Sunday, June 5, 2011

Opioid analgesics : remain the main group of drugs used to treat severe pain.

Due to its high efficiency compared with other pain medication opioid analgesics are most often used for severe pain of traumatic, vascular origin in patients with malignant tumors, as well as in the postoperative period (AP Golikov, 1994; RN Lebedeva, 1994 , AN Osipov, 1994).
Identify several subtypes of opioid receptors on the basis of different interactions with a specific subtype of opioid receptor, opioid analgesics are divided into 4 groups.
Full agonists mediate the analgesic effect by binding to opioid receptors. These include: fentanyl, alfentanil, sufentanil, remifentanil, morphine, pritramid, mepiridin, promedol, prosidol, codeine, omnopon, tramadol. Total (net) agonists by binding to opioid receptors mainly cause their activation, which leads to the development of the maximum analgesic effect. Partial agonists (buprenorphine) is weaker than activate opioid receptors. Agonist-antagonists bind preferentially to one type of opioid and block opioid receptors in the other. Representatives of this group are pentazocine, butorphanol and albufin. Full antagonist naloxone upon binding to opioid receptors blocks them, eliminating the effects of agonists (M. Ya Avrutsky, 1997).
In Russian clinical practice in neonatal intensive care unit, ambulance traditionally used narcotic analgesics: morphine, promedol, omnopon. However, they can depress respiration, motility of the gastrointestinal (GI) tract, vomiting, addiction and dependence. In Britain and Germany in this regard over the past decade have found a wider application of opioid analgesics having mixed type of action, agonist-antagonists: piritramid, buprenorphine, pentazocine, pethidine, nalbuphine. The most frequent adverse events seen with narcotic analgesics, is observed in almost half of patients with sedation. Other side of manifestation, which as nausea and vomiting, sweating, hot flashes, GB, hallucinations and dizziness occur, according to different authors, with a frequency not exceeding 5% for each drug.
One of the most serious problems encountered in the application of drugs is the occurrence of this addiction. Well-known researcher of pain problems JJ Bonica (1986) urges medical personnel are not afraid to prescribe narcotic analgesics primarily to those patients whom they are vitally important: in acute pain (traumatic, post-operative) and chronic pain in incurable oncology patients.
Necessary to clearly distinguish the medical aspects of the use of analgesics on the social problems caused by the use of drugs in the home. Physical dependence in patients to a greater extent the true form of opiates (morphine and its analogues), whereas opioids are related to the group of agonist-antagonist, to a much lesser extent, provoke physical dependence.

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