Narcotic analgesics, drug reaction

Discuss the uses, general drug action, general adverse reactions, contraindications, precautions, and interactions of the narcotic analgesics. 

A narcotic is a substance that produces insensibility, or a stuporous state. The most notable characteristics of narcotics are their ability to decrease the perception of pain and alter the reaction to pain, and their extremely addictive properties. Narcotics often induce a state of euphoria or extreme well being. The word narcotic is derived from the Greek word narke (meaning stupor), and traditionally applies to drugs known as opiates. Recently, the word narcotic has been adopted to include non-opiate, addictive drugs such as cocaine and cannabis. Narcotics are primarily used in medicine as pain killers and are often called narcotic analgesics. 

Asthmatic attacks due to non-narcotic analgesics, mostly occur in patients with so-called intrinsic or idiosyncratic asthma (often associated with nasal polyposis, sinusitis and eosinophilia of the blood) (McFadden and Austen 1977). About 10% of patients with this kind of asthma show severe reactions to aspirin, methyl-salicylate, pyrazolone derivatives, indomethacin, ibuprofen, diclofenac and sometimes even phenacetin and paracetamol. (Sodium salicylate is often tolerated.) The special reactivity may appear only in later life and concerns a number of chemically unrelated drugs. In some of these patients analgesic therapy with a morphine derivative such as pentazocine (Fortalgesic) or hyoscine butylbromide (Buscopan) may be necessary. However, in other patients, those with aspirin urticaria rather than asthma, the reaction may also rely on a drug-specific allergic mechanism (de Weck 1971). 

The combination of MAOIs with meperidine, and perhaps with other phenylpiperidine analgesics, also has been implicated in fatal reactions attributed to the serotonin syndrome. Aspirin, nonsteroidal anti-inflammatory drugs, and acetaminophen should be used for mild to moderate pain. Of the narcotic agents, codeine and morphine are safe in combination with MAOIs, although doses may need to be lower than usual. 

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