NSAIDs

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NSAIDs
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NSAIDs

• Non-steroidal anti imflamatory drugs

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NSAIDs? ???
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?? ??? ????? CNS ?? ?? ??? ???? Anaphylaxis
Acetaminophen            
Salicylates Aspirin                
Acetis acid Diclofenac Ketoloac Indomethacin Sulindac Tolmetin                                                                                                
Fenamics Mefenamic acid                               
Propionic acid Fenoprofen Ibuprofen Ketoprophen Naproxen                                                                                  
Oxicam Piroxicam Tenoxicam                                              
Nabumetone            
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Tramadole

• Mechanism
• µ-opioid receptor ? ?? ?? ?????
  norepinephrine, serotonin ? reuptake ? ???? ?????
  ???? ??? ??.
• ???? ????.
• CNS? ?? ???? side effect ??. ?? ????? ??
  metoclopramide ????? ??.

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• Dose
• ??? 100-200µg/day, Max.400µg/day
• Side effect ???? ????? ???? ??? ??? Tramadole?
  AAP? ????? ??.
• ex) Utacet

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????? ???? ?? ?? ??
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????? ???? ?? ?? ??

• ??? ???? ???? ?? ? ?? ??? ???? ????
• 1. Serotonin
• 2. Norepinephrine
• ????? Serotonin, Norepinephrine, Dopamine?
  reuptake? ???? ???? ????? ????? ???? ????? ????.

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????? ???? ?? ?? ??

• ??? ?? ??? ??? ?? ?? ??? ? ??? ???? ????.
• ??? Antidepressants? ????? ??? ?? ??
• ????? ??? ??? ???? ????? ????.

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????? ???? ?? ?? ??
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????? ???? ?? ?? ??
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lt?-1gt ????? ??/???
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Antidepressant ???? ???? ???? ???? ??? ??? ??? ??? ??? ???
  NE 5HT 5HT DA ??? ?? ??? ?? ??? ?? ???? ??? ??? ???
Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants Tricyclic antidepressants
3? amine Amitriptyline Clomipramine Doxepine Imipramine Trimipramine 2? amine Amoxapine Desipramine Nortriptyline 2   2   1   2   1     3   4   2   2   2   1   2   1     3   4   2   4   5   2   4   1     2 2 3 -   -   -   -   -     -   -   -   4     3   3   4     3   2   3 3     3   3   3     3   2   2   3     3   3   3     3   2   2   4     4   3   4     2   2   3   3     2   4   3     1   3   1   4     2   4   4     2   3   3  
Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine? Triazolopyridine?
Trazodone 0 3 3 - - - 2 3 3 1
Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone? Aminoketone?
Bupropion 0/1 0/1 0/1 2 - - 4 - - 1
Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI)
Fluoxetine Paroxetine Sertraline 0/1 0/1 0/1 5 5 5 5 5 5 - - - - - 1 1 1 1
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???? 3 ? ???

• ???? ?? ??? ?? ?? ? ?????.
• Serotonin ? Noradrenaline ??? ????
• ???? ???? Sodium Channel? ????
• ?? ?? ??? ????? ????
• ???? ?????? 1/3?? ?????? 50????.?? ???? ???????
• ??? ??? ???? ???? ??

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???? ??? ??? ?

• 1) ??? ?? ??????? ???? ?? ? ??? ? ?? ???
• 2) ??? ????? ??  ???? ? ?? ?? ???? ??? ??? ?? K,
  Na, Ca ? ???? ?????? ?? ???? ??? ???? ????
• 3) ??? ?? ??? ??? ???? ??? ?? ?? ??? ???? ?? ????
  ??? ???? ??? ??? ????

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• 1) ?? ??? Sodium channel ????
• ?? ???? ?????? ??
• --3??? ???? --???? Carbamazepine,
  Oxcarbazepine, Phenytoin, Topiramate,
  Lamotrigine--???? Mexiletine, Lidocaine
• 2) ?? ??? K channel? ???? ?????? ???
• --???? Gabapentin

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• 3) ?? ??? Calcium Channel ??
• --???? Gabapentin. Lamotrigine.
• 4) ??? ????? ??????
• (Sprouting Sympathetic Axons)? ??
• --3? ?? ???? Bupropion, Venlafaxine.

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• 5) ?? ??? ? 2? ???? ???? ?????? ??? ????? ?? ??
  ????? ????? ?? (Substance P, CGRP, Glutamate,
  NMDA?)? ???? ??
• --???? Gabapentin, Lamotrigine, carbazepine,
  Topiramate
• --Dextromethorphan, Tramadol
• 6)???, ???? SSRI ? ?venlafaxine.