Narcotic Analgesics

DEFINITION:

Narcotic analgesics are strong painkillers made from opiates taken from the poppy plant. They work by reducing the amount of pain that is felt by the brain, and some narcotic analgesics can give the user a feeling of powerfulness and fearlessness. The narcotic analgesics vary in potency, but all are effective in treatment of visceral pain when used in adequate doses. Adverse effects are dose related. Because these drugs are all addictive, they are controlled under federal and state laws. Narcotic agents are potent analgesics which are effective for the relief of severe pain. Analgesics are selective central nervous system depressants used to relieve pain. The term analgesic means "without pain". Even in therapeutic doses, narcotic analgesics can cause respiratory depression, nausea, and drowsiness. Long term administration produces tolerance, psychic, and physical dependence called addiction.Narcotic agents may be classified into four categories:

1) Morphine and codeine - natural alkaloids of opium.
2) Synthetic derivatives of morphine such as heroin.
3) Synthetic agents which resemble the morphine structure.
4) Narcotic antagonists which are used as antidotes for overdoses of narcotic analgesics.

The main pharmacological action of analgesics is on the cerebrum and medulla of the central nervous system. Another effect is on the smooth muscle and glandular secretions of the respiratory and gastro-intestinal tract. The precise mechanism of action is unknown although the narcotics appear to interact with specific receptor sites to interfere with pain impulses.

INDICATIONS:

Used in cases of severe pain like in diseases such as
  • Cancer (Breast Cancer)
    Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way. Breast cancer is the most common cancer in women, but it can also appear in men. In the U.S., it affects one in eight women.
  • AIDS (Acquired Immune Deficiency Syndrome)
    is a disease that recognizes no territorial, social, political and economic boundaries for which there is no known cure.
    an epidemic, transmissible retroviral disease caused by infection with the human immunodeficiency virus, manifested in severe cases as profound depression of cell-mediated immunity, and affecting certain recognized risk groups

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DRUGS:
1.) GN: Oxycodone

Side effect:


  • Serious adverse reactions that may be associated with Oxycodone hydrochloride tablets therapy in clinical use are those observed with other opioid analgesics and include: respiratory depression, respiratory arrest, circulatory depression, cardiac arrest, hypotension, and/or shock

Available Dosage Forms:
  • immediate-release tablet
  • capsule


Contraindication:
  • Oxycodone hydrochloride tablets are contraindicated in patients with known hypersensitivity to Oxycodone, or in any situation where opioids are contraindicated. This includes patients with significant respiratory depression (in unmonitored settings or the absence of resuscitative equipment) and patients with acute or severe bronchial asthma or hypercarbia. Oxycodone hydrochloride tablets are contraindicated in any patient who has or is suspected of having paralytic ileus.
Pregnancy Category:
  • Teratogenic Effects. Category B

a. BN: Percocet Specific Class:
b. BN:OxyIR
c. BN:Roxicodone


2.) GN: Morphine Sulfate

a. BN: MST CONTINUS
  • SE: bronchospasm, asthenia, headache, abdominal pain, nausea and vomitting
  • DF: modified-release tablet
  • CI: respiratory depression, obstructive airways disease, liver dysfunction, paralytic ileus, morphine sensitivity, preganancy, nursing period pediatric use.
  • Pregnancy category: C;D if prolonged use/high dose at term

b. BN: M-DOLOR
  • SE: nausea and xerostomia, anorexia and dysgensia, increased blood pressure and heart rate, mood swings, hypersensitivity reactions
  • DF: controlled- release tablet
  • CI: existing intestinal obstruction(ileus) and pregnancy and lactation
  • Pregnancy category: C;D if prolonged use/high dose at term

c. BN: RELIMAL
  • SE: nausea and vomitting, hypotension, gastrointestinal spasm, mood changes, decreased appettite
  • DF: controlled- release tablet
  • CI: asthma, shallow breathing, brain damage, epilepsy, chronic alcohol abuse, recent bile duct surgery,
  • Pregnancy category: C;D if prolonged use/high dose at term

3.) GN: Codeine

Side Effects:
  • shallow breathing, slow heartbeat;
  • feeling light-headed, fainting;
  • confusion, agitation, hallucinations, unusual thoughts or behavior;
  • seizure (convulsions); or
  • problems with urination.

Available DF:
  • tablet

Contraindication:
  • Do not drink alcohol while you are taking codeine.
  • allergic reaction to a narcotic medicine
  • having an asthma attack or if you have a bowel obstruction called paralytic ileus.
Pregnancy Category:
  • C;D if prolonged use/high dose at term

4.) METHADONE
Side Effect:
  • shallow breathing;
>hallucinations or confusion; or
>chest pain, dizziness, fainting, fast or pounding heartbeat; or
>trouble breathing, feeling light-headed, or fainting.
>feeling anxious, nervous, or restless;
>sleep problems (insomnia);jhgfk



Pregnancy Category: C;D if prolonged use/high dose at term

Brand names

a.)Diskets,
b.)Dolophine
c.)Methadose


Available Dosage Form:


Contraindication:

>allergic reaction to a narcotic medicine
>having an asthma attack or if you have a bowel obstruction called paralytic ileus.
>liver or kidney disease;
>epilepsy or other seizure disorder;



Pregnancy Category: C;D if prolonged use/high dose at term

Brand names

a.)Diskets,
b.)Dolophine
c.)Methadose


5.) OXYCONTIN

Side Effect:
>Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; difficulty urinating; fast, slow, or irregular heartbeat; seizures; severe dizziness, lightheadedness, or fainting; slowed or difficult breathing; tremor; vision changes.

Available Dosage Form:
>sustained release tablet


Contraindication:
>you have severely slow or difficult breathing or severe asthma, or you are having an asthma attack
>you have severe bowel motility problems (eg, paralytic ileus) or severe diarrhea associated with antibiotic use (pseudomembranous colitis)
>if you are pregnant, planning to become pregnant, or are breast-feeding
  • heart problems, low blood pressure, liver or kidney problems, underactive thyroid, adrenal gland problems (eg, Addison disease), stomach or bowel problems, gallbladder problems, inflammation of the pancreas,

Pregnancy Category: C;D if prolonged use/high dose at term



Brand names

a.)ETH-Oxydose,
b.)Oxyfast,
c.)Percolone


6.) DARVOCET

Side Effect:


  • shallow breathing, slow heartbeat;
  • feeling light-headed, fainting;
  • confusion, unusual thoughts or behavior;
  • seizure (convulsions); or
  • nausea, stomach pain, loss of appetite, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Available Dosage Form: Tablet

Contraindication:
>asthma, COPD, sleep apnea, or other breathing disorders;
>liver or kidney disease;
>a history of head injury or brain tumor;
>low blood pressure;
>a stomach or intestinal disorder;
>curvature of the spine;
>mental illness; or

Pregnancy Category: C;D if prolonged use/high dose at term


Brand names
a.)Balacet,
b.)Darvocet A500
c.)Propacet 100

7.) MEPERIDINE

Side Effect:
  • shallow breathing, slow heartbeat;
  • seizure (convulsions);
  • cold, clammy skin;
  • confusion;
  • severe weakness or dizziness; or
  • feeling light-headed, fainting.
  • constipation;
  • nausea, vomiting, loss of appetite;
  • dizziness, headache;

Available Dosage Form: Tablet

Contraindication:
  • asthma, COPD, sleep apnea, or other breathing disorders;
  • liver or kidney disease;
  • underactive thyroid;
  • curvature of the spine;
  • a history of head injury or brain tumor;
  • epilepsy or other seizure disorder;
  • low blood pressure;
  • gallbladder disease;
  • Addison's disease or other adrenal gland disorders;
  • enlarged prostate, urination problems;
  • mental illness; or
  • a history of drug or alcohol addiction.

Pregnancy Category: C;D if prolonged use/high dose at term

Brand names:

a.) Demerol HCl
b.)
c.)

8.) FENTANYL
Side Effect:
Available Dosage Form: Tablet
Contraindication:
  • a breathing disorder such as chronic obstructive pulmonary disease (COPD);
  • a history of head injury or brain tumor;
  • a heart rhythm disorder;
  • seizures or epilepsy;
  • mental illness such as depression, hallucinations;
  • low blood pressure;
  • liver disease;
  • kidney disease; or
  • a history of drug or alcohol addiction.

Pregnancy Category: C;D if prolonged use/high dose at term

Brand names:

a.) Fentora,
b.) Onsolis
c.)

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