Action:

Bind to opioid receptors in the CNS, Opioids Analgesics Non-opioids

blocking transmission of pain signals
NSAIDS
Typical side effects - Prevention
of clear thought, clouded
Paracetamol
PAIN LADDER Action:
consciousness, nausea, vomiting,
Scaled approach to pain control (mild --> strong) Blocks prostaglandin Typical side effects -
constipation, drowsiness,
production in the Typical side effects - Minimal but rarely Irritation of the GIT,
•Paracetamol +/- adjuvant* respiratory depression
CNS, reducing pain rashes, blood dyscrasias and pancreatitis ulceration/bleeding of
•NSAIDS +/- adjuvant Overdose - coma, respiratory sensation in the the stomach/duodenum
arrest, death Overdose - potentially fatal liver/kidney
brain and reducing
•Combination of the above +/- adjuvant damage
fever
•Combination with opioids +/- adjuvant *Adjuvant e.g. tricyclic
added as needed to  Typical side effects - Possible heart
•Opioids (mild) +/- adjuvant
fear + anxiety ( attacks in those with previous history
COX-2 inhibitors Action:
•Opioids (strong) (PO --> patch --> pump) +/- central sensitisation) Blocks
cyclo-
Class Name Indication Adult dose Route Implications for us
oxygenase
Paracetamol Fever, pain, rheumatic pain 500mg-1g, Q4-6H PO Look out for skin rashes in chronic use (COX)
(Panadol, Disprol) IV Can cause hypotension enzymes
following
NSAIDs Aspirin (Anadin, Mild-moderate pain (headache, toothache, period 300-900mg, Q4-6H PO Screen for GIT issues if chronic use tissue
(non- Dispirin, Alka-Seltzer) pain), fever, cold, flu, rheumatic pain May rarely cause SOB, wheeze, tinnitus, dizziness (medical damage,
selective) Anti-platelet emergency)
75-300mg, QD reducing
prostaglan
Ibuprofen (Nurofen, Rheumatic pain, MSk pain, moderate 600mg-2.4g, up to PO Rare ankle oedema, SOB, wheeze (medical emergency)
din
Cuprofen) inflammatory pain, post-op pain, mild-moderate QID
pain, fever, cold, flu
production
leading to
Diclofenac sodium Rheumatic pain, inflammation and other MSk 75-150mg, TID PO, PR, IV, SOB, wheeze (medical emergency) reduced
(Voltarol) disorders topical pain and
inflammati
COX-2 Celecoxib RA, OA 200-400mg, QD-BID PO Increased risk of CVS events (stroke, MI)
on at the
inhibitors
site of
Opioids Codeine phosphate Mild-moderate pain 120-240mg, QD PO or IV Constipation/decreased gut motility injury
Diarrhoea 30-120mg, QD Rash (medical emergency)
Cough 45-120mg, QD

Fentanyl (Durogesic) Moderate-severe pain, perioperative analgesia, IV, patches Controolled drug list (risk of abuse)
enhances general anaesthetic Fatal overdose if patches chewed
Action:
Morphine sulphate Severe pain, associated stress and anxiety, 5-25mg+ per dose PO, PR, IV Controolled drug list (risk of abuse), tolerance, dependence
(Oramorph, MS perioperative analgesia, enhances general Q4H (Q12-24H slow-
Blocks only COX-2
Contin) anaesthetic, antidiarrhoeal/antimotility release) (involved in the
inflammatory
Compound Paracetamol + Mild-moderate pain 8/500mg PO Constipation cascade) but not
analgesics codeine (Co-codamol) Moderate pain 30/500mg (Px only) COX-1
(gastroprotective),
Paracetamol + Mild-moderate pain 10/500mg PO Constipation
reducing GIT side-
dihydrocodeine (Co-
dydramol) effects

Aspirin + codeine (Co- Mild-moderate pain 8/400mg PO Constipation

codaprin)