Analgesic tools

Analgesic funds (Analgetica; from the Greek. negative consoles'an and algos - pain) - neurotropic substances Central action, the main effect of which consists in selective inhibition of pain sensitivity without oppression the sensitivity of other kinds, without loss of consciousness. Analgesic effect A. S. independent hypnotic effect, in some of them. By type of action A. S. are divided into two groups.
1. Narcotic analgesic funds (group of morphine) include derivatives phenanthrene - morphine (see), Tebodin (see), hydrocodone (see), heroin (in the USSR is not applied due to toxicity and high ability to cause addiction). Here are adjacent opium and its products, the main current top of which is the morphine; derivative phenylpiperidine - promedol (see), isopropanol, legal (in the USSR does not apply because superseded by similar action and have advantages and injected); derived heptanone - penadon.
2. Non-narcotic A. S. (analgesic and antipyretic) include derivatives of pyrazole - amidopyrine (see), analginum (see), phenazone (see), butadiene (see); derivative aniline - phenacetin (see); derivative of salicylic acid (salicylates) - sodium salicylate, acetylsalicylic acid; cinchophen, similar to action with salicylates.
Analgesic drugs of group of morphine are the strongest pain relievers. In appropriate doses, they can suppress or sharply reduce pain almost any intensity and backgrounds, including pain associated with diseases of internal organs, which distinguishes them from non-narcotic A. S. Greatest analgesic activity possesses fenazon, exceeding in this respect, morphine and other drugs several times. Analgesic effect, A. S. group of morphine due to their depressing impact on afferent system of the brain. The main role of dysfunction thalamocortical projection systems, exciting associative and non-specific thalamic nuclei, and their relation to the cerebral cortex. There is a blocking parts of afferent ways and in downstream parts of your brain. At the same time with painful sensations A. S. morphine group suppress and other negative feelings and emotions, due to physical exhaustion, hunger, the heat and so on) or mental (fear, anxiety, depression) causes, creating a kind of euphoria - feeling of physical and mental comfort, well-being. This property A. S. group of morphine causes a danger of addiction to them - addiction. Drugs in this group is clearly influenced by the intellectual sphere of the person. In moderate doses may experience a revival fantasy and perceptions, facilitation of easy mental work. However difficult voltage thoughts and focus, weakened self-control. In high doses, is developing the oppression of the higher nervous activity. All A. S. morphine group to some extent inherent in widespread effects that gives the basis to identify this group of substances is also the term narcotic A. S.
Analgesic drugs of group of morphine have a direct depressant effect on the respiratory center, expressed primarily in the ischemia of breath. The depth of respiration with moderate doses A. S. usually not reduced or only slightly increased, so pulmonary ventilation is not suffer essential changes. With increasing doses, and intravenous there is a reduction in minutes of the breathing due to the reduction of the depth and sharp ischemia. This property is most expressed in morphine and fendona, making unwanted their use in patients with the threat of respiratory failure and when the pain in childbirth in connection with the danger of asphyxia fruit. In such cases it is preferable to assign other A. S. this group - promedol, Tebodin. A. S. morphine group reduces anxiety kashlevogo centre. Under the action of these substances can occur aetiology, associated with increases tone wandering nerve. This side effect can be eliminated by atropine. Fairly constant Central effect is narrowing pupils, have diagnostic value in acute and chronic poisoning. Often there is another side of the Central effect - nausea and vomiting.
All analgesic drugs of group of morphine have a marked, although different, the effect on the smooth musculature. Derivatives phenanthrene reinforce the reduction of muscles of a biliary tract, bronchial tubes, uterus, sphincter of the bladder and the gastrointestinal tract. The latter, combined with the inhibition of secretion of digestive glands and weakening of intestinal peristalsis leads to constipation. The direct effect of derivative phenylpiperidine on the smooth musculature is to ease her contractions, which is particularly well expressed in the background spasms (spasmolytic effect). Promedol relaxes the muscles of the cervix of the uterus during childbirth, causing the acceleration of this act. Direct relaxing effect of fendona on the smooth musculature bowel is usually masked androgennam effects: agitation stray nerves leads to increased peristalsis.
In conditions of re-use of narcotic A. S. pronounced phenomenon of addiction, consisting in the development of resistance (tolerance) of an organism to action of these substances. Especially quickly reduced analgesic, and hypnotic effects of the applied doses, respiratory depression and kashlevogo centre. The achievement of the initial effect requires progressive dose increases. The phenomenon of cross-addiction: the emergence of tolerance not only to the use of means, but also to other drugs in the same group.
Testimony to the use analgesic funds morphine group are mainly pain of different origin - traumatic associated with surgery, malignant neoplasms, diseases accompanied by spasms of smooth muscles (gastrointestinal, renal, hepatic colic), pain syndrome in acute myocardial infarction, severe pain. Drugs in this group are widely used for pain relief during childbirth, or as penaltiesa funds. They are part of the so-called political cocktails. The use of narcotic analgesic funds before surgery reduces mental stress, anxiety patients, fear anticipation of pain. Relatively rarely applied these preparations to resolve breathlessness associated with excessively increased excitability of the respiratory center (cardiac asthma, pulmonary edema), and only in exceptional cases - as protivokashlevoe. When bowel diseases (peritonitis, damage to the intestinal wall, some diarrheas) A. S. morphine group - mostly opium preparations - are used for the reduction of peristalsis of intestines. When choosing a drug of A. S. should be based on the individual characteristics of individual representatives of this group, their relative of pain management activity, has side effects that are denominated in various agents to varying degrees (see articles about individual drugs). One of the main factors affecting the practical application of A. S. this group as a whole, is their inherent ability to cause addiction. In this respect, all narcotic A. S. dangerous, and the danger is greater than the higher analgesic activity of the drug. Prevention of drug addiction requires a physician to follow certain rules in the appointment of narcotic A. C. To these tools should be resorted to only in cases when all other measures to eliminate pain are not sufficiently effective. It is necessary to avoid regularity villas drugs (same hours), striving for a possible large intervals. It is advisable not to put the patient know which treatment he receives. It is necessary to strictly follow special instructions for storage, transportation and vacation narcotic A. S. General contraindications to the use of analgesic funds morphine group are: old age, state of total exhaustion, respiratory insufficiency. Not assigned to these drugs and children up to two years.

Acute poisoning by narcotics A. S. is characterized by the development of a coma, collapse and sharp respiratory depression, narrowing pupils, changing their extension asphyxia. Treatment consists of gastric lavage (better with the addition of potassium permanganate, activated carbon), the introduction of salt laxatives, the appointment of analeptics (korazol, kordiamin, caffeine, camphor). Special value is nalorfin (see)- physiological antagonist drug of A. S., similar in chemical structure to morphine. Very effective oxygen therapy, artificial respiration. It is recommended that the warming of the patient, the change of position of a body, catheterization of the bladder.
Chronic poisoning analgesics - see Drug abuse.
Non-narcotic A. S. have relatively weak (compared to the group of drugs morphine) pain management activity. In addition, they are effective mainly in muscle, joint, headaches, neuralgia, etc. and ineffective when the pain associated with significant injuries and diseases of internal organs. The action of the substances in this group are directed apparently at the centers of pain sensitivity in the visual hill. Non-narcotic A. S. do not have widespread effects, do not affect the intellectual and emotional sphere and help, so euphoric action. They are deprived of all other Central effects typical of narcotic A. E., and have no effect on the smooth musculature. Non-narcotic analgesic funds operate on the centers temperature regulation, resulting in increased thermal efficiency and reduced body temperature. This effect is the application of therapeutic doses is observed only in conditions of a fever.
The most wide practical application is non-narcotic analgesic effect A. S. For best effect often use a combination of drugs that includes a number of substances in this group, sometimes in combination with barbiturates, caffeine. The use of these A. S. as antipyretic limited; the temperature decrease with their help it is considered expedient only in those cases when the feverish phenomena become excessive, dangerous for the body intensity. Salicylates and pyrazole derivatives have Antirheumatic, anti-inflammatory properties and is widely used for the treatment of joint acute rheumatism. These drugs, especially phenylbutazone, is also effective in the treatment of infectious and gouty arthritis.
With long-term use non-narcotic analgesic funds, especially in high doses, can be of different kinds of side effects: allergic skin reactions, diarrhoea phenomenon pain in the stomach, hemorrhage (in the use of salicylates, butadiona), the weakening of hearing, tinnitus, hallucinations (salicylates), nitrate (from fenatsetina). The most dangerous toxic effect - granulocytopenia and agranulocytosis damage the bone marrow is sometimes observed at application of pyrazole derivatives.
In the treatment of these drugs need medical control, the study of blood (when using butadiona every 5-7 days).