Assessment of Pain Medication Regime: NSAIDs vs Opioids

This essay assesses the effects of none-steroidal anti-inflammatory drugs (NSAIDs) and opioids on pain management. It reviews the patient's drug changes regime and the underlying effects of these drugs on the patient's state.

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Introduction
Drug medication is an important aspect in patient diagnosis management. This essay
assess patient Miller aged 37 years old taking pain drug administration to lower his lower
back pain. The patient has been taking cocodamol 8/500 two tabs QDS for the past week,
however there is still persistence of pain. This essay reviews patient drug changes regime and
the underlying effects of none –steroidal anti-inflammatory drugs vis-a-vis opioid on the
patient state.
Pain analgesia drug medication criteria
Medication administration incorporates appropriate decision-making skills and
effective clinical judgment which enable full understanding of the drug administration
(Agency for Healthcare Research and Quality, 2014). The administration of pain drug on the
patient offers analgesic. Key questions regarding patient status such as allergy information is
critical for accessing patient tolerability. Asking and probing the patient on presence of any
allergies, reactions, and severity is critical. Further, reviewing pateintassessment before
administering medication plays fundamental role.All medications necessitate requires
reviews of the patient lab values, pain assessments score, and respiratory assessments among
other crucial tests. Thus this will allow the patient receives the correct medication for pain
management (Milton, 2013).
Further careful calculation of the dosage requirements for the patient is crucial as it
reduces dosage errors and improves on adjustment and titration of the dosages.
Communicating with the patient on the new medication regime is essential. Patient answers
regarding the usage, dosage and special consideration and an opportunity to ask questions are
critically essential to asses any adverse reactions that might occur (Prakash et al., 2014).
Influence of pharmacology of NSAIDs and Opiates
None –steroidal anti-inflammatory drugs and opiates are widely used drugs for
management of pain. Opioid has been shown to mimic the endogenous actions of opioid
peptides through the interaction of the kappa opioid, mu and delta receptors in the body. The
opioid receptors entangled with G1 proteins and the related action of opioids is inhibitory.
The operation of the N-voltage operated calcium channels and open calcium-dependent

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inwardly potassium changes (Tacconelli et al., 2017). The resulting effect leads to
hyperpolarization and the reduction of the neuronal excitability. This leads to a significant
decrease in the intracellular cAMP, offering modulation release of nociceptive
neurotransmitters. The occurring inhibitory process of the prostaglandin synthesis occurring
in the cyclooxygenase is key analgesic action mode of the anti-inflammatory effects of
NSAIDS. The occurring inhibition of the cocli-oxygenase leads to adverse effects of this
drug. The resulting effect of the NSAIDs is the reduction of the prostaglandin production in
the CNS thus lowering pain effect (Pickering, 2018).
Ibuprofen administration for patient Miller aims at reducing the pain action occasioned
from osteoarthritis diagnosis. The Ibuprofen mechanism of action entails inhibition on the
cyclooxygenase (COX) enzymes, by conversion of the arachnoids acid to prostaglandin, this
leads to conversion into various enzymes which act as mediators on the reduction of pain,
inflammation, and reduction of fever. The drug is nonselective to COX inhibitors by
inhibiting two forms of isoforms of COX1 and COX2. The resultant analgesic antipyretic
effect and the consequential anti-inflammatory effect of the drug appears to work through the
COX 2 which reduces the synthesis action of the prostaglandins which is involved in the
mediation of the pain and swelling. The resultant antipyretic effects lead to action on the
hypothalamus activity, hence increased peripheral blood flow,vasodilatation elevation, and
heat dissipation thus reducing the pain (Manchia, Pinna & Denovan-Wright, 2016).
Adverse side effects of the drug include nausea, dyspepsia, constipation, dizziness,
headache, ulceration, fluid retention and elevation of blood pressure. Thus these observations
and the counteractions need to be monitored for the patient carefully.
Administration of co-codamol 30/500 to the patient is aimed at achieving relief of pain
from mild to moderate pain when the administered NSAIDs ibuprofen cannot offer the
needed pain relief. The therapeutic indications of the drug are geared at offering short term
pain relief for the patient due to the inability of the NSAIDs ibuprofen to offer relief effect.
Its mechanism of action entails the ability to allow exertion of prostaglandin synthesis. It has
mild sedative effects and less potent analgesic however its therapeutical effect of relieving
pain with a shorter period is curcial (Kennedy, Duggan, Bennett & Williams, 2019).
The drug could have significant contraindications on active substances such initiation
of hypersensitivity, diarrhoea, respiratory depression, and obstructive airways. Long term

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usage of the drug is likely to cause headaches and further risks of concomitant use can lead to
sedation (Torrance et al., 2018).
Liquid-Filled Capsules vs. Tablet Pills
Liquefied capsules tend to be absorbed faster compared to tablets thus offering a faster
mechanism of action. The drug nutrients tend to suspend in the form of liquid before being
broken down for usage. In capsule form, the body engages in breaking down the coating
surrounding the liquid then initiating absorption process, while the tablets have to be broken
down first completely taking longer duration. Averagely the liquid-filled capsule is broken
down and absorbed into the bloodstream and takes a few minutes while the tablet takes time
to be absorbed (Wheate et al., 2017).
Liquid capsules can be either hard or soft gels. The soft gels are easily broken down in
the body and enter into the bloodstream .The tablet pills are made from the granulate
powdered which its ingredients are pressed together during the manufacturing to making it
hard, they have two or more active ingredients and various recipients which help in holding
them more closely together. They have more additives and nonadditive ingredients compared
to the liquid capsules.
The liquid capsules pharmacokinetics is essential in that after its ingestion, it reaches
peak at 1-2 hours and 99% of the drug is bounded by the proteins. The greater portion of the
drug is metabolized in the body within 24 hours thus offering great relative on the pain state
of the patient, thus reducing and alleviating pain. The tablets are coated with protective
substances which protect them from the action of gastric acid in the stomach thus limiting its
breakdown until they reach the ileum. The liquid filled capsules are readily digestible in the
body and thus offer an analgesic effect of releasing of the pain as it is absorbed faster into the
body system (Bjarnason et al., 2018).
Usage of smaller doses of ibuprofen in transdermal gel compared to oral ingestion
Oral intake of ibuprofen has the ability to produce gastrointestinal effects on the body
of the patient while the transdermal administrations avoid contact of the GI, achieving the
therapeutic effect and lesser complications. The inhibition of COX1 has the ability to cause
GI effects such as nausea, vomiting, constipation and gastric upset (Rajabalaya, Musa, Kifli
& David, 2017). Further oral administration has been associated with poor absorption rate

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due to low solubility ad lowered dissolution rate (Irvine, Afrose & Islam, 2018).
The intake of ibuprofen at lower dosage levels forshorter duration of time is able to
relieve pain to the patient. The transdermal route allows the drug's ingredients to the body
thus offering a relieving effect. The transdermal delivery of smaller dosages is beneficial as it
leads to direct enterohepatic circulation system thus producing a more reliable clinical
outcome. The effect of the transdermal delivery is essential in that it is equivalent to
continuous IV infusion in none invasive system (Cater, Zhu, Patel & Kozwich, 2017).
Conclusion
This essay has reviewed pain management based on two classes of drugs; none –
steroidal anti-inflammatory and opioid classes which are essential in managing pain. Patient
assessment is critical in determination of appropriate drug dosage process. The mechanism of
these drugs ensures alleviation of pain. Administration of ibuprofen administered trans
dermaly offers a fast acting action mechanism thus relieving pain in short periods. Thus
patient Miller state is bound to improve based on the changes of the drug regime applied.

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