Analgesic Drugs Flashcards
What is codeine used for?
Cough suppressant
What is hudrocodone used for?
Cough suppressant
What is Dextromorphan OTC (DXM) used for?
Cough suppressant
What is morphine sulfate used for?
Analgesia
What is hydromorphone(dilaudid) used for?
Analgesia
What is fentanyl used for?
Analgesia
What is the MOA of opioids in the presynapse? Postsynapse?
Presynapse-bind to Mu receptors and decrease Ca2+ permeability=decreases release of glutamate and substance P
Postsynapse-binds to Mu receptors and increases K+ permeability=hyperpolarizes the neuron
What are the name of the receptors that opioid binds to?
Mu
Kappa
Delta
Where do opioids work?
Spinal cord
What are the only opioid receptors found in the spinal cord?
My receptors
What are the indications for opioids?
Analgesia
Antitussive
Antidiarrheal
Why would a MD prescribe a pt opioids after a GI surgery?
B/c they decrease bleeding
What are the 5 cardinal signs of inflammation?
Heat-calor Swelling-tumor Redness-rubor Loss of function-functio laeso Pain-Dalor
What type of medication is Prednisone?
Corticosteroid
Why is asthma a contraindication to using morphine/opioids?
B/c opioids release histamine
Why are the ADR of opioids?
CNS depression N/V Oliguria Miosis Constipation
What is a residual side effect of opioids that are present regardless how long or short you take them?
Constipation
Why do opioids cause oliguria?
Because they causes the release of ADH
What can long terms use of opioid use cause?
Pharmacodynamic tolerance Physical dependence (used to stop pain)
An individual using opioids and experiencing euphoria (with zero pain relief) every time he takes it, is considered what?
Psychological dependent (addicted)
What are the Sx of opioid overdose?
Decrease BP Bradycardia Miosis Constipation Decrease RR Unresponsive
What drug is used to Tx a opioid Overdose?
Naloxone(narcan)
What are the Sx of a opioid withdrawal pt?
- seizures
- agitated
- diarrhea
- anxiety
- pt in excited state
What drugs interact with opioids?
Alcohol
Antihistamine
Benzodiazepines
Barbiturates
What is the potency ranking of morphine, hydromorphone and fentanyl?
Morphine
What are the 4 different route fentanyl can be taken?
Buccal
IV
Intranasal
Transdermal
What does diuresis mean?
Increased urine production
What drugs are used to relieve pain but are not opioids or anesthetic a?
NSAIDS
Corticosteroids
antidepressants
Anticonvulsant
What are some adjuvant drugs for neuropathic pain?
Amitriptyline (antidepressant)
Gabapentin/pregabalin (anticonvulsant)
What vital sign is pain considered? How is it rated?
The fifth vital sign
On a visual analog scale (VAS)-1 to 10
How can a or avoid getting N/V when taking opioids?
Eat opioid with food
True of false:pt ambulating on opioids should have an attendant near by
True
At what RR should a provider be contacted for a pt on opioid medication?
Below 10-12 RR
In order to help w/ opioid medication, what supplements should also be taken?
Fiber and water (to help deal with constipation)
How are the two ways you can die with opioids?
Decreases BP
Decreased respiratory rate
What part of arachdonic acid activates pain receptors?
Prostaglandins
What part of arachdonic acid increase inflammatory response?
Prostaglandins
What part of arachdonic acid activates platelet adhesion?
Thromboxane
What part of arachdonic acid increases the production of gastric mucus?
Prostacyclin
What does COX1 work on?
All cells
What does COX2 work on
Inflammatory cells like macrophages
What level of pain are NSAIDs used for?
Mild to moderate pain
What are the indications of NSAIDS?
HA dental pain Dysmenorrhea Join and muscle pain OA and RA
What effect does NSAIDs have on the body?
Antipyretic
Anti platelet
What level of pain are opioids used for?
Moderate to severe pain
What drugs causes the most tolerance and dependence?
Opioids
What drugs causes and increased risk of bleeding? What can prevent that?
NSAIDs
Eat the medicine with food
What is considered a non-opioid?
Corticosteroids
NSAIDs
APAP
Salicylates
How much of ibuprofen must be taken to have an anti-inflammatory effect on an adult?
600mg
What are the OTC dosages of naproxen and ibuprofen?
220mg naproxen
200mg ibuprofen
What effect does ASA have on the body?
Antipyretic
Anti inflammatory
Anti platelet
Analgesic
Where does ASA come from?
Willow bark
What is methyl salicylate? Where is it found?
Another salicylate
Found in icy hot patches
Why does ASA prevent clots to form?
Blocks COX from making thromboxane by permanently
What can a lose dose of ASA decrease a risk of?
MIs, TIAs and strokes
What type of drug is Asacol,Pentasa and Rowasa? What is it indicated for?
ASA
Ulcerstice Colitis
Why is ASA a good drug to use for pt with polyps or colorectal cancer?
B/c polyps use prostaglandins to grow
What is the baby ASA dosage?
81mg
What is adult ASA dosage?
325mg
What syndrome can be caused due to giving a teen or baby ASA?
Reye’s syndrome
What are the Sx of a pt with Reye’s syndrome?
Rash
N/V
Diarrhea
Liver damage
What can kill a pt with Reye’s syndrome?
Fatty liver
Swelling of the brain
Why is a COX2 inhibitor good for a pt with ulcers and another inflammatory condition?
Because it doesn’t hurt the stomach mucus like NSAIDs
How does NSAIDs directly and indirectly hurt the GI system?
Direct-irritates stomach lining
Indirect-decreases prostaglandins from increasing stomach mucus production
How can NSAIDs harm the kidneys?
NSAIDs constrict the afferent arteriol in the kidney which decrease the amount of blood the kidneys get
How can overuse of NSAIDs effect the ears?
Tinnitus(ringing in the ears)
How can NSAIDs cause HTN?
Because they increase water and fluid retention due to lack of blood flow through kidneys through afferent arteriol
Why can a risk of stroke,MI and CHF be caused by Chronic NSAID use?
Because of the increased fluid retention from the kidneys d/t a lack of blood flow from afferent arteriols
Why shouldn’t an NSAID be taken with an antacid?
Because NSAIDs already irritate the gastric lining when no mucus is produced
True of false:enteric-coated tablets can be crushed but not chewed?
False: they can be neither crushed or crewed because they need to end up in the duodenum to be absorbed
What does APAP inhibit? Where is it found?
cox3
Normally found in the brain
What effect does APAP have on the body?
Antipyretic
Analgesic
What age is APAP often used for?
Kids
What can an overdose of APAP cause?
Liver failure
What is APAP indicated for?
Fever
HA
Earaches
Teething
Why is APAP good for pt with clotting disorders or peptic ulcers?
Because APAP has no effect on the stomach or anti platelets
What is the max pediatric dose for APAP?
5 doses/day
What non-opioid is often carried in opioids?
APAP
Where does most of your Uric acid come from? What nitrogen bases do they come from?
Break down of purines
Adenine and guanine
Why can enzyme defects cause gout?
Because more proteins gets broken down
What foods increase purine consumption?
Alcohol, cheese, red meat and beans
Why can CKD (chronic kidney disease) lead to gout?
Because you can’t excrete the Uric acid
What can diabetic ketoacidosis cause gout?
Because the acidic environment increase more production of weak acid which doesn’t allow Uric acid to dissolve as well
Why does chemo and malignancy of cells cause gout?
Because there is a high cell turnover rate
Where to urate stone form in the body? (2)
Kidneys and joints
What are tophi?
Deformed joints from gout
What does PLA2 do?
Turns phospholipids into arachidonic acid
What enzymes to NSAID block?
cox1 and COX2
What part of arachidonic acid increases outflow of ocular tissues?
Prostaglandins
What enzyme helps make leukotrienes?
5-lipoxygenase
What are the 5 neurotransmitters that cause N/V when they increase?
- ACh
- DA
- 5HT
- histamine
- sub P
What drugs are used for prevention of gout?
xanthene oxidase
Uricosuric
What is the Tx of a gout attack?
Colchicine
Naproxen
Indomethacin
Have a genetic disposition for PD increases the chance of getting PD by how much?
20%
What does benzodiazepine bind to on GABA-A receptors?
BZD-1
True or false: APAP is an NSAID?
False it has no anti-inflammatory effect
