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disorders
Paracetamol / Acetaminophen
Indications
Paracetamol has good analgesic and antipyretic properties. It is suitable for the
treatment of pain from any orthopaedic pathology and is usually the first line drug. In
general, Paracetamol is less efficacious than salicylates and other antirheumatic agents
for problems that require anti-inflammatory treatment.
Paracetamol is well suited for use in children. Paracetamol appears to have little
potential for dependence. Paracetamol is safe in pregnancy and lactation.
Adverse reactions
When metabolized in the liver, small amounts of an intensely active metabolite, which
is normally immediately inactivated by glutathione, are produced. An overdose causes
a glutathione deficiency; the reactive metabolite may then cause hepatocellular
damage and necrosis leading to acute liver failure. Toxic effects have been observed
in adults treated with doses of more than 10 g (20 tablets). However, if there is a pre-
existing liver insufficiency, Paracetamol can be hepatotoxic even in small amounts.
The antidote N- acetyl cysteine must be administered within 8 to 10 hours when there
is intoxication.
Contraindications
Hypersensitivity to Paracetamol.
NSAID
Ibuprofen
Indications
Ibuprofen is suited for the treatment of pain, in particular of pain related to the
musculoskeletal system. Pain accompanying arthritis can be reduced and the mobility
of the joints can be increased. Non-steroidal anti-inflammatory agents only have a
symptomatic effect on joint diseases; the development of the disease is not
significantly influenced. In average, ibuprofen has proven equally as efficient as other
anti-inflammatory drugs in all areas of application (e.g. diclofenac, indomethacin, and
naproxen).
Adverse reactions
Anti-inflammatory drugs have other side-effects like vertigo, headaches, skin rashes,
increase of liver enzymes, etc. Dangerous renal complications (water and salt
retention, acute renal failure), hepatitis, and general hypersensitive reactions (fever,
hypertension, and aseptic meningitis) are rare.
Contraindications
Diclofenac
Indications
Adverse reactions
Dangerous reactions such as bleeding gastric ulcers, perforations, hepatitis and renal
failure are rare.
Patients with pre-existing heart failure, hypertension or renal failure are more prone to
the development of renal function disorders and should be observed closely after the
beginning of the treatment.
Contraindications
Active gastric or duodenal ulcers. Aspirin intolerance. All NSAIDs are better avoided
in third trimester of pregnancy.
Codeine
Indications
Codeine is suitable for the treatment of mild and moderate pain. A minority of the
population does not respond to the analgesic effect. Codeine can be combined
advantageously with non-opioid analgesics. Aspirin (500 mg), Paracetamol (500 mg),
or other more recent non-steroidal anti-inflammatory agents can be suitably combined
with codeine (30 mg).
Adverse reactions
In many cases the imperative constipating effect of codeine is undesired and it is often
a reason against long-term use of the drug. Vomiting and nausea also occur regularly.
All the other opioid side-effects are also present with codeine but they are
comparatively mild. Retention of urine, itching, vertigo, palpitations or bradycardia,
sweating, and mild central nervous effects (sedation, mood changes, and some
hallucinations) have been observed.
Contraindications
Morphine
Morphine is the principal medical alkaloid of opium. Its effect at the µ-receptors in
the central nervous system is said to be responsible for analgesia, euphoria,
dependence potential and respiratory depressions. Morphine also binds with k-
receptors which mediate spinal analgesia, miosis and sedation.
Indications
Morphine still is the drug of choice for the treatment of severe acute or chronic pain.
Adverse reactions
Contraindications
Corticosteroids are hormones that are produced naturally by the adrenal glands. They
have many important functions in the body, including control of inflammatory
responses. Corticosteroid medicines are man-made derivatives of the natural
hormones.
Triamcinolone
Local complications:
Glucosamine
The possible effects of glucosamine sulfate in patients with osteoarthritis may be the
result of its anti-inflammatory activity, the stimulation of the synthesis of
proteoglycans and the decrease in catabolic activity of chondrocytes inhibiting the
synthesis of proteolytic enzymes and other substances that contribute to damage
cartilage matrix and cause death of articular chondrocytes.
Clinical use
Safety
Clinical studies have consistently reported that glucosamine appears safe. Since
glucosamine is usually derived from shellfish, those allergic to shellfish may wish to
avoid it. It does not interfere with control of diabetes.
Chondroitin sulphate
Clinical use
Safety
Clinical studies have not identified any significant side effects or overdoses of
chondroitin sulfate, which supports its long-term safety.