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Pharm 1 > 03, 04, 05. Pain: Opiates and non-opiates. > Flashcards

03, 04, 05. Pain: Opiates and non-opiates. Flashcards

1
Q

In order to activate and sensitize pain receptors, The cell produces either (1), or produces (A), (B) and (C).

This causes (X) and (Y)

A
  1. Bradykinin
    A. Arachidonic acid
    B. Cyclooxygenase
    C. Prostaglandins

X. Vasodilitation (redness, warmth, swelling) and Y. the notification of pain receptors.

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2
Q

How is pain classified?
By (A), as either (1) or (2),
By (B), as either (1) (2) or (3)

A
  • DURATION as acute or chronic

- ORIGIN as somatic, visceral or neuropathic

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3
Q

3 categories for pain management, and when to use them (in terms of a 1-10 pain scale)

A

1) Opiates / opioids or narcotics (legal term)
* *9-10 on pain scale
2) Nonopiates
* *1-3 on pain scale
3) Adjuvant
* * In between on the pain scale.

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4
Q

Therapeutic effects of opiates are due to the fact that they _____________ to decrease the level of pain.

A

Interfere with pain impulses

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5
Q

Most drug have a ________, meaning there is a point where an increased dose will not have any increased effects. Which drug does not?

A

Ceiling effects, Morphine

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6
Q

What is the prototype for opiates?

A

MORPHINE

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7
Q

Give three non-opiate prototypes:

A

Salisilates –> ASPRIN
NSAIDS –> IBUPROFEN (Advil)
Acetaminiphen –> (Tylenol)

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8
Q

______ refers to joint pain

A

Arthralgia

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9
Q

_______ refers to muscle pain

A

Myalgia

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10
Q

_______ refers to painful menstrual cycles

A

Dysmenorrhea

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11
Q

_______ refers to blood in the stool

A

Melena

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12
Q

______ refers to coughing up blood

A

Hemoptysis

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13
Q

_______ refers to vomiting blood

A

Hematemesis

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14
Q

________ refers to blood in the urine

A

Hematuria

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15
Q

________ refers to a bruise

A

Hematoma

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16
Q

________ refers to a nose bleed

A

Epistaxis

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17
Q

_______ means “acting like”

________ interferes with or inhibits

A

“agonist”

“antagonist”

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18
Q

________ interferes with blood coagulation

A

Anti-thrombotic

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19
Q

_______ means “prevention”

A

Prophylaxis

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20
Q

______________ (CVA) means _______

A

Cerebral vascular accident

STROKE

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21
Q

________ refers to a ringing in the ear

A

Tinnitus

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22
Q

_________ refers to vomiting

A

Emesis

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23
Q

(1) Pupil dilates

(2) Pupil constricts

A

1) Mydriasis

2) Miosis

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24
Q

PCA stands for ___________

A

Patient Controlled Analgesia

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25
Q

Increased ICP stands for _______

A

Increased Intracranial Pressure

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26
Q

_________ refers to a loss of appetite.

A

Anorexia

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27
Q

____________ refers to a low oxygen concentration in the blood.

A

Hypoxia

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28
Q

_________ refers to passing out, loss of consciousness

A

Syncope

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29
Q

________ means “from outside the body”

________ means “from inside the body”

A

Exogenous

Endogenous

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30
Q

Normal BP < ____ / _____

A

120/80

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31
Q

______ refers to low BP.

______ refers to high BP

A

Hypotension

Hypertension

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32
Q

According to the WHO, what drug categories should be used to treat a pain category of 1-3?

A

Non-opiod + adjuvant

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33
Q

According to the WHO, what drug categories should be used to treat a pain category of 4-6?

A

Opioid for mild to moderate pain
+ Non-opioid
+ Adjuvant

34
Q

According to the WHO, what drug categories should be used to treat a pain category of 7-10

A

Opioid for moderate to severe pain
+ Non-opioid
+ Adjuvant

35
Q

Give three examples of an Adjuvant:

A

Benzodiazopines
TCA
Corticosteroids

36
Q

What is an Adjuvant?

A

A medication that doesn’t treat pain, but treats other symptoms involved with pain. (Some enable sleep, some decrease nausea)

37
Q

What should you ask about pain?

  • 3 things AND
  • PQRST
A 
- Location, intensity, relation to time / activity
Precipitates / Provokes
Quality
Radiation
Severity
Timing
38
Q

When should you go back and reassess the pain with each type of administration?

  • PO
  • IM
  • IV
A
  • PO: Check back in 40-60 minutes
  • IM: Check back in 25-30 minutes
  • IV: Go back in 5-10 minutes
39
Q

4 categories of adverse effects of opiates

A
  • Depresses CNS
  • Depresses GI Tract
  • Alters psychological responses to pain
  • Produces euphoria
40
Q

3 manifestations of opiates depressing the CNS (Opiates)

A
  • Serious: Drop in Respiration

- Common: Sedation, Dizziness

41
Q

3 Common manifestations of depressing the GI tract (Opiates)

A

Nausea, Vomiting, Constipation

42
Q

5 clinical uses of opiates

A
  • Relief of moderate to severe pain
  • Acute pulmonary edema
  • Severe non-productive cough
  • Invasive diagnostic tests
  • Pre-op sedation
43
Q

Opiates should be sparingly or not at all for _____ because ______________.

A
  • Head trauma with increased intracranial pressure

- Opiates make it difficult to get an accurate neurological exam

44
Q

What should you do before administering opiates to a patient? (5)

A

Check vitals to know where you started

  • Esp respiratory
  • Check pain / pain levels
  • Listen to peristalsis
  • Ask about allergies
  • Tell them drug will make them sleepy / dizzy- “ask for help if you need to reach for something or get up”
45
Q

______ % of people prescribed opiate for pain relief become addicted.

A

<1%

46
Q

Opiate antagonists work by ____________

A

Displacing the opiate at the receptor site

47
Q

Name one opioid antagonist - generic and brand name

A

NALOXONE (Narcan)

48
Q

How do you care for a patient who has overdosed on opiates? (5)

A
  • Give them Naloxone (Narcan)
  • Repeated doses may be needed
  • Maintain respirations
  • Prepare to handle withdrawl
  • Monitor patient (may need to be intubated, on a respirator)
49
Q
  • Name four opiod agonists
A
  • Morphine
  • Demerol
  • Codeine
  • Dilaudid
50
Q

What is the agonist / antagonist prototype?

A

PENTAZOCINE

51
Q

What drug is often used post-partum?

A

Nalbuphine (Nubane), it’s an agonist/antagonist

52
Q

List eleven effects of opiate abuse

A
  • Depresses CNS
  • Droopy eyelids
  • Nodding head
  • Pupils are pinpoint and non-reactive to light
  • Slurred speech
  • Slower respiratory rate
  • Lower BP
  • Lower HR
  • Depresses GI tract
  • Dry skin
  • Slowed gait
53
Q

Opiate abuse during pregnancy can result in (3)

A
  • Lowered birthweight
  • Stillbirth
  • Addicted babies can die from withdrawal
54
Q

Cold turkey withdrawal from Opiates can last _____, and has the following symptoms: (7)

A
  • *5-7 days
  • Deep bone pain
  • Deep muscle pain
  • Chills
  • Fever
  • Diarrhea
  • Respirations up
  • Pulse up
55
Q
  • Two drugs used to treat withdrawal from opiates
  • Are they addictive?
  • Why are these better to be on than opiates? (3)
A
  • Methadone & Suboxone
  • Yes
  • Clearer head, prevents negative lifestyle factors involved with drugs, risk of overdosing is lower
56
Q

ASA

  • Name of drug
  • Prototype
A
  • Acetylsalicyclic Acid

- ASPRIN

57
Q

Four characteristics of Asprin

A
  • Analgesic
  • Anti-inflammatory
  • Antipyretic
  • Anti-thrombotic
58
Q

How many annual deaths from ASA?

A

16,000

59
Q

EIGHT adverse side effects of ASA

A
  • Tinnitus
  • Reye’s syndrome
  • N/V
  • GI System
  • Bleeding
  • Pregnancy issues
  • ASA sensitive asthma
  • Salsilate poisoning
60
Q

What is Reye’s syndrome?

A
  • High BP, seizures, brain damage, death
  • In children under 12
  • Due to taking Asprin during a viral illness
61
Q

What is salsilate poisoning - 6 characteristics

A
  • Drowsiness, confusion, sweating, thirst

- Imbalanced pH due to high CO2 levels & hyperventilation to balance the pH

62
Q

NSAID stands for

A

Non Steroidal Anti-Inflammatory Drugs

63
Q

NSAID Prototype

A

Ibuprofen (advil)

64
Q

NSAID Uses (4)

A
  • Analgesic
  • Anti-inflammatory
  • Antipyretic
  • Antithrombotic
65
Q

As an anti-thrombotic, how does asprin differ from ibuprofin?

A
  • Asprin binds to the platelet for the life of the platelet
  • Ibuprofin binds to the platelet for only 4 hours or so.
  • So we really don’t use ibuprofin for its antithrombotic properties.
66
Q

Adverse effects of NSAIDs

A
  • CNS (tinnitus)
  • Eyes
  • GI system (ulcers, bleeding - like asprin)
  • Renal system (Kidney necrosis - rare)
67
Q

NSAIDs drug interactions (7)

A
  • Steroids
  • Oral anticoagulants
  • Lithium
  • Oral hypoglycemics
  • Alcohol
  • Heparin
68
Q

Acetaminophen prototype

A

Tylenol

69
Q

2 therapeutic properties of tylenol

A
  • Analgesic

- Antipyretic

70
Q

Four examples of when you should use tylenol

A
  • Headache
  • Fever
  • Children under 12
  • People who are allergic to Asprin
71
Q

Tylenol is contraindicated for patients with ___ or ____.

A

Liver problems or kidney problems.

72
Q

Serious (2) and common (3) ADEs of acetametaphen

A
  • SERIOUS: Hepatic or renal toxicity

- COMMON: Rash, urticaria, nausea

73
Q

Tips for taking OTCs (7):

A
  • Read and follow package directions
  • Take at onset of pain
  • Don’t drink
  • Do not take if pregnant or nursing
  • Avoid drug interactions
  • Asthmatics should take special care
  • Elderly should take special care (due to increased chance of liver issues, and they are more likely to be taking lots of meds)
74
Q

Risk for acetemetophen overdose / hepatotoxicity starts at ____ grams or ___ tablets.

A

10 grams, 30 tablets

75
Q

Acetemetophen overdose: First 24 hours

  • 3 symptoms
  • Treatment plan
A
  • Diaphoresis, sweating, malaise
  • Can treat with acetylcystein (mucomyst)
  • Can also do a gastric lavage during the first 24 hours as well
76
Q

Talk about mucomyst / acetylcystein

  • Administration
  • What it does chemically
  • What it can prevent
A
  • Usually given orally
  • Prevents the metabolites from acetametaphen from binding in the proteins in the liver.
  • This may prevent liver failure
77
Q

Acetametophen overdose: 24-48 hours

- 2 symptoms

A
  • Begin to decrease the amount of urine produced

- Pain in upper right quadrant of abdomen due to the start of liver necrosis

78
Q

Acetometaphen overdose: 2-6 days

- Symptoms (6)

A
  • Bruising
  • Eyes become jaundiced
  • Renal failure
  • Bilirubins, liver enzymes go WAY up
  • Coagulation profiles are all out of whack
  • Can go into complete liver failure and death
79
Q
  • What is the prototype Cox 2 inhibitor?
A
  • Celecoxib (Celebrex)
80
Q

Celebrex:

  • What are its therapeutic effects (2)
  • ADEs?
A
  • Analgesic, anti-inflammatory
  • BLACK BOX WARNING! Rx only. Increases platelet activity, thus increasing the risk of clots. Patients at risk of coronary artery disease and carotid artery disease, and puts them at higher risk for myocardial infarction and stroke.

Pharm 1 (6 decks)

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