Pharmacologic Management Of SCD Pain Case Study

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Pharmacologic management of SCD pain entail a clear understanding of the pharmacology, potential impact, and adverse effects associated with each of the compound prescribed. Non-opioids, opioids and adjuvants are the main compounds used in pharmacotherapy of SCD pain. Non-opioid analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors.
Acetaminophen has analgesic and antipyretic effects but it does not reduce inflammation (Botting, 2000). The daily total dose should not exceed 4g, since it has been associated with hepatotoxicity (Hu et al., 2017, Kelava and Cavar, 2014). Although the therapeutic doses of acetaminophen are not associated with hepatotoxicity, in patients with liver
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Tramadol is a centrally acting synthetic non-NSAID analgesic of the aminocyclohexanol group with opioid-like effects. Although the exact mode of action is not known, tramadol shows opioid activity by binding to mu-opioid receptors and monoaminergic activity through weak inhibition of norepinephrine and serotonin reuptake. Tramadol can be tried alone for analgesia, but its efficacy increases in combination with another non-narcotic and narcotic agent. Tramadol infusion combined with non-opioids was effective to relieve moderate to severe pain due to VOC in SCD (Erhan et al., 2007). Comparison of efficacy of tramadol and meperidine revealed that both are safe and effective for emergency use in pain management of SCD patients (Uzun et al., 2010). A retrospective study revealed that the co-administration of tramadol and ketorolac in SCD patients with VOC relieved pain and improved mood and sleep (de Franceschi et al., 2004). Further, addition of scheduled oral tramadol to concomitant intravenous morphine and ketorolac, reduced requirements of morphine and ketorolac in paediatric SCD patients (Borgerding et al., 2013).

Opioids are powerful analgesics and have been considered as important substances for the severe pain management, especially if the pain is not managed by above non-opioid agents. There are many adverse effects such as constipation, sweating, weight gain, sleep disturbance, memory loss, anorexia, nausea, vomiting, fatigue and opioid

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