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Pain Medications and Muscle Relaxers

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Peripheral inhibition of prostaglandin synthesis = analgesic effect ... Mechanism is not well understood; overall effect is sedation. All are general CNS depressant ... – PowerPoint PPT presentation

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Title: Pain Medications and Muscle Relaxers


1
Pain Medications and Muscle Relaxers
  • ESAT 4001
  • Pharmacology in Athletic Training

2
Pain and Analgesics
  • Pain. Good, or bad?
  • Pain usually prevents individual from continuing
    a harmful activity
  • Masking pain. Good, or bad?
  • Types of pain medications

3
Non-Narcotic Analgesics
  • Salicylates
  • Aspirin
  • Peripheral inhibition of prostaglandin synthesis
    analgesic effect
  • Antipyretic effect as a result of inhibition of
    prostaglandin synthesis in the hypothalamus
  • Possibly increases blood flow to skin causing
    sweating dissipation of heat

4
Non-Narcotic Analgesics
  • Ibuprofen
  • Analgesic effect w/in 2-4 hr
  • Acetaminophen
  • Tylenol
  • Weak prostaglandin inhibitor
  • Useful in treatment of mild-moderate pain
  • Can be supplemented by strong narcotic agent to
    increase potency for treating severe pain

5
Narcotic Analgesics
  • Codeine, morphine
  • Exogenous opioids more powerful than endogenous
    opioids
  • Opioid receptors
  • Common side effects drowsiness, dizziness,
    blurred vision, nausea, and vomiting
  • ADDICTION

6
Anesthetics and Skeletal Muscle Relaxants
7
Neuromuscular-Blocking Agents
  • True skeletal muscle relaxants
  • Decrease the response to the neurotransmitter Ach
    at the neuromuscular junction
  • Also either depolarizes membrane (causes muscle
    twitch) or do not (no twitch)

8
Depolarizing Drugs
  • Succinylcholine only depolarizing NM-blocking
    agent used in US
  • Effects are similar to ACh
  • Longer effect than ACh

9
How Succinylcholine Works
  • Not metabolized effectively at synapse
  • Membranes remain depolarized and unresponsive to
    stimulus
  • Flaccid paralysis
  • Continued exposure causes decreased
    depolarization membrane repolarizes
  • Membrane cannot be depolarized by ACh as long as
    succinylcholine is present
  • Desensitization of membrane by succinylcholine

10
Non-depolarizing Drugs
  • Tubocurarine
  • Work in one of 2 ways
  • Low dose attaches to nicotinic receptor,
    prevents ACh binding
  • Works as long as dose is sufficient if more Ach
    is made available it will over power drug
  • High dose blocks ion channels of the synapse
  • Further weakens nerve transmission, makes ACh
    more inactive

11
Cardiovascular Other Effects of
Neuromuscular-Blocking Agents
12
Local Anesthetics
  • Work only on area of administration
  • Locals can block all nerves in area
  • Sensory and motor functions blocked
  • Surgical concern, will block both
  • Continued athletic participation

13
Action of Local Anesthetics
  • Preferentially block small fibers due to shorter
    pathways
  • Small-diameter fibers are first to fail to
    conduct
  • Anesthesia of large, myelinated nerve requires
    that 3 successive nodes be blocked
  • The thicker the nerve the farther apart the
    nodes greater resistance to blockade
  • Myelinated tend to be blocked before unmyelinated
    of same diameter
  • Exception to above nerve bundles

14
Administration of Local Anesthetics
  • Topical application
  • Small-nerve injection
  • Major nerve trunk injection
  • Spinal cord infiltration
  • Sympathetic fiber block

15
Types of Local Anesthetics
16
Central-Acting Muscle Relaxants
  • Soma, flexeril, valium, robaxin, norgesic
  • Actions
  • Mechanism is not well understood overall effect
    is sedation
  • All are general CNS depressant
  • No evidence that they can selectively relax
    skeletal muscle
  • Side effects
  • Drowsiness, nausea, light-headedness, vertigo,
    ataxia, headache
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