1. Pharmacotherapy: opioids, NSAIDs, adjuvants, and

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

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Tufts OpenCourseWare

© 2007 Tufts University

Pharmacotherapy

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

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Pharmacotherapy of Pain

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

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Tufts OpenCourseWare

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Pharmacotherapy

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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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Pharmacotherapy

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Severity: WHO analgesic ladder

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Pain Source

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

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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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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

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Positioning Opioid Therapy

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Opioids: Mode of action

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

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Pharmacotherapy

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Guidelines for Management of Opioid Therapy

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Opioid Agents

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

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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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Pharmacotherapy

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When to consider alternatives to morphine?

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When to consider alternatives to morphine?

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

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Pharmacotherapy

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When to consider alternatives to morphine?

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When to consider alternatives to morphine?

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

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Pharmacotherapy

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When to consider alternatives to morphine?

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Transdermal Fentanyl

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

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Pharmacotherapy

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Mixed Agonist-Antagonists/Partial agonists

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Antagonists

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

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Pharmacotherapy

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Naloxone

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Medication Schedules

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

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Pharmacotherapy

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Opioid Selection: Poor Choices for Chronic Pain

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Opioid-drug interactions

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

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Pharmacotherapy

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Routes of Administration

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Opioid Therapy: Dosing Guidelines

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

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Pharmacotherapy

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Opioid Therapy: Dosing Guidelines

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Poor Opioid Responsiveness

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

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Pharmacotherapy

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Opioid Rotation

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How does this look?

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

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Pharmacotherapy

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Equianalgesic Conversion

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Tolerance

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

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Pharmacotherapy

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Incomplete cross-tolerance

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Equianalgesic conversion

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

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Pharmacotherapy

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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)

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Pharmacotherapy

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Equianalgesic conversion example

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Equianalgesic conversion example

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

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Pharmacotherapy

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Equianalgesic conversion example

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Equianalgesic conversion example

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

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Pharmacotherapy

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Equianalgesic conversion example

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Equianalgesic conversion example

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

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Pharmacotherapy

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Nonopioid Analgesics

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NSAIDs: Properties

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

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Pharmacotherapy

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Non-opioid analgesics

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Non-opioid analgesics: WHO ladder

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

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Pharmacotherapy

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Positioning NSAID Therapy

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Guidelines for Management of NSAID Therapy

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

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Pharmacotherapy

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NSAID with or without opioid?

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NSAID with or without opioid?

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

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Pharmacotherapy

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NSAIDs - Adverse effects

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NSAIDs: drug interactions

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

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Pharmacotherapy

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Which NSAID to choose?

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Which NSAID not to choose?

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

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Pharmacotherapy

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NSAIDs: available agents

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NSAID Recommendations

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

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Pharmacotherapy

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Coxibs - place in therapy

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Adjuvant Analgesics

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

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Pharmacotherapy

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Adjuvant Analgesics

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Adjuvant Analgesics - place in therapy

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

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Pharmacotherapy

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Adjuvant Analgesics

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Risk factors for herpes zoster

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

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Pharmacotherapy

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Pharmacotherapy: Slide 69

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Anticonvulsants

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

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Pharmacotherapy

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Gabapentin/Pregabalin

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Gabapentin

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

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Pharmacotherapy

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Pregabalin

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Pregabalin

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

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Pharmacotherapy

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Pregabalin in neuropathic pain

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Antidepressants

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

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Pharmacotherapy

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Antidepressants

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Local anesthetics and oral analogues

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

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Pharmacotherapy

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Steroids

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Alpha-2 adrenergic agonists

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

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Pharmacotherapy

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NMDA-receptor antagonists

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Topical Analgesics/Anesthetics

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

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Pharmacotherapy

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“Muscle relaxants”

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Miscellaneous drugs

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

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Pharmacotherapy

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Adjuvant Analgesics for Cancer Pain

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First-line medications for neuropathic pain

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

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Pharmacotherapy

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Add the following?

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Treatment Options

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

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Pharmacotherapy

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Summary

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Summary

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

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Pharmacotherapy

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NSAIDs: Summary

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Summary

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

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Pharmacotherapy

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

Pharmacotherapy: Slide 93

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