Analgesics choice

Pain the phenomenon of pain clinical evaluation of analgesics choice of analgesics treatment of pain syndromes spasm of smooth and striated muscle neuralgias migraine... 

Recommend an appropriate choice of analgesic, dose, and monitoring plan for a patient based on type and severity of pain and other patient-specific parameters. 

Base the initial choice of analgesic on the severity and type of pain, as well as on the patient s medical condition and concurrent medications. 

Pain episodes usually can be managed at home. Hospitalized patients usually require parenteral analgesics. Analgesic options include opioids, nonsteroidal anti-inflammatory agents, and acetaminophen. The patient characteristics and severity of the crisis should determine the choice of agent and regimen. 

Choice of initial analgesic should be based on previous pain crisis pattern, history of response, current status, and other medical conditions... 

There are some additional choices in patients with refractory arthritis despite the use of NSAIDs or paracetamol (acetaminophen), alone or in combination. Narcotics can be used with little risk of addiction, but with the caveat that they can cause cognitive changes, constipation, urine retention and respiratory depression (see section on analgesics). Codeine... 

Drug treatment is one of the most important principles in the management of pain. The WHO has described in its pain relief ladder a practical approach to the choice of analgesics in symptomatic treatment of cancer pain. The ladder is based on a pharmacological approach rather than based on the physiology of pain. 

Paracetamol is an effective analgesic without obvious clinical anti-inflammatory effect. It has low toxicity if it is used appropriately. Paracetamol is a first choice treatment for mild to moderate pain and can... 

Remains the strong analgesic of choice for acute, severe pain, acute Ml pain, and the agent of choice for chronic cancer pain... 

Analgesics, such as aspirin or acetaminophen, and furosemide, a loop diuretic, are better choices because they apparently do not interfere with lithium s reabsorption. 

Quinine Quinine, molecular formula C20H24N2O2, is a white crystalline quinoline alkaloid, isolated from Cinchona hark Cinchona succirubra), and is well known as an antimalarial drug. Quinine is extremely bitter, and also possesses antipyretic, analgesic and anti-inflammatory properties. While quinine is stiU the drug of choice for the treatment of Falciparum malaria, it can be also used to treat nocturnal leg cramps and arthritis. Quinine is an extremely basic compound, and is available in its salt forms, e.g. sulphate, hydrochloride and gluconate. 

Morphine is the gold standard opioid against which all others are compared (McQuay, 1999) and it is the analgesic of choice for terminal pain. 

While opioid peptides have been very useful for investigating the pharmacology of different opioid receptor subtypes, pharmacological investigations have established that no pharmacodynamic advantage is to be expected from opioid peptides with respect to analgesic activity or side-effects. Furthermore, they have their own shortcomings with respect to potential clinical applications. Most importantly their peptidic structure usually prohibits administration by the oral or transdermal route, which are the routes of choice for pain treatment. 

Opioids are compounds that bind one or more of the many different opioid receptors in the body. Opioids act primarily on the central nervous system. The selectivity of a given opioid for the various opioid receptors determines its characteristic activity. While many opioids are powerful analgesics, opioids often cause physical dependence and have tolerance issues. Sedation and decreased rate of breathing are also side effects associated with opioids. Despite their problems, opioids are generally the drug of choice for treating severe, acute pain. 

Pyrazolone derivatives, specifically phenylbutazone [50-33-9] and, for limited conditions, dipyrone [5907-38-0], are very popular with equine practitioners and are particularly useful in managing cases of lameness and controlling inflammation after trauma or suigery (4). Dipyrone is an analgesic for cases of equine colic. Phenylbutazone is an effective antiinflammatory dmg, but is more toxic than the salicylates, which limits its long-term use. For short-term usage, its ease of administration as injectable or oral preparations makes it a popular product for the equine or small-animal specialist. However, ketoprofen [22071 -15-4] is a new dmg of choice. 

Correct choice = A. Methadone shows an analgesic action similar to that of morphine. Methadone is effective for 15 to 20 hr, whereas morphine acts for 4 to 6 hr. A major advantage of using methadone in the controlled withdrawal of heroin and morphine abusers is that it can be given orally. 

Correct choice = D. Acetaminophen does not antagonize the uricosuric agent probenecid and therefore may be used in patients with gout. Acetaminophen has little anti-inflammatory effect, but has analgesic and antipyretic activities equal to those of aspirin. It is the analgesic-antipyretic of choice for children with viral infections aspirin can increase the risk for Reye s syndrome in children. Acetaminophen is a suitable substitute for the analgesic and antipyretic effects of aspirin in those patients with gastric complaints. 

Yes. Although stimulant laxatives are often considered to be second line, it has been said that laxative choice is best based on symptoms, patients preference, adverse effects and cost. In the case of Mr A the stimulant laxatives have the advantage of being fairly quick acting, and are often useful to counteract the effects of decreased bowel motility caused by opioid analgesics. They are also useful for occasional use. 

Paracetamol is considered to be first-line treatment for osteoarthritis. It should be taken regularly. Paracetamol is the initial drug of choice because there is only a small inflammatory component to osteoarthritis and paracetamol is usually effective in the early stages of the disease. Compound analgesics like co-codamol may be used although their benefit over paracetamol alone is small and the opioid component may lead to unwanted side-effects. 

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