Acetaminophen: Non-Opioid Analysis

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

The objective of this lab was to use Thin Layer Chromatography to separate the different compounds found in four over-the-counter drugs. TLC uses the polarities of the different compounds to separate them and the uses their Rf value to determine the exact compound(s) present. Compounds with higher polarity will stay closer to the baseline because they have a stronger connection to the silica.

Acetaminophen is a non-opioid analgesic. We are not sure about how acetaminophen reduces the pain. It could have an inhibitory effect on central prostaglandin synthesis (cyclooxygenase (COX)-2) as well as increase the pain threshold. Acetaminophen cure fever by inhibiting the formulation and release of prostaglandins in the CNS. It stops endogenous pyrogens at the hypothalamic thermoregulator center. Acetaminophen is effective on curing fever, and may also relieve mild pain caused by cancer. Compared with Ibuprofen, they have very similar effectiveness. Acetaminophen provides a faster and greater temperature drop than aspirin. Acetaminophen may cause vomiting, constipation, nausea, pruritus, and agitation. For more serious circumstances,

When patients are prescribed to a medicine for low amounts of pain, they are usually prescribed daily use of anti-inflammatory pills such as ibuprofen or tylenol. For more severe pain, patients are often prescribed these pills in higher dosages, or even prescribed opiates such as vicodin or oxycontin (Meisel & Perrone). Anti-inflammatory pills are not as powerful as drugs such as opioids, but they present the risk of cardiovascular problems

Opioid analgesics are the most potent in the alleviation of pain. In this class, Fentanyl is the strongest. Morphine is the gold standard of opioid analgesics, according to Rxlist. The other medications that fall under opioids are either more or less potent in comparison to morphine.

Although she finds it mildly beneficial, she complained of intense gastric pain while taking ibuprofen. Heather is wary of supplementing with any form of acetaminophen as she felt “loopy,” at one instance which she did not attribute to any other underlying cause (i.e. fever, medication). Heather also has an aversion to opiates, as she does not tolerate the euphoria and confusion while being on them. The option of bupivicaine +/- corticosteroid was presented to treat her SI join pain and to produce a NSAID sparing effect. However, she is afraid of needles therefore this option was not pursued. Rather a trial of Tramadol immediate release, at a dose of 25-50 mg PO at bedtime was provided to Heather. Her SI joint pain was reduced by 30% (9/10 to 6/10) within 30 minutes of starting Tramadol, without any noticeable side effects. There was no effect on her chronic daily headache pain. She started taking tramadol immediate release around the clock, and wore off after 4 hours. Therefore a prescription for Zytram XL (Tramadol CR) was provided to decrease her baseline pain and address end of dose pain. In addition to she was provided an additional repeat of immediate release tramadol for breakthrough pain. Lastly she discontinued use of ibuprofen as her pain relief from Tramadol was

After the analgesics or the non-steroidal anti inflammatory drug commonly referred to as (NSAIDs) have proven non-responsive, disease modifying

Naproxen (Naprosyn) is a nonsteroidal anti-inflammatory drug (NSAIDs) used to treat joint pain. M.H. was previously prescribed Naproxen to reduce the bilateral wrist pain and associated inflammation. Naproxen is mainly used to reduce inflammation, stiffness, and pain. NSAIDs block the formation of prostaglandins. Prostaglandins are involved in the body’s normal function and inflammatory response. Proteins, Cox-1 and Cox-2, control these prostaglandins. Cox-1 controls the formation of the prostaglandins involved in the normal function of the body’s organs. Cox-2 controls the formation of the prostaglandins involved in the body’s inflammatory response. By preventing the body from producing prostaglandins, NSAIDs reduce swelling and pain.

Anne is currently taking paracetamol for the pain in her wrist, within healthcare analgesia should always be monitored to assess whether it is achieving elimination of pain and should be adapted to the individual patient (Vargas-Schaffer, 2010). If paracetamol were not effective in eliminating Anne’s pain then practitioners should consider a non-steroidal anti-inflammatory medication [NSAIDS] or a mild opioid medication such as codeine as the next step (Vargas-Schaffer, 2010). However as Anne is asthmatic NSAID medication should be used with caution due to the risk of increased frequency of asthma attacks and breathlessness (Joint Formulary Committee, 2015); if Anne has taken NSAIDS before with no issue then this would be the next choice of analgesia followed by codeine if combined paracetamol and NSAID did not prove effective (Vargas-Schaffer,

aspect to assess the safety and appropriateness of IV acetaminophen use in hospital setting. Several published hospital utilization medication reports showed an increase consumption of intravenous acetaminophen.

According to the systematic review covered by Apfel, Turan, Souza, Pergolizzi & Hornuss, 2013 there is a significant reduction in postoperative nausea and vomiting and opioid use when using intravenous acetaminophen. The reviewers used Medline and Cochrane databases to conduct their search along with a hand search of abstracts to identify randomized-controlled trials using intravenous acetaminophen. The review was to determine if the acetaminophen was going to have a significant decline in nausea and vomiting following surgical procedures as

As mentioned above, opioids are extremely helpful in killing acute and cancer pain. Because opioid receptors are G-protein coupled reactions, the inhibitory G-protein is usually coupled or attached with the receptors (Ghelardini et al., 2015, page 219). The onset of reaction in inhibit the pain is rapid and effective due to multiple inhibitory actions at the terminal site (refer to the previous section of mechanism of action). Besides, the interaction of opioids gradually increases the threshold of pain neuron as well as attenuates the pain subjective evaluation (Ghelardini et al., 2015, page 220).

Nonsteroidal anti-inflammatory drugs are a common class of analgesic typically used chronically for pain such as musculoskeletal pain including osteoarthritis. It is commonly used in the elderly population.

A review of thepublished data focusing on the pharmacokinetics of opioids brought forth pertinent variations that is critical in making optimal analgesic choice.

PRACTICAL REPORT ON THE ISOLATION AND IDENTIFICATION OF CODEINE AND PARACETAMOLPRACTICAL REPORT ON THE ISOLATION AND IDENTIFICATION OF CODEINE AND PARACETAMOL