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PHARMACOLOGY > 13-Drugs for Pain > Flashcards

13-Drugs for Pain Flashcards

1
Q

Nociceptor pain

A
  • pain produced by tissue injury

- receptors on nerve endings are activated & transit pain signals to the CNS

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2
Q

What are the 2 divisions of nociceptor pain? What are the pain descriptors?

A
  1. Somatic pain - sharp localized pain

2. Visceral pain - generalized dull, throbbing/aching pain

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3
Q

Neuropathic pain (what causes it & pain descriptors)

A
  • pain caused from damage to neurons (due to a lesion/disease)
  • direct nerve injury (damage from surgery, diabetic neuropathy, etc.)
  • pain descriptors: burning, shooting, numbness
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4
Q

Acute vs Chronic pain

A

Acute: Intense pain occurring over a defined period of time (from injury to recovery/repair) - less than 6 months

Chronic: pain lasts longer than 6 months, interferes with daily activities, high incidence of depression. Not the same as end of life pain!

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5
Q

Explain what happens when tissue is damaged.

A

Tissue damage –> arachidonic acid is present –> converted to prostaglandins that blocks platelet aggregation and contributes to pain & inflammation.

Pain mediators such as histamine, bradykinins and PGs are released. Cytokines like pyrogens cause fever.

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6
Q

Substance P

A
  • A neurotransmitter that is involved in the transmission of pain messages to the brain
  • activates post-synaptic neurons –> pain signal travels along the thalamic tract to the brain
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7
Q

What 3 things inhibit the release of substance P?

A
  • opioids (enkephalins)
  • serotonin
  • NE

These 3 substances send inhibitory signals down the descending tract (modulates the release of substance P).

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8
Q

Briefly describe steps in the transmission of acute pain.

A
  1. Tissue injury/trauma
  2. Pain transduction (release of mediators)
  3. Pain transmission: afferent neural transmission - to the CNS –> signal reaches spinal cord receptors (substantia gelatinosa)
  4. Pain perception & modulation: transmission to the brain (via the spino-thalamic tract)

*After pain transmission, there can be a reflex sympathetic response to the painful stimulus.

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9
Q

Pain Physiology

A
  1. Transduction: trauma stimulates nociceptors
  2. Transmission to peripheral nerves: pain impulse travels to spinal cord through A and C fibres
  3. Transmission in spinal tracts: Impulse continues along ascending tracts
  4. Perception: cortex recognizes pain stimulus
  5. Modulation: limbic system reacts to pain; modulating signals are sent along descending tracts.
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10
Q

T or F: The production and transmission of painful impulses can be modulated at specific stages of transduction/transmission.

A

False, it can be modulated at almost every stage.

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11
Q

Tylenol 3 contains?

A
  1. Acetaminophen: modulates substance P
  2. Codeine: an opioid
  3. Caffeine: enhances absorption
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12
Q

Vicodin

A

hydrocodone (opioid) + acetaminophen

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13
Q

What type of therapy refers to the use of varied techniques and multiple drug classes to achieve effective analgesia?

A

multi-modal therapy

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14
Q

Non-opioid analgesics includes:

A

Acetaminophen and NSAIDs

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15
Q

What are NSAIDs commonly administered for?

A

Relieving mild/moderate pain, inflammation & fever.

  • insufficient to manage pain associated with extensive injuries or pain involving visceral structures (greater than 4 on the scale)
  • Inhibits the inflammatory response to tissue injury
  • inhibits COX –> PGs that induce pain + inflammation are not produced
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16
Q

Examples of non-selective COX inhibitors

A

ASA & ibuprofen (inhibits both COX 1 and 2)

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17
Q

Example of a selective COX inhibitor + which enzyme does it inhibit

A

Celecoxib - inhibits COX 2 so that PGs for pain + inflammation are not produced

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18
Q

NSAIDs act by inhibiting pain mediators at which level?

A

The nociceptor level

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19
Q

What should all analgesic regimens include? Why?

A

A non-opioid drug (acetaminophen/NSAID) - even in cases of severe pain!
Bc these drugs can reduce opioid requirements by ~ 30%

20
Q

What do endogenous opioids do? Examples?

A

Modulate the transmission of pain to the brain and spinal cord. Includes beta endorphins & enkephalins.

21
Q

What happens to the presynaptic & postsynaptic neurons when opioids bind to the receptors?

A

Presynaptic neurons: Closes Ca channels, inhibiting release of excitatory neurotransmitters (ach, substance P, glutamate)

Postsynaptic neurons: Opens K+ channels, causing membrane hyperpolarization, inhibiting neuronal activity

22
Q

Which receptors do opioid drugs bind to to exert their analgesic effects? Where are these receptors located?

A

mu and kappa opioid receptors in the brain & spinal cord

23
Q

When are opioid drugs used to treat pain?

A

When the pain is moderate-severe (especially pain in visceral structures) & cannot be treated by other analgesics.

24
Q

How are opioid drugs used to treat acute pain?

A

Use the lowest dose for the shortest amount of time in combination with an NSAID (bc acute pain has an inflammatory component as well).

25
Q

Clinical uses for opioid drugs (2)

A

Severe diarrhea & antitussive therapy (treat coughs)

26
Q

Are opioid drugs commonly prescribed to treat chronic pain?

A

No, the use of opioids for chronic pain is controversial.

27
Q

What does the canadian guideline for opioids suggest for chronic non-cancer pain?

A
  • use non-opioid drugs & non-pharmacological therapy before giving opioids
  • stabilize psychiatric disorders first
  • don’t use opioids in clients with a substance abuse disorder
28
Q

Exmple of an opioid antagonist (and what are the routes of administration)

A

naloxone (IV, IM, SC) - used to treat an opioid overdose

29
Q

Symptoms of opioid withdrawal

A
  • lacrimation
  • rhinorrhea
  • chills
  • gooseflesh
  • muscle aches
  • diarrhea
  • anxiety
  • hostility
30
Q

Adverse effects of opioids

A
  • Constipation
  • Nausea & Vomiting
  • Pruritus
  • Sedation
  • Respiratory depression (naloxone)
  • Delirium (opioid induced neurotoxicity)
31
Q

Where are opioids metabolized and excreted? Which opioids produce active metabolites?

A

liver; urine

Active metabolites = morphine + codeine

32
Q

Pain receptors in peripheral tissues can be blocked with local anaesthetic agents such as? How do these drugs work?

A
  • lidocaine and bupivacaine
  • they block afferent nerve transmission of pain (e.g. nerve block)
  • can also be used at the level of the spinal cord (spinal or epidural techniques) to block afferent and efferent impulses including the sympathetic response
33
Q

Endogenous pain suppression pathways release which 2 neurotransmitters?

A

GABA & serotonin

34
Q

Benzodiazepines act on which receptor? What do they do?

A

GABA receptors; they intensify the effect of GABA at the receptor

*GABA is used to augment analgesia

35
Q

T or F: SSRIs have a strong nociceptive effect.

A

False, they have little nociceptive effect!

36
Q

Triptans bind to which receptors to treat what condition? How do triptans work?

A

5-HT1D receptors; migraine headaches

They have a vasoconstrictive effect on vessels in the skull and also inhibits the release of substance P to modulate pain.

37
Q

Which steroids are used for pain management? What are they used to treat?

A

Dexamethasone, prednisone

Bone pain and nerve compression

38
Q

Anticonvulsant drugs treat what kind of pain?

A

neuropathic pain

39
Q

Pain is multi-dimensional, and incorporates?

A
  • The physical stimulus
  • The physical state of the patient
  • The emotional state of the patient
  • The patient’s past experience with pain
  • The patient’s beliefs about the implications of being in pain
40
Q

Pain

A
  • Unpleasant sensory and emotional experience associated with actual or potential tissue damage
  • patient reports the experience (requires communication)
41
Q

Numeric rating score (NRS) is used for clients above the age of? What numbers correlate w/ mild, moderate & severe pain?

A

8
Mild: <4
Moderate: 4-6
Severe: 7-10

42
Q

Alternate scales (other than the NRS) have to be used for which client populations?

A
  • pre-verbal children (early developmental stage)
  • developmentally delayed individuals (youth & adults)
  • intubated patients
  • patients w/ an altered LOC
43
Q

What do behavioural observation tools measure? What doesn’t it measure?

A
  • Measures the presence/absence of pain (e.g. facial expression, leg movement, activity, cry and eating, sleeping, etc..)
  • Doesn’t measure intensity!!
44
Q

The FACES scale is used for what age range? What does it measure?

A

4-18; intended to measure how children feel inside, not how their face looks

45
Q

How should pain be assessed? (baselines?)

A
  • baseline pain should be measured

- pain should be monitored to assess the therapeutic effect of analgesia

46
Q

T or F: Pain is what the patient says it is; it is the health care providers responsibility to treat the pain.

A

TRUE

PHARMACOLOGY (27 decks)

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