Narcotics pain relievers

Pain Does not interfere with activity Repeated use of nonnarcotic pain reliever >24 h or interferes with activity Any use of narcotic pain reliever or prevents daily activity Emergency room (ER) visit or hospitalization... 

Many commonly used medications also contain substances that are eliminated by the MAOIs and must not be taken by these patients. The list of medications to be avoided inclndes the narcotic pain reliever meperidine (Demerol), and many over-the-connter cold remedies containing dextromethorphan or pseudoephedrine. Finally, patients taking MAOIs must also avoid medications that elevate serotonin levels. This inclndes certain appetite snppressants and antidepressants including the SSRIs, venlafaxine, duloxetine, mirtazapine, nefazodone, and trazodone. Medications that interact with the MAOIs cannot be taken until at least 2 weeks after the MAOI has been stopped. 

Delta-9-tetrahydrocannabinol (THC), the main active ingredient in marijuana, reduces the amount of time spent in REM sleep, although tolerance to this effect can develop over time and the overall amount of time spent in REM sleep returns to normal levels. However, like people who constantly drink alcohol or take narcotic pain relievers, people who smoke marijuana daily can experience REM rebound after stopping the drug. 

The increase in concern seems to reflect a true increase in incidence. The numbers of new nonmedical users of the four major classes of prescription-type drugs (narcotic pain relievers, tranquilizers, stimulants, and sedatives) increased between 1991 and 2001.4 There were substantially more new users for narcotic pain relievers than for the other three drug categories — an increase from 628,000 initiates in 1990 to 2.4 million in 2001.5 This increase in new users was accompanied by a 76% increase between 1997 and 2000 in the number of primary treatment admissions for narcotic-analgesic abuse.6 Initiation of nonmedical tranquilizer use also increased steadily during the 1990s, from 373,000 initiates in 1990 to 1.1 million in 2001.5... 

The biological consequences of molecular shape can be dramatic. Look at the structures of dextromethorphan and levomethorphan, for instance. (The Latin prefixes dextro- and levo- mean "right" and "left," respectively.) Dextromethorphan is a common cough suppressant found in many over-the-counter cold medicines, but its mirror-image, levomethorphan, is a powerful narcotic pain-reliever similar in its effects to morphine. The two substances are chemically identical except for their shapes, yet their biological properties are completely different. 

The majority of people who use narcotic pain relievers do so safely and appropriately without becoming addicted. Despite widely held assumptions that increased prescribing of these drugs will lead to increased abuse, recent studies suggest this is not the case. 

Acetaminophen can interact with other drugs, both in good and bad ways. For example, hospitals often combine acetaminophen with the narcotic pain reliever codeine (CoTylenol ) to treat more severe pain. Caffeine can increase the effectiveness of acetaminophen similarly to the way it does with aspirin. Brand names that use a combination of aspirin, caffeine, and acetaminophen include Excedrin and Vanquish . Combining these ingredients for their additive effects also reduces the dose needed for each one and thereby reduces the risk of side effects. However, there are a few drugs that should not be mixed with acetaminophen. These include anticonvulsants and alcohol, both of which increase the risk of liver damage. 

Understanding the neurochemistry of these compounds has led to the synthesis and availability of several useful drugs. Fentanyl is a common narcotic pain reliever used in surgical procedures, and sumatriptan (trade name Imitrex) is used to relieve pain and light sensitivity in patients who suffer from migraine headaches. 

Incidence and prevalence of opiate nse are widely variable depending on the drug. In 2002, there were 166,000 current heroin users. Collectively, use of opiates other than heroin is far more common. An estimated 4.4 million people used narcotic pain relievers and 1.9 million persons ages 12 or older used what SAMHSA classified as OxyContin nonmedically at least once in their fifetime." ... 

Codeine (C18H21NO3) is a narcotic pain reliever that forms a salt with HCl. What is the pH of 0.050 M codeine hydrochloride (pA"b of codeine = 5.80) ... 

Naloxone should be administered with great caution and only when necessary in patients receiving a narcotic for severe pain. Naloxone removes all of the pain-relieving effects of the narcotic and may lead to withdrawal symptoms or the return of pain. 

When a patient does not have a painful terminal illness, drug dependence must be avoided. Signs of drug dependence include occurrence of withdrawal symptoms (acute abstinence syndrome) when tiie narcotic is discontinued, requests for tiie narcotic at frequent intervals around tiie clock, personality changes if the narcotic is not given immediately, and constant complaints of pain and failure of tiie narcotic to relieve pain. Although these behaviors can have other causes, the nurse should consider drug dependence and discuss the problem with tiie primary health care provider. Specific symptoms of tiie abstinence syndrome are listed in Display 19-3. 

Tramadol is a pain reliever (analgesic). Its action is similar to opioid narcotics such as codeine and morphine, but it does not depress breathing the way the others can, and less often leads to abuse and addiction. 

Methadone, a synthetic opioid narcotic, is discovered in Germany. Originally named Amidon, methadone was used mainly as a pain reliever. 

Hydromorphone is a semi-synthetic prescription drug that has similar pain-relieving properties to that of morphine and codeine. It is classified as an opioid or narcotic analgesic. It is an effective treatment for moderate-to-severe pain and is sometimes used in patients with a non-productive cough. It is used to treat several types of pain, including headache, cancer pain, and back pain. 

Methadone is a synthetic opioid narcotic, discovered in Germany in 1939. Its original name was Ami-don, and it was used mainly as a pain reliever. After the conclusion of World War II, Eli Lilly and other American pharmaceutical companies began clinical trials of the medication, renamed methadone, and also began commercial production. Its original uses in the United States were for pain control and as a component of cough medicine. 

Codeine is a potent pain reliever. It acts on the pain centre in the brain, rather than interrupting pain messages from, for example, a headache or a sore arm. It is potentially habit-forming and classified as a narcotic. 

Codeine (methylmorphine) is another natural constituent of opium. More active by mouth than other narcotics, it is a weaker pain reliever than morphine, and doctors freciuently prescribe it today to treat for moderate pain. 

Biologically active derivatives of 2-phenylethylamine—adrenaline, noradrenaline, methamphetamine, mescaline, dopamine, fentanyl (a synthetic narcotic), and sumatriptan (Imitrex, a synthetic pain reliever) (Section 25.6C)... 

For all the dmg wholesalers and fledgling manufacturing concerns, the bulk of pharmacy care took place in either the physician s office or, in more cosmopolitan settings, the apothecary shop. Even by the beginning of the twentieth century, the majority of physicians stiU dispensed their own medicines. 28 They prescribed and compounded a wide variety of vegetable, mineral, and animal substances, but a review of the 1860 United States Pharmacopoeia (USP) indicates that 587 (or 67 percent) of the total number of 871 medicinal substances listed therein were botanical.29 Some of the more popular were cinchona, sometimes referred to as Pemvian bark, and its refined counterpart, sulfate of quinine, both used as antiperiodics O opium from Papaver somniferum, the powerful narcotic and anodyne (i.e., pain reliever) of choice for many physicians of the day, as well... 

Narcotic A central nervous system depressant that contains sedative and pain-relieving properties (Chapter 2). 

Narcotic analgesics (narcotic agonists) such as opioids act on the central nervous system to treat moderate and severe pain, suppress respiration and coughing by acting on the respiratory and cough centers in the medulla of the brain stem. All narcotic analgesics relieve pain. All except meperidine (Demerol) are also antitussive (cough suppression) and antidiarrheal. 

The narcotic and pain relieving properties of opium have been known for several millennia and records of its use can be foimd in ancient Egyptian and Greek writings. Opium was also widely employed by early Greek and Roman physicians and there are extensive written records of its use, also its addictive properties. The products of the poppy were widely known as a useful medicine. 

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