Dr. Steven I. Dworkin Drugs for the Treatment of Pain.

Dr. Steven I. Dworkin

Drugs for the Treatment of Pain


Narcotic Analgesics

• Used to treat mild to severe pain

• Opiate Activity and Effects

– related to occupation of three opiate receptor subtypes.

• Mu morphine-like supraspinal analgesia, respiratory and physical depression, miosis, reduced gastrointestinal motility.

• Delta Dysphoria, psychotomimetic effects.

• Kappa Sedation and miosis


Narcotic Analgesics

• Actions related to receptor binding or occupancy

– Agonists - binds to receptor produces an effect

– Partial agonists – binds to receptor produces limited response

– Antagonist – binds to receptor blocks effect of agonist

– * partial agonist can antagonize the effects of a full agonist by binding to the site.


Uses of Narcotic Analgesics

• Manage moderate to severe acute and chronic pain

– Analgesic effects depend on several factors

• Drug, dose, route of administration, type of pain, the patient.

• Lessen anxiety and sedate a patient before surgery

• Support anesthesia

• Obstetrical analgesia

• Treat severe diarrhea

• To relieve severe, persistent cough

• Manage opioid dependence


Adverse Reactions to Narcotic Analgesics

• Most common– Light-headedness, dizziness, sedation, constipation, anorexia,

nausea, vomiting, sweating.• Other adverse effects include:

– CNS - euphoria, weaknesses, pinpoint pupils, insomnia, agitation, tremor, impairment of activity.

– Gastrointestinal – dry mouth, biliary tract spasms.– Cardiovascular – flushing, tachycardia, bradycardia, and

palpitations– Genitourinary – spasm of ureters and bladder sphincter, urinary

retention or hesitancy.– Allergic – pruritus, rash– Narcotic drug dependence

Dr. Steven I. Dworkin Drugs for the Treatment of Pain.

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