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27) Non-narcotic Analgesic

Classification:-
A) analgesic & anti inflammatory
salicylates – aspirin, salisylamide, benorylate
pyrazolone derivatives – phenylbutazone
indole derivatives – indomethacin, sulindac
propionic acid – ibuprofen, naproxen
anthranilic acid - mephemamic acid
oxicam derivatives – piroxicam
B) analgesic but poor anti inflammatory
paraaminophenol derivatives – paracetamol
pyrazolone derivatives – metamizol
benzoxazicine derivatives – nefipam

Mech of action:-
Inhibits cyclooxygenase activity  inhibition of proteoglycan synthesis  increase
hypothalamus activity
Prostaglandins induce hyperplasia by affecting the transducing property of free nerve
endings, stimuli that normally do not elicit pain able to do so.

Pharmacological effects:-
Antipyretic action
- rapidly reduce body temperature in fever patient but not cause hypothermia in
normostenic individuals. It resets the hypothalamic thermostat which is disturbed
during fever. Fever during infection is produced through the generation of
pyrogen which increases PG synthesis in hypothalamus.
Anti-inflammatory action
- pain, tenderness, swelling, vasodilation and leukocyte infiltration.
Respiration
- effects are dose dependent. At anti-inflammatory doses, respiration is stimulate
by peripheral and central respiratory center.

Therapeutic uses:-
Analgetic – headache, backache, myalgia, joint pain.
Antipyretic – analgesia
Rheumatic fever – are high doses
Rheumatic arthritis - are high doses
1st line treatment postmyocardial infarction & poststroke patients

Adverse effects:-
Nausea, vomiting, epigastric distress, increase in occult blood loss in stool, peptic ulcer,
back diffusion of hematocrite in gastric mucosa, decrease production of cytoproteate PGs

Salicylism
Contraindications to aspirin:-
In patients who are sensitive to aspirin
In peptic ulcer, bleeding tendencies.
In children suffering from chicken pox or influenza.
In diabetics patients
In patients with low cardiac reserve or frank CHF.
In juvenile rheumatoid arthritis.
In pregnancy & in breast feeding mothers.