ANALGESICS FOR

TREATMENT OF ACUTE
OCULAR PAIN
Dr. Paula Eunice C. Felix
ANESTHETIC VS ANALGESIA
 OCULAR PAIN
Ocular pain, or eye pain, can manifest as discomfort on the eye's
surface (scratching, burning, itching) or deeper within (stabbing,
throbbing) and can stem from various causes, ranging from mild
irritations to serious conditions.

Types of Ocular Pain:

● Ocular pain:
○ Pain experienced on the surface of the eye,
often described as itching, burning, or a
scratching sensation.
● Orbital pain:
○ Pain felt deeper within the eye, which may be
described as stabbing, throbbing, or aching.
 OCULAR PAIN
Common Causes of Ocular Pain:
1. Surface-related:
a. Trauma: Injury to the eye.
b. Infection: Bacterial, viral, or fungal infections of the eye.
c. Foreign objects: Something lodged in the eye.
d. Dry eyes: Insufficient tear production.
e. Contact lens problems: Irritation or infection caused by contact
lenses.
f. Allergies: Eye irritation from allergens.
2. Deep-seated:
a. Glaucoma: Increased pressure inside the eye.
b. Uveitis: Inflammation of the middle layer of the eye.
c. Scleritis: Inflammation of the outer layer of the eye (sclera).
d. Endophthalmitis: Infection inside the eye.
e. Orbital cellulitis: Infection of the tissues around the eye socket.
f. Orbital pseudotumor: Non-cancerous swelling in the eye socket.
3. Other:
a. Neuropathy: Nerve damage.
b. Eyestrain: Fatigue of the eye muscles.
c. Migraine: Headaches that can cause pain behind the eyes.
d. Sinus problems: Sinus infections can cause pain behind the eyes.
 OCULAR PAIN
When to Seek Medical Attention:
1. Severe or persistent pain: If the pain is intense or doesn't
subside after a few hours.
2. Vision changes: Blurred vision, halos around lights, or vision
loss.
3. Swelling or redness: Visible swelling or redness of the eye or
surrounding tissues.
4. Nausea or vomiting: These symptoms can accompany eye
pain.
5. Sensitivity to light: Increased pain or discomfort in bright light.
6. Recent eye trauma: If you have experienced an injury to the
eye.
7. Difficulty opening the eye: If you have trouble opening your
eye.
8. Known foreign body or other injury: If you suspect something is
in your eye or you have a known eye injury.
 ANALGESIA
Analgesia refers to pain relief without causing loss of consciousness. It is used to
manage pain during and after medical procedures or due to conditions like
arthritis, injuries, or cancer.

Types of Analgesia

A. Narcotic Analgesics (Opioids)

B. Non-Narcotic Analgesics
 NARCOTIC ANALGESICS
● Definition: Powerful pain relievers that work on the central nervous
system (CNS) by blocking pain signals in the brain.
● Used for:
○ Severe pain (e.g., post-surgical pain, cancer pain).
○ Acute or chronic pain that does not respond to milder painkillers.
● Common Drugs:
○ Morphine (used in hospitals for severe pain).
○ Fentanyl (extremely potent, used in surgeries or for chronic pain).
○ Oxycodone, Hydrocodone (prescribed for severe injuries or
post-surgery).
● Effects:
○ Strong pain relief.
○ Sedation or drowsiness.
● Risks:
○ High risk of addiction, dependence, and overdose.
○ Side effects include nausea, constipation, and respiratory
depression.
 NON-NARCOTIC ANALGESICS
● Definition: Pain relievers that are not addictive and do not act on the CNS
like opioids.
● Used for: Mild to moderate pain (e.g., headaches, muscle aches, joint pain).
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
● Definition: Reduce pain and inflammation by blocking prostaglandins,
chemicals responsible for swelling and pain.
● Common Drugs:
○ Ibuprofen (Advil, Motrin) – Used for fever, muscle pain,
arthritis.
○ Naproxen (Aleve) – Longer-lasting than ibuprofen, used
for arthritis or menstrual cramps.
○ Aspirin – Also used for heart disease prevention
● Effects:
○ Pain relief, fever reduction, anti-inflammatory.
● Risks:
○ Stomach irritation, ulcers, and kidney issues with long-term use.
 NON-NARCOTIC ANALGESICS
2. Acetaminophen (Paracetamol, Tylenol)

● Definition: A mild pain reliever that reduces fever but has little
anti-inflammatory effect.
● Used for:
○ Fever, headaches, mild pain (e.g., after dental procedures).
○ Risks:
○ Liver damage if taken in high doses.
MECHANISM OF PAIN AND ANALGESIA
 MECHANISM OF PAIN AND ANALGESIA
● Definition of Pain:
○ Pain is a subjective sensory and emotional experience linked
to tissue damage.
○ It has both biological and psychological components that
must be addressed for effective relief.
● Types of Pain:
○ Acute Pain: Short-term, with a specific and obvious cause
(e.g., trauma, surgery).
○ Chronic Pain: Requires different management strategies.
● Acute Ocular Pain:
○ Generally has a clear cause and is predictable.
○ Often managed with topical agents that have fewer side
effects than systemic medications.
○ Some patients may need additional oral analgesics.
 MECHANISM OF PAIN AND ANALGESIA
● Pain Mechanism in the Eye:

○ Nociceptors: Specialized pain receptors in the eye and orbit.

○ Pain Triggers: Can be mechanical (trauma) or chemical (e.g.,
serotonin, histamine, prostaglandins).
○ Pain Signal Transmission:
■ Starts at nociceptors → Travels via the trigeminal
nerve → Reaches the brainstem and somatosensory
cortex.
● Physiologic & Emotional Impact of Pain:

○ Can cause tachycardia, hypertension, and increased heart

workload, especially in cardiac patients.
○ Unmanaged pain can lead to anxiety, poor sleep, and slow
recovery.
 MECHANISM OF PAIN AND ANALGESIA
Pain Management Strategies:

1. Peripherally Acting Agents:

○ Block pain mediators at the site of injury.

○ Example: NSAIDs (e.g., aspirin) block prostaglandins.
2. Anesthetic Agents:

○ Interrupt pain signals between the peripheral source and the brain.
○ Caution: Long-term use of topical anesthetics can cause
complications.
3. Centrally Acting Agents:

○ Affect the central nervous system (CNS) to reduce both pain

perception and emotional distress.
○ Example: Opioid analgesics.
 NON-OPIOID (NON-NARCOTIC)
● ANALGESICS
Nonopioid Analgesics for Mild to Moderate Pain
○ NSAIDs are the most effective and commonly used.
○ Acetaminophen is an alternative but lacks anti-inflammatory effects.

Salicylates (Aspirin) Overview:

● Mechanism of Action:

○ Inhibits prostaglandin E2 synthesis via irreversible cyclooxygenase (COX) inhibition.

○ Works mainly in peripheral tissues but also has central pain perception effects.
● Clinical Uses:

○ Effective for pain with inflammation, but often replaced by other NSAIDs due to GI side effects.
○ Can be combined with narcotics for severe pain.
○ Various formulations exist, including enteric-coated and buffered aspirin to reduce stomach irritation.

Dosage & Administration:

● Standard Dose: 325–650 mg every 4 hours (max: 4 g/day).

● Should be taken: With food and water to minimize GI irritation.
 NON-OPIOID (NON-NARCOTIC)
ANALGESICS
Side Effects & Risks:

1. Gastrointestinal (GI) Issues:

○ Most common side effect (dyspepsia, irritation, bleeding, ulcers).
○ Enteric-coated aspirin or misoprostol can reduce GI toxicity.
2. Bleeding Risks:
○ Inhibits platelet aggregation → prolonged bleeding time (12–15 days).
○ Not recommended for patients undergoing surgery or with bleeding disorders.
3. Hypersensitivity Reactions:
○ More common in asthmatics, rhinitis, or nasal polyps (“Aspirin Triad”).
○ Can cause respiratory distress, rash, or anaphylaxis.
4. CNS Effects:
○ Headache, tinnitus, dizziness, confusion (especially in elderly).
5. Renal & Cardiovascular Effects:
○ Can worsen hypertension, fluid retention, and heart failure.
6. Reye ’s Syndrome Risk:
○ Children & teenagers should avoid aspirin during viral infections (influenza, chickenpox) due to
risk of fatal encephalopathy.
 NON-OPIOID (NON-NARCOTIC)
ANALGESICS
Alternative Options:

● Acetaminophen (if aspirin is contraindicated).

● Nonacetylated Salicylates (for patients with aspirin sensitivity
or GI issues).

Conclusion:
Aspirin is an effective nonopioid analgesic but must be used cautiously
due to its GI, bleeding, and hypersensitivity risks. Alternative NSAIDs
or acetaminophen may be safer options in certain patients.
NON-OPIOID (NON-NARCOTIC)
ANALGESICS
NON-SALICYLATE NON-STEROIDAL ANTI
INFLAMMATORY DRUGS
 NON-SALICYLATE NON-STEROIDAL ANTI
INFLAMMATORY DRUGS
1. Analgesic Efficacy & Use Cases

● Effective alternatives to aspirin for mild to moderate pain and ocular pain.
● Primarily used for anti-inflammatory effects but also function as analgesics.
● Types: Propionic acid derivatives, COX-2 inhibitors, and other agents.
● Used in postoperative and posttraumatic pain, often delaying the need for narcotics.
● Individual response to NSAIDs varies; alternatives should be considered if a drug is
ineffective.

2. Mechanism of Action

● Inhibits cyclooxygenase (COX) enzymes, reducing pain sensitizers.

● Ceiling effect: Increasing the dose beyond a certain point does not enhance efficacy.
● No tolerance or addiction with chronic use.
 NON-SALICYLATE NON-STEROIDAL ANTI
INFLAMMATORY DRUGS
3. Side Effects & Safety Considerations

● Gastrointestinal (GI) issues: Possible ulceration, bleeding, dyspepsia, and

perforation.
○ High-risk NSAIDs: Piroxicam, ketoprofen, azapropazone.
○ Lower-risk NSAIDs: Ibuprofen, fenoprofen, diclofenac, nabumetone, sulindac.
○ Preventive measures: Taking NSAIDs with food, milk, or antacids; proton
pump inhibitors for GI protection.
● CNS effects: Possible memory loss, confusion (elderly), headaches.
● Platelet function: NSAIDs inhibit platelet aggregation temporarily, unlike aspirin’s
irreversible effect.
● Renal concerns: Increased risk of acute renal failure in patients with heart failure,
kidney disease, cirrhosis, or diabetes.
● Cardiovascular risks: May contribute to heart failure and hypertension
exacerbation.
 NON-SALICYLATE NON-STEROIDAL ANTI
INFLAMMATORY DRUGS
4. Contraindications

● Peptic ulcer disease: Can cause severe GI bleeding.

● Aspirin/NSAID hypersensitivity: Avoid in patients with asthma, rhinitis, or allergic
reactions.
● Renal insufficiency: High risk of kidney damage.
● Pregnancy & nursing: Avoid, particularly in the third trimester, due to risks to the
infant’s cardiovascular system.

5. Patient Guidance

● Avoid aspirin and alcohol while on NSAID therapy.

● Take with food or antacids to minimize GI discomfort.
● Monitor for GI bleeding symptoms (black stools, severe stomach pain).
● Consider alternative analgesics (opioids, tramadol, acetaminophen) if NSAIDs are
unsuitable.
 ACETAMINOPHEN
1. Overview & Uses

● One of the most commonly used analgesics in the U.S.

● First-line treatment for mild to moderate pain; also used as an adjunct to
narcotics for severe pain.
● Key Differences from NSAIDs:
○ No significant anti-inflammatory effects (not ideal for inflammatory
pain).
○ Does not cause GI irritation, platelet inhibition, or bleeding risks.
○ Safer for use in children (no Reye’s syndrome risk), pregnant
women, and those with bleeding disorders.

2. Mechanism of Action

● Exact site and mechanism are unclear, but CNS involvement is suspected.
● Weak inhibitor of prostaglandin synthesis, making it less effective than
aspirin for inflammatory pain.
 ACETAMINOPHEN
3. Clinical Uses & Safety

● Safer alternative when NSAIDs or aspirin are contraindicated (e.g.,

allergies, GI ulcers, bleeding disorders).
● Safe for pregnancy & breastfeeding, with no known risks to infants.
● Available in multiple formulations (tablets, capsules, liquids,
suppositories) for different patient needs.
● Dosage: 325–1,000 mg every 4 to 6 hours; do not exceed 4 g/day for
short-term use.

4. Side Effects & Toxicity

● Minimal side effects at recommended doses.

● Overdose risk (>7.5 g): Can cause severe liver toxicity and death
(lethal dose: 13–25 g).
● Chronic alcohol use + acetaminophen = High liver damage risk,
even at therapeutic doses.
 ACETAMINOPHEN
5. Contraindications & Precautions

● Use with caution in:

○ Chronic alcoholics (increased risk of liver failure).
○ Patients with preexisting liver disease.
○ Those taking barbiturates, phenytoin, or rifampicin (increased
hepatotoxicity risk).
● FDA Warning: Individuals consuming >3 alcoholic drinks per day
should consult a doctor before using acetaminophen.
ACETAMINOPHEN
NON NARCOTIC COMBINATIONS
1. Overview & Usage

● Combination products mix nonnarcotic analgesics with other agents.

● Commonly used for self-treatment of minor pain conditions like headaches.
● Efficacy data is limited, but these products remain popular.

2. Common Ingredients & Their Roles

● Analgesics: Acetaminophen, salicylates, salsalate, salicylamide.

● Sedatives: Barbiturates, meprobamate, antihistamines.
● Gastroprotection: Antacids to reduce gastric irritation from salicylates.
● Adjuvants:
○ Caffeine: Enhances effectiveness for vascular headaches.
○ Belladonna alkaloids: Provide antispasmodic effects.
○ Pamabrom (diuretic) & Cinnamedrine (sympathomimetic amine): Used in
premenstrual syndrome (PMS) treatments.
NON NARCOTIC COMBINATIONS
 OPIOID (NARCOTIC)
●
ANALGESICS
Definition & Classification

Opioids (previously called narcotic analgesics) include natural, semi-synthetic, and synthetic compounds
with morphine-like analgesic effects.
● Classified as agonists, partial agonists, and mixed agonist–antagonists based on receptor activity.
● Bind primarily to mu and kappa opioid receptors to relieve pain.
● Morphine is the standard for comparison among opioids.

Pharmacology & Mechanism of Action

● Mimic endorphins, acting on opioid receptors in the brain, brainstem, and spinal cord.
● Affect both pain perception and emotional response to pain.
● Most opioids do not have a ceiling effect, meaning higher doses provide more pain relief but increase side
effects.

Clinical Use

● Opioids are preferred for severe acute pain but should be used cautiously due to tolerance, dependence,
and side effects.
● Combination with NSAIDs or acetaminophen enhances pain relief while minimizing opioid dose and side
effects.
 OPIOID (NARCOTIC)
ANALGESICS
Key Clinical Guidelines

1. Opioid doses should be individualized and adjusted as needed for pain control.
2. Avoid alcohol & other CNS depressants while on opioids.
3. Monitor for respiratory depression, especially in high-risk patients.
4. Use non-opioid analgesics whenever possible to reduce opioid reliance.
5. Opioid prescriptions should balance pain management with addiction risk awareness.
OPIOID (NARCOTIC)
ANALGESICS
Common Opioids & Their Properties

1. Morphine – Effective but high potential for addiction &

side effects, limiting outpatient use.
2. Codeine – Metabolized to morphine (ineffective in patients
with P-450 deficiency). Used with acetaminophen or
aspirin.
3. Oxycodone – 10–12 times stronger than codeine;
available in combination formulations; high abuse
potential.
4. Hydrocodone – 6 times stronger than codeine, with less
sedation & constipation.
5. Propoxyphene – Weak analgesic, no better than placebo
alone; often combined with aspirin or acetaminophen.
6. Tramadol – Weak opioid with low abuse potential but
contraindicated in patients taking MAOIs.
Side Effects & Safety Concerns

● Common side effects: Drowsiness,

dizziness, nausea, vomiting, constipation,
respiratory depression.
● Serious risks: Respiratory depression
(especially in patients with lung disease),
potential for addiction, and overdose.
● Opioids should be avoided in patients
with COPD, asthma, kidney/liver
dysfunction, and depression/suicidal
tendencies.
Contraindications & Precautions

● Avoid in patients allergic to opioids due to cross-sensitivity.

● Use with caution in pregnancy due to potential neonatal withdrawal and respiratory depression.
● Breastfeeding mothers should wait 4–6 hours after taking opioids to minimize drug exposure to
infants.
 GENERAL STRATEGIES FOR PAIN
MANAGEMENT
Important Notes on Analgesic Therapy for Acute Ocular Pain

General Approach:

● Diagnosis first: Identify the cause of pain and initiate specific treatment.
● Pain tolerance varies: Adjust analgesic therapy based on pain severity, not just objective findings.
● Patient history is crucial: Consider systemic diseases, allergies, drug interactions, and pregnancy before
prescribing analgesics.
● Use the simplest and safest option: Prioritize non-opioid analgesics when possible.
● Scheduled dosing: Provide 24-hour pain relief to prevent pain recurrence.
● Oral administration is preferred for ease, effectiveness, and convenience.
 GENERAL STRATEGIES FOR PAIN
MANAGEMENT
Stepwise Pain Management:

1. Mild to moderate pain: Start with NSAIDs (ibuprofen, ketoprofen) or acetaminophen.

○ Aspirin/acetaminophen ceiling dose: 1,300 mg per dose (exceeding this does not enhance effect).
○ If ineffective, switch to a different NSAID rather than increasing the dose.
○ Avoid NSAIDs in thrombocytopenic or surgical patients due to bleeding risk.
2. Moderate to severe pain:

○ Use opioids (oxycodone, hydrocodone, codeine) if non-opioids are insufficient.

○ If opioid side effects occur, adjust dose or switch to an alternative opioid.

Enhancing Analgesia:

● Adjuvant treatments: Pressure patching, bandage contact lenses, cold compresses, cycloplegics.
● Caffeine may enhance pain relief and counteract opioid-induced drowsiness.
● Topical anesthetics should never be used long-term due to high risk of complications.
ANALGESICS IN CHILDREN
 ANALGESICS IN CHILDREN
General Guidelines:

● Few opioid and nonopioid analgesics have widely accepted pediatric dosage guidelines.
● Use FDA-approved dosage schedules for safety.

Treatment of Mild to Moderate Pain:

● Aspirin is avoided in children due to its association with Reye’s syndrome.

● Acetaminophen is the preferred first-line treatment due to its safety and effectiveness.
○ Dosage: 10 mg/kg orally or 10–15 mg/kg rectally every 4 hours (max: 5 doses/24 hours).
○ Rectal absorption may be inconsistent, requiring higher doses.
● NSAIDs (ibuprofen, naproxen, tolmetin) are effective for inflammatory pain and can reduce opioid
need.
○ Must be taken with meals to prevent gastritis.
○ If GI side effects occur, switch to a different NSAID.
 ANALGESICS IN CHILDREN
Treatment of Moderate to Severe Pain:

● Opioids are combined with nonopioids (e.g., acetaminophen) for better pain relief.
● Codeine is the most commonly prescribed opioid for children older than 3 years.
○ Dosage: 0.5–1.0 mg/kg orally, combined with 10 mg/kg acetaminophen every 4–6 hours.
○ The acetaminophen dose should not exceed 15 mg/kg every 4 hours.
● Oral administration is preferred for convenience and effectiveness.

Managing Side Effects:

● Constipation: Use stool softeners or cathartics.

● Nausea & vomiting: Usually improve with time but can be treated with antihistamines (hydroxyzine,
promethazine).
● Sedation/drowsiness: Lower the opioid dose to minimal effective levels.
● Respiratory depression (rare in children): Usually managed by reducing the opioid dose.
 ANALGESICS USED IN ELDERLY PATIENTS
General Considerations for Pain Management in the Elderly

● Increased Risk of Drug Side Effects: Elderly patients are more prone to gastrointestinal
(GI) issues, renal impairment, and hepatic dysfunction, which can affect drug metabolism
and increase toxicity risks.
● Higher Likelihood of Drug Interactions: Due to polypharmacy (use of multiple
medications), elderly patients face a greater risk of adverse drug interactions when taking
analgesics.
● Altered Drug Metabolism:
○ Reduced renal function increases the risk of NSAID-induced acute kidney
injury (AKI), especially in patients on diuretics or those with heart failure, liver
disease, or kidney disease.
○ Reduced hepatic function slows metabolism of opioids, increasing their effects
and potential toxicity.
● CNS Sensitivity: Elderly patients are more sensitive to the central nervous system (CNS)
depressant effects of opioids, leading to increased risks of sedation, confusion, and
respiratory depression.
Safer Analgesic Options for Elderly Patients
Nonopioid Analgesics:

● Acetaminophen: Preferred first-line analgesic due to its minimal impact on renal function. Short-term use is considered
safe, but long-term use at high doses should be monitored.
● NSAID Alternatives:
○ Sulindac (Clinoril) and nonacetylated salicylates are safer for those with renal impairment.
○ Ibuprofen and diclofenac are possible options, as they do not accumulate significantly in renal impairment.

Managing NSAID-Induced GI Risks

● Older patients, especially women, are at a higher risk of NSAID gastropathy, which can cause GI bleeding and
ulcers.
● Strategies to reduce NSAID-related GI issues include:
1. Selecting NSAIDs with lower gastric irritation potential, such as ibuprofen, fenoprofen, diclofenac, COX-2
inhibitors, choline–magnesium salicylate, enteric-coated aspirin, or acetaminophen.
2. Adding gastroprotective agents, such as:
■ H2 blockers (e.g., ranitidine, famotidine) for acid suppression.
■ Misoprostol (Cytotec), a synthetic prostaglandin E1 analogue that protects the gastric mucosa.
■ Proton pump inhibitors (PPIs) like omeprazole (Prilosec), which significantly reduce gastric acid
secretion and may have fewer side effects than misoprostol.
● For elderly patients undergoing cataract surgery or those with bleeding disorders, acetaminophen or nonacetylated
salicylates are preferred due to their minimal impact on platelet aggregation.
Stepwise Approach to Pain Management in Elderly Patients

1. Treatment of Mild to Moderate Pain

● First-line therapy: Acetaminophen 650–1,000 mg (maximum 4,000 mg/day).

● If pain persists, switch to an NSAID (if no contraindications exist).
● If NSAID is ineffective, try an alternative NSAID from a different class.
● If the alternative NSAID is still ineffective, consider combining full-dose acetaminophen with an
NSAID.
● Avoid using multiple NSAIDs together due to increased risk of side effects.
● Opioids should be avoided unless absolutely necessary.

2. Treatment of Moderate to Severe Pain

● Opioid use should be minimized due to higher risks of toxicity, sedation, and respiratory
depression.
● Preferred opioid regimens include:
○ Acetaminophen + codeine (15–60 mg) OR oxycodone (5–30 mg).
○ Hydrocodone-acetaminophen combinations are also commonly used.
● If pain persists, switch to an alternative opioid.
● Caffeine can be used as an adjuvant to enhance opioid analgesic activity.
Managing Common Opioid Side Effects in the Elderly

1. Constipation (Most Common Side Effect in Elderly Patients)

● Opioid-induced constipation is particularly problematic in older adults and should be proactively managed.
● Recommended laxative regimen:
○ Psyllium (fiber supplement) + stool softener (docusate sodium).
○ If additional relief is needed, add a mild stimulant laxative such as bisacodyl (Dulcolax).

2. Nausea and Vomiting

● More pronounced in elderly patients due to vestibular sensitivity and slowed metabolism.
● Strategies to reduce nausea:
○ Limit movement to reduce vestibular stimulation.
○ Use antiemetics if needed—hydroxyzine is preferred over phenothiazines due to fewer side effects.
○ Avoid routine use of antihistamines, as their anticholinergic effects can cause confusion and drowsiness in elderly
patients.

3. Sedation and CNS Depression

● Opioids have enhanced sedative effects in elderly patients, especially those with:
○ Preexisting CNS dysfunction (e.g., stroke, dementia).
○ Chronic conditions affecting respiratory function (e.g., COPD, obesity).
● Strategies to reduce sedation risk:
○ Use the lowest effective opioid dose and monitor response.
○ If excessive sedation occurs, reduce opioid dose or switch to a different opioid.
4. Respiratory Depression

● More likely in elderly patients due to age-related decline in respiratory function.

● High-risk groups:
○ Patients with obesity or COPD (reduced CO₂ drive).
○ Patients with underlying CNS depression (stroke, dementia).
● If respiratory depression occurs:
○ Reduce opioid dose or discontinue if necessary.
○ Monitor oxygen levels closely.

5. Urinary Retention

● More common in elderly men with benign prostatic hypertrophy (BPH).

● Monitor for urinary retention and reduce opioid dose if symptoms develop.

Key Takeaways for Analgesic Use in Elderly Patients

✅ Acetaminophen is the safest first-line option for mild to moderate pain.

✅ NSAIDs should be used cautiously due to risks of GI bleeding, renal impairment, and cardiovascular effects.
✅ NSAID gastropathy can be reduced with PPIs, H2 blockers, or misoprostol.
✅ Opioids should only be used for moderate to severe pain and in the lowest effective doses.
✅ Common opioid side effects (constipation, nausea, sedation, respiratory depression) should be proactively managed.
✅ Close monitoring is essential to avoid drug toxicity and adverse reactions.
ASSIGNMENT: DUE ON APR
11 Ocular Anesthetics and
● Create a chart/table on the different
Analgesics that are used, base on the book by Bartlett plus online
articles/journals. Make sure to include:
○ Name
○ Type of Medication (Anes/Analg, Chemical derivative)
○ Category (Parasympathomimetic/lytic, Sympathomimetic/lytic/
none)
○ Mode of Action
○ Mode of Administration
○ Desired Effect (Systemic & Ocular)
○ Adverse Effect (Systemic & Ocular)
○ Contraindications
● Be creative, make it colorful and understandable, for our reviewer.
 REFERENCES
● Ocular Drug Delivery PPT by Crisfel R. Del Mundo, MSc, RPh
● Ocular Drug Delivery System PPT and Video by AV Badari Nath
● Clinical Ocular Pharmacology by Jimmy D. Bartlett & Siret D.
Jaanus
● Eye Pain: Causes, Common Conditions & Treatment, Cleveland Clinic
● Ocular Neuropathic Pain - StatPearls - NCBI Bookshelf
● Aug 25, 2023 — Ocular neuropathic pain may present with
accompanying visible damage to tissue; however, it can also occur
as a result...., NCBI
● Eye Pain: Causes, Treatments, and Prevention - Healthline