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Pharmacology > Analgesia > Flashcards

Analgesia Flashcards

1
Q

Nociception

A

Receptors that transduce stimuli to generate pain signal
Noxious stimuli are transmitted via different forms of pain receptor or Nociceptors

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2
Q

What does nociceptors control

A

Thermal (>42C)
Excessive pressure
Chemical ( Capsaicin, toxins, acid)

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3
Q

How are painful stimuli released

A

Bradykinin
Nerve growth factor
5 Hydroxytryptamine
Substance P
Prostaglandin E2

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4
Q

Lateral spinothalamic tract

A

Deliever sensations of pain and temperature

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5
Q

Anterior Spinothalamic tract

A

Light touch and gentle pressure

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6
Q

Gate control theory

A

pain conduction is modulated at the level of the spinal cord by peripheral nerve impulses and impulse coming from the brain

The impulses may increase pain conduction or reduce it.

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7
Q

Gate closing stimuli to reduce pain

A

Peripheral nerve stimulation
(Rubbing)

Neurohumoral influences (mental state):
Dynorphins
Enkephalins
Endorphins

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8
Q

Gate opening influences

A

Bradykinin and other inflammatory mediators

Mental states (stress)

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9
Q

Examples of analgesics

A

Opioids:
Morphine, pethidine and codeine

Non-opiods:
Aspirin,paracetamol, dicolofenac, ibuprofen

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10
Q

Opioid action

A

Bind to opioid receptors on pre-ganglionic nerve which reduces neurotransmitter release.

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11
Q

Endogenous sources of opioids

A

Enkephalins
Dynorphins
ENdorphins

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12
Q

Effects of Opioids

A
  • Pupil constriction
  • Euphoria
  • Drowsy
  • Flushing
  • RR and rhythm depression
  • Vasodillation
  • Cough centre depression
  • DIaphoresis
  • Bronchial contraction
  • Billiary spasms (if not billiary problem then give opioids)
  • Decreased peristalsis (Constipation)
  • Increased bladder tone
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13
Q

Contra-indication

A

Head injury:
increased brain pressure
Impairs brain function assessment

Pregnancy/lactation:
Passes the placental barrier

Respiratory depression and hypotension

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14
Q

Nursing care

A

Monitor vital signs:
RR
BP

Over dosage treatment: Naloxone

monitor for other adverse effects:
Poor urine output
urinary retention/ hypotension

Constipation
Nausea and vomiting

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15
Q

NSAIDs

A

Non-Steroidal Anti-inflammatory drugs

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16
Q

WHat do NSAIDs do

A

Inhibit production of COX 1 and COX 2 so reduced inflammatory response

17
Q

Examples of NSAIDs

A

Paracetamol
Aspirin
Diclofenac

18
Q

Paracetamol

A

treats Mild Pain, pyrexia (safe in children)
Hypothalamus site of action
Little peripheral anti inflammatory effect
No anti-platelet effect

19
Q

Administration, metabolism and excretion of paracetamol

A

Administration
Oral, Rectal, IV

Metabolism
Liver (95%)

Half life
1 – 4hours

Excreted
Renal
Placenta

20
Q

Overdose of paracetamol

A

(> 4g (8 tablets) / 24hours)

those under 50kg= 500mg per dose

21
Q

Aspirin

A

Used for:
Mild to moderate pain
Decreases platelet aggregation
Prophylaxis:
Trans ischaemic attacks (strokes)
Acute Coronary Syndrome (heart attacks)

22
Q

Aspirin: pharmacokinetics

A

Rapid absorption

99.6% plasma bound

Metabolism: hepatic

Half life (T1/2): 500 – 1000 mg (3-5 hours)
Excretion: renal

23
Q

Aspirin: Adverse Effects

A

Hypersensitivity
Potentiates other NSAIDs
‘Bleeds’:
-GI tract
-Gums
-Urinary tract

Increased bleeding in association with warfarin, heparin, clopidogrel

Heart burn

Nausea

Ototoxic

Bronchospasm

24
Q

Reye’s disease

A

Due to aspirin and viral infections

Results in:
* Multi-organ disorder
* Brain and Liver most effected
* Aspirin not given to children

25
Q

Fenamates
(Mefenamic acid and Diclofenac)(NSAIDs)

A

Diclofenac used in musculoskeletal pains (COX2 selective)
Mefenamic acid first line treatment for uterine pains
Mefenamic acid causes little gastric disturbance, but may cause diarrhoea which if severe necessitates termination of use.

26
Q

Pharmacokinetics of Diclofenac

A

Protein binding (99%)
Metabolism
CYP 2C9 (primary), 2C8, 3A4.
As well as phase II conjugation

Elimination
T1/2 = .2-2 hrs

Excretion 40% biliary & 60% renal, (0% unchanged).

27
Q

General Adverse and side effects of NSAIDs

A

Potentiates bleeding with anti coagulants and antiplatelet medications (contraindicated for concomitant use).

Gastric Irritation
Bronchospasm
Renal damage
Inhibits ovulation
Mental disorientation
Hypersensitivity

Pharmacology (18 decks)

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