Analgesics or pain medication are substances that reduce or block the pain without losing consciousness (the difference with general anestetika).
Definitions.Pain is a sensory and emotional feeling of not feeling and relating to (the threat) of tissue damage. Pain is a personal feeling and pain tolerance threshold varies for each person limit for the temperature is constant pain, which is at 44-45oC.
The pain in most cases only a gejela, which serves to protect the protect the body. Pain should be considered as an indication of the danger of a disruption in the network, such as inflammation (Rema, gout), infectious microorganisms, or muscle spasms. Pain caused by mechanical stimulation, chemical or physical (heat, electricity), can cause damage to the network. These stimuli trigger the release of certain substances, called mediators of pain.
Mediataor pain now also called autocoida and comprising, among others, histamine, serotamin, bradyinin, leukotrienes, and prostaglandin2. Bradykinin is a polypeptide (amino acid sequences) that is formed from plasma proteins. Prostaglandin-like structure with fatty acids and are formed from amino arachidonat. According to estimates of these substances increase the sensitivity of the tips of sensory nerves for pain stimulation.
Seagai-defined pain threshold level (level) Diman pain is felt for the first time. Thus, the low intensity of stimulation when a person feels pain. For each person the pain threshold is constant.
Fever. In general, fever is also a symptom and not a separate disease. Now, experts bersependapat that fever is a useful countered reaction of the body against infection. At temperatures above 37oC lymphocytes and macrophages become more active. When the temperature exceeds 40-41oC, then place the critical situations that could be fatal, because no longer restrained by the body.
The pain in most cases only a gejela, which serves to protect the protect the body. Pain should be considered as an indication of the danger of a disruption in the network, such as inflammation (Rema, gout), infectious microorganisms, or muscle spasms. Pain caused by mechanical stimulation, chemical or physical (heat, electricity), can cause damage to the network. These stimuli trigger the release of certain substances, called mediators of pain.
Mediataor pain now also called autocoida and comprising, among others, histamine, serotamin, bradyinin, leukotrienes, and prostaglandin2. Bradykinin is a polypeptide (amino acid sequences) that is formed from plasma proteins. Prostaglandin-like structure with fatty acids and are formed from amino arachidonat. According to estimates of these substances increase the sensitivity of the tips of sensory nerves for pain stimulation.
Seagai-defined pain threshold level (level) Diman pain is felt for the first time. Thus, the low intensity of stimulation when a person feels pain. For each person the pain threshold is constant.
Fever. In general, fever is also a symptom and not a separate disease. Now, experts bersependapat that fever is a useful countered reaction of the body against infection. At temperatures above 37oC lymphocytes and macrophages become more active. When the temperature exceeds 40-41oC, then place the critical situations that could be fatal, because no longer restrained by the body.
Classification
On the basis of work farmakologisnya, analgesics were divided into two major groups, namely:
a. Peripheral analgesic (non-narcotic), which consists of drugs that are not central narcotic and does not work.
b. Special narcotic analgesic used to block the intense pain, as in fractura and cancer. These drugs are discussed in Chapter 23, Drugs.
Handling pain
Based on the occurrence, the pain can be combated in several ways, namely:
a. Hinder the formation of stimulating the peripheral pain receptors to the peripheral analgesic
b. Impede the distribution of stimuli in sensory nerves, for example with local anestetika.
c. Blockade of CNS pain centers with central analgesics (narcotics) or with the general anestetika.
b. Impede the distribution of stimuli in sensory nerves, for example with local anestetika.
c. Blockade of CNS pain centers with central analgesics (narcotics) or with the general anestetika.
In the treatment of pain with analgesics, psychological factors also play a part as already described above, for example, individual patience and power to block the pain. These medications below can be used according to type of pain.
Mild pain can be treated with medication peripheral, such as paracetamol, asetosal, mefenaminat, propifenazon, or aminofenazon, as well as pain with fever. For the pain is to be added kofein or codeine. Pain is accompanied pembengkakanatau due to trauma (falls, kicks, collisions) should be treated with a analgetikum anti-inflammatory, such as aminofenazon and NSAIDs (mefenaminat, nifluminat). Pain is a great need to be tackled with morphine or other opiates.
Pain in cancer is generally treated by a four-story scheme that is providing:
1. Drug peripheral (non-opioid) per oral or rectal: paracetamol, asetosal.Mild pain can be treated with medication peripheral, such as paracetamol, asetosal, mefenaminat, propifenazon, or aminofenazon, as well as pain with fever. For the pain is to be added kofein or codeine. Pain is accompanied pembengkakanatau due to trauma (falls, kicks, collisions) should be treated with a analgetikum anti-inflammatory, such as aminofenazon and NSAIDs (mefenaminat, nifluminat). Pain is a great need to be tackled with morphine or other opiates.
Pain in cancer is generally treated by a four-story scheme that is providing:
2. Peripheral drug with codeine, or tramadol
3. Central Drugs (opioids) as oral or rectal
4. Parenteral opioid medication.
To strengthen analgetikum effects can be added co-analgetikum, like psikofarmaka (amitriptyline, lovepromazin) or prednisone.
PERIPHERAL analgesics
Chemically, peripheral analgesics can be divided into several groups, namely:
a. Paracetamol;
b. Salicylates: asetosal, salisilamida, and benorilat;
c. Prostaglandin inhibitors (NSAID's): ibuprofen (Arthrifen), and others;
d. Derivative-derivative antranilat: mefenaminat, niflumat acid glafenin, floktafenin;
e. Derivative-derivative pirazolinon: aminofenazon, isopropilaminofenazon, and metamizol;
f. Other: benzidamin (Tantum).
b. Salicylates: asetosal, salisilamida, and benorilat;
c. Prostaglandin inhibitors (NSAID's): ibuprofen (Arthrifen), and others;
d. Derivative-derivative antranilat: mefenaminat, niflumat acid glafenin, floktafenin;
e. Derivative-derivative pirazolinon: aminofenazon, isopropilaminofenazon, and metamizol;
f. Other: benzidamin (Tantum).
CO-analgesic efficacy is a drug and its main indications are not dispel the pain, ie, NSAIDs (non-steroidal anti inflammatoryDrugs), antidepresiva trisiklis (amitriptyline), and anti-epileptika (carbamazepine, valproic). These drugs are used alone or combined with other analgesics in certain circumstances, such as in pain due to inflammation and neuropathy.
Side effects
The most common are gastrointestinal disorders (b, c, e), damage to blood (a, b, d, and e), liver and kidney damage (a, c), as well as allergic skin reactions. These side effects occur mainly on the use of old or in high doses. Therefore, continuous use of analgesics is not recommended.
Intraksi. Most analgesics strengthen antikoagulansia effect, unless the setamol and glafenin: Both of these drugs in normal doses can be combined safely to wakyu maximum of two weeks.
Intraksi. Most analgesics strengthen antikoagulansia effect, unless the setamol and glafenin: Both of these drugs in normal doses can be combined safely to wakyu maximum of two weeks.
PARENT substances
1. Paracetamol: acetaminophen, Panadol, Tylenol, Tempra, * Nipe.
-Asentanilida derivatives are metabolites of fenasetin, who was formerly widely used as analgeticiu, but in 1978.
Side effects often occur, including hypersensitivity reactions and blood disorders. Overdose can cause, among others, nausea, vomiting, and anorexia.
Women hamildapat use paracetamol safely, also during lactation although mencapi breast milk.
Dosage: for oral pain and fever 2-3 dd 0.5 to 1 g, maximum 4 g / day, the chronic use maksimum2, 5 g / day. Children: 4-6 dd 10 mg / kg, the average age of 60 mg 3-12 months, 1-4 years 120-180 mg, 180 mg 4-6 years, 7-12 years 240-360 mg, 4-6 a day. Rectal 20 mg / kg each time, adult 4 dd 0.5 to 1 g, children aged 3-12 months 120 mg dd 2-3, 1-4 years 240 mg dd 2-3, 4-6 years 4 dd 240 mg, 7-12 years 2-3 dd 0.5 g.
2. Acetylsalicylic acid (FI): asetosal, Aspirin, Cafenol, Naspro.
Asetosal is the oldest anti-pain (1899!), Which until now the most widely used around the world.
Side effects The most common form of gastric mucosal irritation with risk of peptic ulcers and bleeding cryptic (occult). The reason is the nature of asetosal acid, which can be reduced through a combination with a antasidum (MgO, aluminiumhidroksida, CaCO3) or calcium salts (carbasalat, ascal).
Pregnant women are advised not to use asetosal in high doses, especially in the last quarter and before labor, because of long gestation and birth can be extended, as well as increased bleeding tendencies.
Dose: oral pain and fever in 4 dd 0.5 to 1 g pc, maximum 4 g daily, children up to 1 year 10 mg / kg 3-4 times a day from 0.1 to 2 yrs 4-6 dd, above 12 4 yrs dd320-500 mg, maximum 2 g / hari.Rektal 4 dd 0.5 to 1 g of adult, children up to 2 yrs 2 dd 20mg/kg, over 2 yrs 3 dd 20 mg / kg pc
* The forms that dissolve asetosal:
Karbasalatkalsium (Ascal) is the calcium salt of asetosal, in which crystal water is replaced by urea (1951).
Iysin-asetosal are compounds that are after the break in the form of soluble ammonia acid lysine (Iysine) and asetosal, which is then hydrolyzed into salisiat. Combination (1620 mg) with metoklo-pramida (10 mg) is recommended for migraine (Migrafin).
a. Diflunisal (Diflonid, Dolocid) is a derivative-difluorfenil (1980) with the efficacy and side effects are more or less the same.
Dose: for pain and at the beginning Rema 0.5 to 1 g, followed by 2dd
0.25 to 0.5 g, maximum 1.5 g / day.
b. Beneroliat (Bentum, benortan) is an ester asetosal with paracetamol (1972).
Dose: maximum 4 dd 0.5 to 1 g.
c. Salisilamida (FI) (salamid, * Neozep, * Refagan) is devirat-salicylate with weaker properties in all areas of effect is less reliable. This substance is often used of digestive hemorrhage rarely arise in the appeal vague asetosal. In overdose can occur hypotension, CNS depression, and respiratory cessation. Its use has been deemed obsolete.
Dosage: 3-4 dd 0.5 g.
d. Natriumsalisilat (FI) (* Nephrolit, Enterosalicy) is weaker than asetosa properties. Sampignya more or less the same effect, but did not inhibit platelet clumping.
Dosage: 4-6 ss 1 to 1.5 g, maximum 12 g / day.
3. Aminofenazon: aminopyrin (FI), amidopyrin, pyriamdom.
Devirat-pirazolinon this (1887) berkasiat anlgetis, antipiretis, and anti-inflammatory. The side effects of the blood (agranulocytosis and leukopenia) are often fatal, this drug has been since the 1980's banned its circulation in many countries.
Pregnancy and lactation. All drugs of pirazolinon group should not be used during pregnancy and lactation.
Dosage: 300-600 mg 3 dd, maximum 3 g / day.
a. Isopropilaminofenazon (* pehazon) is devirat-aminopirin with the same efficacy. In addition, these substances are also vulnerable to high doses of sedative and hypnotic. Toksitasnya otherwise lighter.
Dose: oral, rectal or iv 3dd 400 mg for 1 week, then 600 mg / day.
b. Fenazon (FI) (antipirin) is a compound-parent of the drugs mentioned above without anti-inflammatory properties (1884).
c. Propifenazon (isopropilantipirin, * saridon, migraine) is devirat fenazon (1951)
Dosage: 150-300 mg 1-3 dd, generally combined with other analgenitika.
4. Fenibutazon: Butazolidin, * New Skelan, * Pehazonlforte.Obat is specifically used for certain types of arthritis, such as deviratnya oksifenilbutazon.
Serious side effects, among other things, blood and stomach, so that in many Western countries has been withdrawn from circulation since the late 1980s.
Dose: Rema attack or gout in oral and rectal 200 mg 2-3 dd.
5. Glafenin: Glaphen, Glifanan.
Glafanin is a devirat-4-aminokinolin (such as Rema drug chloroquine), which bound to the acid antranilat (1965).
Side effects such as gastrointestinal disturbances, drowsiness, and using. Even more serious is anafilaktis reaction, liver damage, and animea hemolitis, which sometimes fatal.
Dose: start 400 mg, then 200 mg dd 3-4, maximum 1 g daily.
Floktaferin is CF 3 derivatives with more or less the same efficacy, but less toxic and also more rarely cause allergic reactions. In the liver, these substances are converted into acid floktafeninat.
Dosage: 200-400 mg beginning, then 4-6 dd
Mefenaminat acid (Ponstan) is derival-antinilat with properties analgetis, antipiretis, and anti-inflammatory that is good enough. This drug is also used as medicine Rema. Floktafenin similar side effects.
Dose: 500 mg beginning of the beginning, then 250 mg dd 3-4 pc
6. Tramadol: Tramal, Theradol.
Analgetikum opiates (1977) does not suppress breathing and practically does not affect the cardiovascular system and gastrointestinal motility. The drug is used for pain and paracetamol-codeine NSAISS less effective or can not be used.
Tramadol is not recommended during pregnancy and lactation.
Dose: children 1-14 years old: 3-4 dd 1-2 mg / kg. Above 14 years 50-100 mg dd 3-4, maximum 400 mg daily.
-Asentanilida derivatives are metabolites of fenasetin, who was formerly widely used as analgeticiu, but in 1978.
Side effects often occur, including hypersensitivity reactions and blood disorders. Overdose can cause, among others, nausea, vomiting, and anorexia.
Women hamildapat use paracetamol safely, also during lactation although mencapi breast milk.
Dosage: for oral pain and fever 2-3 dd 0.5 to 1 g, maximum 4 g / day, the chronic use maksimum2, 5 g / day. Children: 4-6 dd 10 mg / kg, the average age of 60 mg 3-12 months, 1-4 years 120-180 mg, 180 mg 4-6 years, 7-12 years 240-360 mg, 4-6 a day. Rectal 20 mg / kg each time, adult 4 dd 0.5 to 1 g, children aged 3-12 months 120 mg dd 2-3, 1-4 years 240 mg dd 2-3, 4-6 years 4 dd 240 mg, 7-12 years 2-3 dd 0.5 g.
2. Acetylsalicylic acid (FI): asetosal, Aspirin, Cafenol, Naspro.
Asetosal is the oldest anti-pain (1899!), Which until now the most widely used around the world.
Side effects The most common form of gastric mucosal irritation with risk of peptic ulcers and bleeding cryptic (occult). The reason is the nature of asetosal acid, which can be reduced through a combination with a antasidum (MgO, aluminiumhidroksida, CaCO3) or calcium salts (carbasalat, ascal).
Pregnant women are advised not to use asetosal in high doses, especially in the last quarter and before labor, because of long gestation and birth can be extended, as well as increased bleeding tendencies.
Dose: oral pain and fever in 4 dd 0.5 to 1 g pc, maximum 4 g daily, children up to 1 year 10 mg / kg 3-4 times a day from 0.1 to 2 yrs 4-6 dd, above 12 4 yrs dd320-500 mg, maximum 2 g / hari.Rektal 4 dd 0.5 to 1 g of adult, children up to 2 yrs 2 dd 20mg/kg, over 2 yrs 3 dd 20 mg / kg pc
* The forms that dissolve asetosal:
Karbasalatkalsium (Ascal) is the calcium salt of asetosal, in which crystal water is replaced by urea (1951).
Iysin-asetosal are compounds that are after the break in the form of soluble ammonia acid lysine (Iysine) and asetosal, which is then hydrolyzed into salisiat. Combination (1620 mg) with metoklo-pramida (10 mg) is recommended for migraine (Migrafin).
a. Diflunisal (Diflonid, Dolocid) is a derivative-difluorfenil (1980) with the efficacy and side effects are more or less the same.
Dose: for pain and at the beginning Rema 0.5 to 1 g, followed by 2dd
0.25 to 0.5 g, maximum 1.5 g / day.
b. Beneroliat (Bentum, benortan) is an ester asetosal with paracetamol (1972).
Dose: maximum 4 dd 0.5 to 1 g.
c. Salisilamida (FI) (salamid, * Neozep, * Refagan) is devirat-salicylate with weaker properties in all areas of effect is less reliable. This substance is often used of digestive hemorrhage rarely arise in the appeal vague asetosal. In overdose can occur hypotension, CNS depression, and respiratory cessation. Its use has been deemed obsolete.
Dosage: 3-4 dd 0.5 g.
d. Natriumsalisilat (FI) (* Nephrolit, Enterosalicy) is weaker than asetosa properties. Sampignya more or less the same effect, but did not inhibit platelet clumping.
Dosage: 4-6 ss 1 to 1.5 g, maximum 12 g / day.
3. Aminofenazon: aminopyrin (FI), amidopyrin, pyriamdom.
Devirat-pirazolinon this (1887) berkasiat anlgetis, antipiretis, and anti-inflammatory. The side effects of the blood (agranulocytosis and leukopenia) are often fatal, this drug has been since the 1980's banned its circulation in many countries.
Pregnancy and lactation. All drugs of pirazolinon group should not be used during pregnancy and lactation.
Dosage: 300-600 mg 3 dd, maximum 3 g / day.
a. Isopropilaminofenazon (* pehazon) is devirat-aminopirin with the same efficacy. In addition, these substances are also vulnerable to high doses of sedative and hypnotic. Toksitasnya otherwise lighter.
Dose: oral, rectal or iv 3dd 400 mg for 1 week, then 600 mg / day.
b. Fenazon (FI) (antipirin) is a compound-parent of the drugs mentioned above without anti-inflammatory properties (1884).
c. Propifenazon (isopropilantipirin, * saridon, migraine) is devirat fenazon (1951)
Dosage: 150-300 mg 1-3 dd, generally combined with other analgenitika.
4. Fenibutazon: Butazolidin, * New Skelan, * Pehazonlforte.Obat is specifically used for certain types of arthritis, such as deviratnya oksifenilbutazon.
Serious side effects, among other things, blood and stomach, so that in many Western countries has been withdrawn from circulation since the late 1980s.
Dose: Rema attack or gout in oral and rectal 200 mg 2-3 dd.
5. Glafenin: Glaphen, Glifanan.
Glafanin is a devirat-4-aminokinolin (such as Rema drug chloroquine), which bound to the acid antranilat (1965).
Side effects such as gastrointestinal disturbances, drowsiness, and using. Even more serious is anafilaktis reaction, liver damage, and animea hemolitis, which sometimes fatal.
Dose: start 400 mg, then 200 mg dd 3-4, maximum 1 g daily.
Floktaferin is CF 3 derivatives with more or less the same efficacy, but less toxic and also more rarely cause allergic reactions. In the liver, these substances are converted into acid floktafeninat.
Dosage: 200-400 mg beginning, then 4-6 dd
Mefenaminat acid (Ponstan) is derival-antinilat with properties analgetis, antipiretis, and anti-inflammatory that is good enough. This drug is also used as medicine Rema. Floktafenin similar side effects.
Dose: 500 mg beginning of the beginning, then 250 mg dd 3-4 pc
6. Tramadol: Tramal, Theradol.
Analgetikum opiates (1977) does not suppress breathing and practically does not affect the cardiovascular system and gastrointestinal motility. The drug is used for pain and paracetamol-codeine NSAISS less effective or can not be used.
Tramadol is not recommended during pregnancy and lactation.
Dose: children 1-14 years old: 3-4 dd 1-2 mg / kg. Above 14 years 50-100 mg dd 3-4, maximum 400 mg daily.
DAFTAR PUSTAKA
1. Katzung g. Bertram.2002.Farmakologi Dasar dan Klinik.Buku 2 Edisi8.Jakarta:Salemba Medika
2. Hay, Drs. Tan dan Raharja, Drs.Kirana.2007.Oboan Tjat-Obat Penting.Jakarta:PT.Elex Media Komputindo
3. Drs. Kirana Rahardja.2002.Obat-Obat Penting.Jakarta:Gramedia
4. Joyce L Kee, Evelyn R Hayes.1994.Farmakologi Pendekatan ProsesKeperawatan.Jakarta:Buku Kedokteran
5. Muh, Ani I.ef.1995.Prinsip Umum dan Dasar Farmakologi cetakanGajah Mada University Press.Yogyakarta
6. Deglin dan Judith Hopfer.2004.Pedoman Obat Untuk Perawat.Jakarta:EGC
2. Hay, Drs. Tan dan Raharja, Drs.Kirana.2007.Oboan Tjat-Obat Penting.Jakarta:PT.Elex Media Komputindo
3. Drs. Kirana Rahardja.2002.Obat-Obat Penting.Jakarta:Gramedia
4. Joyce L Kee, Evelyn R Hayes.1994.Farmakologi Pendekatan ProsesKeperawatan.Jakarta:Buku Kedokteran
5. Muh, Ani I.ef.1995.Prinsip Umum dan Dasar Farmakologi cetakanGajah Mada University Press.Yogyakarta
6. Deglin dan Judith Hopfer.2004.Pedoman Obat Untuk Perawat.Jakarta:EGC
7. Hopfer deglin.judith dan hazard vallerand,April.2004.pedoman obat untuk perawat edisi4.jakarta:EGC
8. http://www.indomedia.com/intisari/1998/mei/trauma.htm
9. http://www.pikiran-rakyat.com/cetak/2005/0205/24/cakrawala/eureka.htm
10. http://zulliesikawati.wordpress.com/2010/05/18/anesthesia-awareness/
8. http://www.indomedia.com/intisari/1998/mei/trauma.htm
9. http://www.pikiran-rakyat.com/cetak/2005/0205/24/cakrawala/eureka.htm
10. http://zulliesikawati.wordpress.com/2010/05/18/anesthesia-awareness/
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