s a relative contraindication in patients with blood clots so if a patient is having high risk for blood clots be careful in prescribing anzacs so use as little

As possible and as short as possible those are the two important things to remember use that like for example we all get pain so i got pain what should i do so use as little as possible for as short time as possible those are the key truths when we use any medication especially tylenol and exits and those are the points i wanted to share with you in the coming

Weeks i will be talking about more pain medications and feel free to follow up in our block thank you so much you

Transcribed from video
Pain Medications: Acetaminophen and NSAIDS By USMLEVideoLectures