1 Reviewer No. 2: IAHPC List of Essential Medicines for Palliative ...
1 Reviewer No. 2: IAHPC List of Essential Medicines for Palliative ...
1 Reviewer No. 2: IAHPC List of Essential Medicines for Palliative ...
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2<br />
Table 1 : Review <strong>of</strong> the recommended medicines in relation to the symptoms<br />
Symptoms <strong>Medicines</strong> WHO essential <strong>Medicines</strong> Model <strong>List</strong><br />
Section, subsection and therapy. class<br />
1. Pain<br />
Mild to moderate Dicl<strong>of</strong>enac<br />
<strong>No</strong>n Opioid analgesic and NSAIMs<br />
Comments<br />
Adjunct to opioid <strong>for</strong> relief <strong>of</strong> post operative pain, better antiinflammatory<br />
comparatively to ibupr<strong>of</strong>en<br />
Decision<br />
ACL<br />
Tramadol<br />
Opioid analgesic<br />
Advantage in acute surgical pain not in chronic pain.<br />
ACL<br />
Moderate to severe<br />
Fentanyl<br />
Opioid analgesic<br />
Useful <strong>for</strong> procedural sedation, as injectable <strong>for</strong>m not patch<br />
AL<br />
Oxycodone<br />
Opioid analgesic<br />
Alternative to morphine<br />
Del<br />
Neuropathic<br />
Gabapentin<br />
Neuropathic pain<br />
Equal to tricyclic antidepressant, more effective when<br />
associated with morphine<br />
Del<br />
Visceral<br />
Hyoscine butylbromide<br />
Antimuscarinic<br />
Quaternary ammonium, less lipid soluble and less crossing<br />
the blood barrier than atropine. Only injectable <strong>for</strong>m<br />
AL<br />
2. Insomnia Diphenhydramine<br />
Sedative antihistaminic<br />
Prolonged sedation not recommended in children<br />
ACL<br />
Lorazepam<br />
Zolpidem<br />
Benzodiazepine<br />
<strong>No</strong>n benzodiazepine hypnotic<br />
Short acting carrying the risk <strong>of</strong> withdrawal in the treatment<br />
<strong>of</strong> insomnia, better indication in status epilepticus<br />
The magnitude <strong>of</strong> the effect is small in comparison to risk<br />
Del<br />
Del<br />
Trazodone<br />
3. Anxiety Midazolam<br />
Mono-amine-oxydase inhibitor<br />
Benzodiazepine<br />
Equivalent to imipramine<br />
Better efficacy when associated with anesthetics, analgesics<br />
Del<br />
ACL<br />
Lorazepam<br />
4. Depression Mirtazapine<br />
Benzodiazepine<br />
Presynaptic α2 antagonist<br />
Useful only as amnesic agent in premedication <strong>for</strong><br />
bronchoscopy or bone marrow biopsy, facilitates the<br />
investigations. Nevermore used as anxiolytic.<br />
<strong>No</strong>t different from the old antidepressant<br />
ACL<br />
Del<br />
Citalopram<br />
SSRI<br />
As a tricyclic antidepressant but useful in panic attack<br />
ACL
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