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Pharmacology > Analgesia > Flashcards

Analgesia Flashcards

1
Q

how pain is transmitted?

A

peripheral pain receptors or nociceptors sending message via afferent nerve fibres

to spinal cord: activates the spinothalamic tracts

to the brain: autonomic response (brainstem - HR, RR, pupillary etc)
conscious pain perception (cerebral)
emotional response (limbic)

and descending pain pathway

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2
Q

Chemical mediators of pain (tissue damage, inflammation and ischemia)

A

Prostaglandin
substance P
cytokines

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3
Q

Non-opioid analgesics

A

Corticosteroids
Paracetamol
Aspirin
NSAIDs

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4
Q

Pharmacodynamics of Paracetamol

A

Inhibits prostaglandins (COX1,2 and 3) to reduce pain and fever

Endocannabinoid reauptake inhibitor

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5
Q

Adverse effects of Paracetamol

A

Well tolerated (no anti-inflammatory benefits, no thromboxane and not GIT irritant

However, highly toxic when overdose

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6
Q

Pharmacodynamics of NSAIDs

A

Inhibits COX 1(enzyme maintaining stomach lining) and COX 2 (enzyme that triggers pain) which synthesise prostaglandins causing inflammation and pain

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7
Q

NSAID drugs

A

ibuprofen
naproxen
diclofenac
celecoxib

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8
Q

Adverse effects of NSAIDs

A

GI upset (N&V, diarrhoea, abdominal pain)
HTN
Kidney problem (NSAIDs are nephrotoxic)
Blood clots (stroke)

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9
Q

NSAIDs, Beta blockers and aspirin can cause bronchospasm for pts with?

A

Asthma

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10
Q

Nursing cosiderations for taking NSAIDs

A

Educate pt to:
take it with food to decrease stomach irritation
do not take it with empty stomach

For acid reflux:
administer Omeprazole

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11
Q

Selective COX 2 inhibitor meds

A

Celecoxib
Etoricoxib
Meloxicam

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12
Q

Salicylates pharmacodynamics

A

Analgesic - inhibits prostaglandins
Antipyretic - decrease body temp
Anti-inflammatory - inhibits COX 1&2
Anticoagulant - prolongs bleeding times and inhibits platelets aggregation (Aspirin)

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13
Q

Salicylates meds

A

Aspirin

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14
Q

Antidote for Aspirin overdose

A

Sodium Bicarbonate

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15
Q

Antidote for salicylate poisoning

A

activated charcoal

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16
Q

Nursing considerations for taking salicylates

A

Cease taking salicylates 1 week before major surgery (risk for bleeding)
Monitor GI bleeding

17
Q

Pharmacodynamics for Nonsalicylates

A

Analgesic and antipyretic (do not have anti-inflammatory or antiplatelet effects)

18
Q

Nonsalicylate meds

A

Acetaminophen (Tylenol) - for mild to moderate pain, substitute for Aspirin allergies and bleeding tendencies

19
Q

Adverse effects of Nonsalicylates (chornic use or higher dosage)

A

Hives
Hemolytic anemia
Pancytopenia (low levels of blood cells - RBC, WBC and platelets)
Hypoglycaemia
Hepatoxicity, Hepatic failure and jaundice (yellow skin)

20
Q

Contradictions to Acetaminophen

A

Liver dysfunction (alcoholism)

21
Q

Nursing considerations for pt taking Acetaminophen

A

Assess alcohol use
Malnourished pts with chronic alcohol use can have increased risk of liver damage
Limit drug dosage below 2g a day

22
Q

Antidote for Nonsalicylates toxicity

A

Acetylcysteine (protects liver cells and destroys acetaminophen metabolism)

23
Q

Categorise weak and strong opiates

A

Strong opiates:
Morphine, fentanyl, oxycodone, methadone, heroin

Weak opiates:
Codeine, tramadol (has SNRI agents)

24
Q

Pharmacodynamics of opioids (opioid agonists)

A

Generally: Binds to opioid receptors in the brain causing an analgesic sedative and euphoric effect (addictive)

Pain signals sent to brain - Inhibits action potentials (causing hyper polarisation) and release of neurotransmitters in spinal cord

Decrease pain perception: activates descending inhibitory controls in the midbrain
Decrease anxiety (euphoric effect)

25
Q

Long term and short term adverse effects of Opioid analgesics

A

Long term:
Constipation (client doesn’t build tolerance)

Short term:
Miosis (constricted pupils)
Orthostatic hypotension
Respiratory depression
Pain suppression
Itch and rash (histamine release)
N&V
Euphoria
Sedation

26
Q

Opioid tolerance means

A

the need to increase dosage to maintain a therapeutic effect

27
Q

Opioid dependence means

A

biological adaptation whereby a dose reduction of cessation will result in withdrawal symptoms

28
Q

Opioid addiction means

A

behavioural response in which a person seeks and develops compulsive behaviour in obtaining and consuming the substance despite of its adverse effects.

29
Q

symptoms of opioid tolerance and intolerance

A

tolerance: N&V, sedation, euphoria and respiratory depression

intolerance: constipation and miosis

30
Q

Opioid meds

A

Morphine
Codeine
Oxycodone
Methadone
Fentanyl

31
Q

Opioids do NOT produce _______ and ___________ benefits as it is not used for fever, gout/ rheumatoid arthritis.

A

antipyretic and anti-inflammatory

32
Q

Nursing considerations for pts taking opioids

A

Constipation:
adm laxatives, encourage fluids, fiber and fruits, encourage to defecate when they the feel the urge

Respiration:
breathing exercise to increase RR
adm naloxone if overdosed or RR dropped < 12

Falls:
encourage to rise slowly and assist with ambulatory acitivities

Opioid meds:
TAKE IT WITH FOOD to avoid GI upset
DO NOT drink alcohol

33
Q

Pharmacodynamics of Fentanyl

A

lipophilic (fat soluble) - can cross membranes easily

Less histamine release

34
Q

weak opioid agonist with SNRI properties

A

Tramadol

35
Q

Adverse effects of Tramadol

A

increased risk of N&V and neurological effects such as hallucinations and seizures

risk of serotonin syndrome

36
Q

Pharmacodynamics of Naloxone (opioid antagonist)

A

Antidote for opioid overdose (causing respiratory depression)

Strong affinity for opioid receptors
Short half life (monitor pt)

Rapid reversal (after adm naloxone) of opiate toxicity can cause:
recurring pain
seizure
hypertension
pulmonary oedema
severe agitation

Pharmacology (27 decks)

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