ological adjustment of the body to the drug; therefore, if the drug is withdrawn, specific withdrawal symptoms may develop). The patient may become addicted to opioids, which may lead to drug
abuse [20] . Table 2 contains frequently used opioids in managing pain.
Table 2: Commonly Used Opioids Drug Dosage
Indications
Side Effects
Morphine Sulfate (Morphine, MSIR, Kadian, Roxanol, MSContin, Avinza)
• Rash. • Palpitation. • Bradycardia.
30 mg orally.
• Moderate to severe pain. • Postsurgical pain.
• Nausea & vomiting. • Constipation. • Lightheadedness. • Drowsiness.
• Postural hypotension. • Respiratory distress. • Renal impairments. • Hepatic impairments.
• Dizziness. • Sweating. • Dry mouth.
Oxycodone (Oxycontin, OxyIR)
20 mg to 30 mg orally.
• Moderate to severe pain. • Postsurgical pain (pain in people with renal impairments).
• Nausea & vomiting. • Constipation. • Diarrhea. • Dry mouth. • Sedation. • Nausea & vomiting. • Constipation. • Diarrhea. • Dry mouth. • Respiratory depression. • Drowsiness. • Muscle rigidity. • Hypotension.
• Abdominal pain. • Anorexia. • Dyspepsia. • Dizziness.
Methadone
• Bradycardia/tachycardia. • Palpitation. • Edema. • Postural hypotension. • Hallucinations. • Vertigo. • Confusion. • Urinary retention. • Sweating. • Mild allergic rash, itching, or hives. • Decreased heart rate. • Stomachache. • Nausea & vomiting. • Difficulty in urination.
Dosage varies.
• Moderate to severe pain. • Postsurgical pain.
Codeine
• Dizziness. • Lethargy. • Difficulty in
200 mg orally.
• Mild to moderate pain. • Severe pain (when combined with aspirin or acetaminophen). • Dry, irritating cough. • Diarrhea. • Cold and flu (combined with antihistamines & decongestants).
concentrating. • Restlessness. • Blurred vision. • Dry mouth. • Limbs feeling heavy or muscle stiffness.
Adjuvant drugs Adjuvants are the pharmacological substances, or immunologi- cal agents, which alter the effect of a drug. Antidepressants, an- ticonvulsants, local anesthetics, and corticosteroids are the most
common adjuvants used in pain management. When adjuvants are combined with opioids they provide the maximum effect. The frequently used adjuvant drugs are mentioned in Table 3 [20][21] .
Table 3: Common Adjuvant Drugs Drug Indications
Contraindications
Side effects
Dose
Tricyclic Antidepressants
Amitriptyline (Elavil) • Depression. • Neuropathic pain. • Insomnia.
• People with heart disease. • Emotionally unstable people.
• Constipation. • Dry mouth. • Blurred vision.
• Cognitive changes. • Tachycardia. • Urinary retention.
10 mg to 25 mg daily.
• People who
• Dry mouth. • Sedation. • Constipation. • Increased appetite.
• Mild blurred vision. • Tinnitus. • Euphoria. • Mania.
10 mg to 100 mg daily.
Nortriptyline (Pamelor, Aventyl)
• Major
undergo acute recovery stage after myocardial infarction.
depression. • Childhood bedwetting. • Chronic fatigue syndrome. • Chronic pain. • Neuralgia. • Depression. • Neuropathic pain. • Attention deficit hyperactivity disorder. • Substance- related disorder.
10 mg to 150 mg daily.
• Difficulty urinating. • Frequent urination. • Blurred vision. • Changes in sex drive or ability. • Excessive sweating.
• People who
• Nausea. • Weakness/tiredness. • Dry mouth. • Skin more sensitive to sunlight than usual. • Changes in appetite or weight. • Constipation.
Desipramine (Norpramin)
undergo acute recovery stage after myocardial infarction.
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