 Hi everyone, this is Leah Medwig, your lead course instructor for advanced e-clinical training and by now I'm sure you're following along with our pharmacology lessons and so today we're talking about analgesics or otherwise known as pain medications. Before we begin to talk about pain medications themselves, we first need to truly understand what is pain. That sounds like a very simple answer, but it's a little bit more complicated than that. So pain is the number one complaint made to clinicians, nearly every clinician, every nurse, every medical assistant, patient care tag, doctor, physician's assistant, interacts with patients who are in pain. So whether you work in an inpatient acute care setting or an outpatient specialty clinic, the odds are that a large number of people you treat or treat or seeing are experiencing some type of physical pain. Now chronic pain is a little bit different than acute pain and we'll talk about that on the next slide, but chronic pain lasts for more than six months and is associated with an increased rate of depression as well as decreased physical activity and increased rates of comorbidities. So, you know, this is why it is very important to take your patients pain seriously when they tell you that they were in pain and treat it accordingly. So pain is what your patient says that it is. So two types of pain here is, you know, we have acute pain. I'm sure by now every one of us has had some short sort of acute pain in our lives and this is short-term pain that comes on suddenly and has a specific cause. Usually associated with some type of tissue injury. Generally, it lasts for fewer than six months and goes away once the underlying cause is treated. Common causes of acute pain include broken bones, surgery, dental work, labor and childbirth, cuts, burns. Now chronic pain is a little bit different. This is pain that lasts for more than six months and even after the original injury has healed, that is when pain is considered to be chronic. Common causes of chronic pain include, you know, migraines, low back pain. Lots of people have chronic low back pain. Arthritic pain either associated with osteoarthritis of large joints or autoimmune disorders such as rheumatoid arthritis and chronic traumatic injury pain. So, you know, patients that have had traumatic injuries that have had, you know, extensive surgical procedures, you know, one or many to fix the problem, you know, continue to have pain when that injury has been fixed. So how do we treat pain? Today, of course, with medications and the logistics, which is what we're talking about today, physical therapy, also, you know, heat and cold. So, you know, heating pads, ice, psychotherapy is one most people don't always consider. Also surgical interventions such as if you have abdominal pain associated with appendicitis, you have an appendectomy where they remove your appendix and then the pain goes away once you're all healed up from the surgery and then, of course, rest. So what are analgesics? So, analgesics are medications that really pain and unlike medications used for anesthesia during surgery, analgesics don't turn off nerves. They don't change the ability to sense your surroundings or alter your consciousness. They are sometimes called painkillers or painkillers. So here you can see a nice little graphic of the breakdown of the types of analgesics. First, we have the non-opioids and these include things like non-steroidal anti-inflammatory drugs, acetaminophen and anti-epileptics and then on the other side, we have just opioids and there are natural opioids and then there are semi-synthetic or synthetic opioids. Here you can see this little chart of non-opioids. Each column you see the classification, the brand name, the generic name, best used form, some side effects and some warnings. Acetaminophen is first, otherwise known as Tylenol or Eccedrine and this is best used for minor aches and pains, also used as a fever reducer. Some side effects include itching, swelling, stomach bleeding and rash. A warning, however, is possible liver damage, especially if you drink alcohol. So you want to limit your total dose to 2,000 milligrams per day. Non-steroidal anti-inflammatory drugs or NSAIDs. The brand names for these include Advil, Motrin and Aleve, generic names are ibuprofen and naproxen. These are best used for a fever reducer as well as pain and an anti-inflammatory. Side effects include heartburn, dizziness, nausea and some warnings. May, NSAIDs may increase the risk of cardiac events and stroke. There's also a risk for GI bleeding and NSAIDs are known to cause kidney damage if taken more than the prescribed dose for an extended period of time. We also have anti-epileptics. Now there are several other drug names for anti-epileptics, but the ones that are used here for pain include Neurotin and Lyrica, otherwise known as Gabapentin and Pregamelin. These are best used for post-herpatic neuralgia or peripheral neuropathy or fibromyalgia. A lot of times you'll see these medications prescribed to people that have diabetes complications where they have neuropathy in their hands or their feet. Also for patients that haven't treated with chemotherapy, sometimes develop neuropathy. So we prescribe Neurotin and Lyrica for that as well. You have to be careful with these medications because sometimes some adverse effects can be suicidal thoughts or depression. This next slide here is just talking about the opioids itself. Now we first have the natural opioids, which include morphine, codeine, and thabene. And then you have this semi-synthetic or synthetic opioids including Ultram or tramadol, oxycodone, Percocet. Percocet is a medication that's mixed with oxycodone and acetaminophen. You also have Vicodin. Vicodin is a medication that is mixed, a mix of hydrocodone and acetaminophen together. There's also methadone, dilated or hydro morphone, and opanate or oxymorphone and fentanyl. Now the side effects for both the natural and the semi-synthetic or synthetic opioids aren't exactly the same. So these medications can induce relaxation, sometimes euphoria, pain relief is exactly what we want. Sedation, but confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary construction, and respiratory depression. And that's something you really need to watch out for if your patient is taking opioids, especially in the acute care setting. And the warning for both of these medications, they can lead to death from respiratory depression. It's overtaking or mixed with other sedatives, including alcohol, and these medications can lead to dependence and addiction. So, you know, some teaching surrounding your, that you need to be cognitive about when talking to your patients about whether, when they're taking opioids is that they're not taking these medications with other sedatives and they're not drinking alcohol with these medications, and they're not misusing or overusing these medications. It's something else you should be aware of as well, that, you know, we've talked at some point through these lessons about farm code dynamics and you know, elderly patients tend to have a more difficult time, you know, processing medications and excreting them through their body, through their kidneys and their liver. So, you know, they can sometimes have a greater reaction or a bigger reaction to these opioids or these types of medications. So just really want to be aware and to make sure that you are doing your duty, doing your duty diligence and just making sure you're educating them about these side effects in the warnings.