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Analgesics and Local Anesthetics

Analgesics and Local Anesthetics. Chapter 10. Analgesics. Used primarily for PAIN relief (reduce pain perception) Often used by many athletes without consent of team MD or ATC Many varieties available (OTC) Encourage the body’s own pain relief system (endogenous opioids). Analgesics.

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Analgesics and Local Anesthetics

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  1. Analgesics and Local Anesthetics Chapter 10

  2. Analgesics • Used primarily for PAIN relief (reduce pain perception) • Often used by many athletes without consent of team MD or ATC • Many varieties available (OTC) • Encourage the body’s own pain relief system (endogenous opioids)

  3. Analgesics • Opioids • 2 forms: endogenous and exogenous • Originally extracted from the opioid poppy • Relief of moderate to severe pain perception • Synthetic compounds include morphine and codeine

  4. Endogenous Opioids • Produced by the body • Endorphins and enkephalins produced on demand by the body • Endorphins • Act similar to morphine by binding to receptors sites in the pain pathway • More potent than morphine • Act on the CNS • Receptors are found in the peripheral nerves is where the endogenous opioids bind to decrease excitability

  5. How Do They Work? • Produce a decreasing effect in the neurotransmitter activity at both the presynaptic and post-synaptic sites • Alters nocioceptive transmissions to the brain (ascending pathway) • Decreases the excitability of the neuron • Reduces the secretion of substance P neurotransmitter at the spinal cord producing the analgesic effect

  6. Exogenous Opioids • Prescribed medications • Tight controlled through the Controlled Substances Act • Highly addictive and cause for potential abuse • Often used for acute pain (surgical intervention) • Often used for short term

  7. What Are The Specifics? • Very popular drug use (most common prescribed drug in year 2000 was Hydrocodone with acetaminophen) • Vicidin, Lortab • Hydrocodon • Semisynthetic • Often combined with acetaminophen • Antitussive • Percodan, Oxycodone • High risk for tolerance • High potential for abuse

  8. Adverse Effects • Addictive • Develop tolerance • Sedating effects, drowsiness, nausea, vomiting, constipation (antiperistalic) • Potentiating effect when used with alcohol • CNS depressant (respiration) • Short application (less than 10 days)

  9. Nonopioid Preparations • NSAIDS • Propoxyphene • Darvon, Darvocet, Darvon-N • CNS depressant • Highly addictive • Toxic effect when used in conjuction with other CNS depressants • Rarely prescribed • #2 cause in drug fatalities (barbiturates #1)

  10. Capsaicin • Zostrix • Derived from pepper seeds • Limits activity of Substance P by preventing pain pathway to the brain from the extremities • Used for arthritic conditions • Used in the athletic arena in a topical cream for pain relief (less than 1% strength)

  11. What Athlete’s Should Know About Analgesic Drugs • “painkillers” • Potential interaction with herbal remedies • Overuse • Abuse • Adverse effects with alcohol

  12. Local Anesthetics • Drugs used to produce partial or complete loss of sensation to a specific area • IV, and topical • Xylocaine, cocaine, ice • Applications • Suturing, surgery

  13. More To Know • Effects of Epinephrine • Prolong the action of the drug • Vasoconstriction • Reduces absorption of the anesthetic to the site • Diminishes the ability of the nerve fiber to conduct an action potential by inhibiting the number of nerve endings that can transmit impulses to the CNS by limiting Ca+ and Na+ ion activity

  14. RAPID UPTAKE Topical (mucosal) Interpleural Intercostal Subcutaneous Epidural Spinal Transdermal SLOW UPTAKE

  15. Delivery and Use of Local Anesthetics • Transdermal – used for skin irritations • Parenteral (IV) – sutures • Peripheral Nerve Blocks – injection close to the truck to prevent afferent pathway in minor surgeries or chronic pain • Central Nerve Block (sympathetic) – major surgical applications • Topical (ICE) - used for ROM, what else?

  16. Commonly Used Local Anesthetics • Cocaine • Novacaine • Marcaine • Xylocaine • Lidocaine

  17. Adverse Effects • Alter CNS activity by either depressing or exciting activity • Allergic reactions • Cardiac arrest

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