NTA Level 4 • Semester 2 • PST04211

Description of Analgesics

Basic Pharmacology • Source Session/Topic 18

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Session 18: Description of Analgesics

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• List indications of analgesics

• List contraindication of analgesics

• Describe dose, dosage and course of analgesics

• List side effects and adverse effects of analgesics

• Describe interaction and precaution of analgesics

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Computer and overhead projector

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Objectives

Presentation/

2 20 minutes Indications of Analgesics

Buzzing

Presentation/

3 20 minutes Contraindication of Analgesics

brainstorming

4 30 minutes Presentation Dose, Dosage and Course of Analgesics

Presentation/ Side Effects and Adverse Effects of

5 20 minutes

brainstorming Analgesics

Description of Interaction and Precaution of

6 15 minutes Presentation

Analgesics

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning tasks (5 minutes)

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of analgesics (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• What are the indications of analgesics?

ALLOW few pairs to respond and let other pairs add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

• Most drugs which have analgesic properties are also anti inflammatory and antipyretics;

they include; Paracetamol, Aspirin and Others are Diclofenac, Ibuprofen, indomethacin,

Piroxicam, Mefenamic acid and Naproxen

• Narcotic analgesics like tramadol are used in the management of pain only, have no

antiiflammatory or antppyretic effects

• They are used in management of pain, fever and inflammation

o Paracetamol and aspirin are used in management of pain and fever

o Diclofenac, ibuprofen, indomethacin. Piroxicam, Mefenamic acid, and Naproxen are

used in management of pain, fever and inflamation

STEP 3: Contraindication of Analgesics (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are the Contraindications of analgesics?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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• Most individual drug which can be used as analgesic has different properties which make

them to be contraindicated to patient with some conditions

o Aspirin in children under 16 years and in breast-feeding due to Reye‘s syndrome,

previous or active peptic ulceration and haemophilia

o Diclofenac, ibuprofen, indomethacin, piroxicam, mefenamic acid, and naproxen are

contra-indicated in patients with a history of hypersensitivity to aspirin or any other

NSAID

o Diclofenac, ibuprofen, indomethacin, piroxicam, mefenamic acid, and naproxen are

contraindicated in severe heart failure and ischemic heart disease

STEP 4: Dose, Dosage and Course of Analgesics (30 minutes)

• Dose dosage and course of analgesics

o Aspirin

 By mouth, 300–900 mg every 4–6 hours when necessary, maximum dose 4 g

daily

 By rectum, 450–900 mg every 4 hours maximum dose 3.6 g daily)

 Intensive care, ADULT and CHILD over 1 month, by intravenous injection,

initially 300–600 micrograms/kg then by intravenous infusion 4.5–29.5

micrograms/kg/minute

 Duration of the course should not exceed 5 days in case of pain and inflammation

o Paracetamol

 By mouth, ADULT 0.5–1 g every 4–6 hours to a maximum dose. of 4 g daily

 CHILDREN 2 months 60 mg for post-immunisation pyrexia, repeated once after

6 hours if necessary

 CHILDREN 3 months–1 year 60–120 mg, 1–5 years 120–250 mg,

 6–12 years 250–500 mg; these doses may be repeated every 4–6 hours when

necessary (max. of 4 doses in 24 hours)

 By rectum, ADULT and CHILD over 12 years 0.5–1 g every 4–6 hours to a max.

of 4 g daily; CHILD under 3 months

 Duration of the course should not exceed 3 days

o Diclofenac

 By mouth, 75–150 mg daily in 2–3 divided doses

 By rectum in suppositories, 75–150 mg daily in 2-3 divided doses.

 Duration of the course should not exceed 5 days

o Ibuprofen

 ADULT and CHILD over 12 years, initially 300–400 mg 3–4 times daily;

increased if necessary to max. 2.4 g daily; maintenance dose of 0.6–1.2 g daily

may be adequate

 Duration of the course should not exceed 5 days

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o Indomethacin

 By mouth, rheumatic disease, 50–200 mg daily in divided doses

 Acute gout, 150–200 mg daily in divided doses

 Dysmenorrhoea, up to 75 mg daily

 By rectum in suppositories, 100 mg at night and in dose 150–200 mg

o Mefenamic acid

 CHILDREN 12–18 years, acute pain including dysmenorrhoea,

 ADULT over 18 years, 500 mg 3 times daily

 In menorrhagia, 500 mg 3 times daily

 Duration of the course should not exceed 5 days

o Naproxen

 Acute musculoskeletal disorders and dysmenorrhoea, 500 mg initially, then 250

mg every 6–8 hours as required; maximum dose after first day 1.25 g daily.

 Duration of the course should not exceed 5 days

o Piroxicam

 By mouth, rheumatic disease, initially 20 mg daily, increased if necessary to 30

mg daily in single or divided doses

 CHILD (6–18 years), juvenile idiopathic arthritis, under 15 kg, 5 mg daily; 16–25

kg, 10 mg; 26–45 kg, 15 mg; over 46 kg, 20 mg

 Duration of the course should not exceed 14 days

o Indomethacin

 By mouth, rheumatic disease, 50–200 mg daily in divided doses;

 Acute gout, 150–200 mg daily in divided doses

 Dysmenorrhoea, up to 75 mg daily

 By rectum in suppositories, 100 mg at night and in the morning if required

 Combined oral and rectal treatment, maximum total daily dose 150 – 200 mg

 Duration of the course should not exceed 5 days

STEP 5: Side Effects and Adverse Effects of Analgesics (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

• What are the side effects and adverse effects of analgesics?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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• Side and adverse effects of analgesics

o Aspirin

 Generally, causes mild and infrequent but high incidence of gastro-intestinal

irritation with slight asymptomatic blood loss

 Increased bleeding time

 Bronchospasm and skin reactions in hypersensitive patients

o Paracetamol

 Rashes

 Blood disorders (including thrombocytopenia, leucopenia, neutropenia)

 Hypotension also reported on infusion

 Liver damage and less frequently renal damage

o Diclofenac, ibuprofen, indomethacin, piroxicam, mefenamic acid, and naptoxen

 Gastro-Intestinal Discomfort

 Nausea

 Diarrhea

 Occasionally Bleeding and Ulceration Due to Gastro-Intestinal damage

 Dyspepsia.

 Hypersensitivity Reactions (Particularly Rashes, Angioedema, and Bronchospas)

 Headache

 Dizziness

 Nervousness

 Depression

 Drowsiness

 Insomnia

 Vertigo, Hearing Disturbances Such as Tinnitus,

 Photosensitivity

 Haematuria

STEP 6: Interaction and Precaution of Analgesics (20 Minutes)

• Interaction and precaution of analgesics

• Diclofenac, ibuprofen, indomethacin, piroxicam, mefenamic acid, and naptoxen

o Interaction:

 They increase risks of renal impairment when given with ACE inhibitors

 They antagonize effect of ACE inhibitors

o Precaution is advised in patients with renal or cardiac impairment, also should be used

with caution in hepatic impairment

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STEP 7: Key points (5 minutes)

• Analgesics are used in pain, fever and some of them are useful in inflammation

• Aspirin should not be used in children

• High dose of paracetamol and pronged use causes liver damage

• Diclofenac, ibuprofen, indomethacin. Piroxicam, mefenamic acid, and naptoxen should

be used with renal impairment and heart diseases

STEP 7: Evaluation (5 minutes)

• What are the indications of analgesics?

• What are the contra indications of analgesics?

• What is the common adverse effect of aspirin?

• Which group of drug which has interaction with analgesics?

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References

Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines & National

Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania

government printers.

Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. 2014.

Pharmacotherapy: A Pathophysiologic approach (9th ed.). New York, McGraw-Hill

Education.

Sally S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,

Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook (2nd ed.).

Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. 2007. Martindale, The Extra

Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary

(59th ed). London, BMJ Group and RPS Publishing.

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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