Table 1: Indications and Side Effects in Commonly Used NSAIDs Drug Dosage Indications
Side Effects
Naproxen (Aleve, Naprosyn)
250–275 mg. (every 6-8 hours).
• Mild pain. • Fever. • Swollen, red & tender tissues. • Stiff joints.
• Breathing difficulties. • Confusion. • Constipation. • Sleeping difficulties. • Dizziness. • Drowsiness. • Headaches. • Kidney problems. • Liver problems. • Sweating. • Hypertension. • Nausea & vomiting. • Diarrhea. • Headaches • Dizziness. • Indigestion. • Nausea & vomiting.
• Diarrhea or
constipation. • Bladder irritation & pain. • Insomnia. • Anemia. • Peptic ulcers. • Kidney/liver impairments. • Depression. • Anxiety & paranoia. • Loss of appetite. • Skin problems. • Stomach pain. • Vertigo. • Skin allergies.
Diclofenac (oral). (Voltaren - 1% topical; Pennsaid - 1.5% topical)
50 mg (orally- 2-3 times a day); 32 g/d topical.
• Mild pain. • Fever. • Swollen, red & tender tissues. • Stiff joints.
Drugs used to treat moderate and severe pain Opioids are mostly used to treat moderate to severe pain. They can be combined with adjuvants, drugs that address the symptoms, and enhance the analgesic effect for specific conditions. Opioids Mild opioids are used to treat moderate pain, whereas strong opioids are used for severe pain. Opioids act centrally on the pain-sensitive areas in the brain and decrease the intensity of signals brought by the afferent pathway of pain.
Opioids do not have ceiling effects; therefore, if the dose is increased, the analgesic effect is also increased accordingly. The long-term dispensation of opioids may lead to tolerance (the body being capable of bearing the effects of a drug, so that it is less responsive to the drug) and physical dependence (physiological adjustment of the body to the drug; therefore, if the drug is withdrawn, specific withdrawal symptoms may develop).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)
30 mg orally.
• Moderate to severe pain. • Postsurgical pain.
• Nausea & vomiting. • Constipation. • Lightheadedness. • Drowsiness.
• Rash. • Palpitation. • Bradycardia.
• 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
Dosage varies.
• Moderate to severe pain. • Postsurgical pain.
• 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.
Codeine
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).
• Dizziness. • Lethargy. • Difficulty in
concentrating. • Restlessness. • Blurred vision. • Dry mouth. • Limbs feeling heavy or muscle stiffness.
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