Operate through inhibition of Cyclooxygenase enzymes COX-1 and COX-2 that convert arachidonic acid into pro-inflammatory prostaglandins, prostacyclins, and thromboxanes
Effective in reducing pain and inflammation
Can cause GI issues and increase the risk of MI and stroke (excluding Aspirin)
Medications in Family
Aspirin (acetylsalicyclic acid) - Primarily inhibits COX-1, reduces formation of blood clots, and can lower risk of MI and stroke. Less effective for pain
Ibuprofen - Common OTC medication for treating mild-moderate pain, weaker than many NSAIDs. Duration of up to 4-6 hours.
Naproxen - Used for treating mild-moderate and chronic pain. Possesses a longer duration of action of 8-12 hours
Celecoxib - COX-2 selective NSAID, effective in treating pain. Significantly increases risk of major cardiovascular complications, as well as kidney and liver issues.
Ketorolac - Strong NSAID used in treatment of moderate-severe pain. Should not be used for more than five consecutive days due to nephrotoxic concerns.
Local Anesthetics
Medications that cause an absence of pain sensation at a specific location in the body without inducing a loss of consciousness
Clinical local anesthetics typically belong to one of two classes: Aminoamides and Aminoesters
Often paired with vasoconstrictors to extend duration of action and reduce hemorrhage
Generally work by blocking sodium channels and decreasing the rate of contraction in the heart
Medications in Family
Cocaine - Ester anesthetic and tropane alkaloid derived from the leaves of two coca species. Stimulant with high abuse potential and increases blood pressure. Has limited medical use when vasoconstriction is desired with anesthetic effect, particularly with nasal cauterization in ENT
Benzocaine - Ester anesthetic. Primarily used as a topical anesthetic or in over-the-counter ointments and cough drops. Higher concentrations (10-20%) are often used to numb mucous membranes prior to local anesthetic administration with a needle. High concentrations can cause methemoglobinemia (lack of oxygen carried in the blood), particularly in young children.
Procaine - Ester anesthetic commonly known as Novocaine. Vasodilatory properties. Less frequently used today since hypoallergenic alternatives like Lidocaine exist. Max dose w/o vasoconstrictor: 7-10 mg/kg, duration of 20-30 minutes; Max dose w/ vasoconstrictor: 10 mg/kg, duration of 30-45 minutes.
Lidocaine - Aminoamide anesthetic very commonly used in dentistry and to treat ventricular tachycardia. Max dose w/o vasoconstrictor: 3-4.5 mg/kg, duration of 30-120 minutes; Max dose w/ vasoconstrictor: 6-7 mg/kg, duration of 120-240 minutes.
Articaine - Thiophene local anesthetic commonly called Septocaine and used more commonly in European countries than any other local anesthetic. Associated with higher risk of nerve damage during blocks, but penetrates dense cortical bone more easily than other local anesthetics. Max dose w/ vasoconstrictor: 7 mg/kg, duration of 60-240 minutes.
Mepivacaine - Aminoamide anesthetic with rapid onset and medium duration of action. Max dose w/o vasoconstrictor: 4.5-5 mg/kg, duration of 45-90 minutes; Max dose w/ vasoconstrictor: 7 mg/kg, duration of 120 minutes.
Bupivacaine - Aminoamide anesthetic with a long duration of action. Causes greater pain on injection compared to other local anesthetics and can damage cartilage when injected into a joint. Often used for post-operative pain. Cardiotoxic. Max dose w/o vasoconstrictor: 2-2.5 mg/kg, duration of 120-175 minutes; Max dose w/ vasoconstrictor: 2.5-3 mg/kg, duration of 180-480 minutes.