Analgesics Flashcards

1
Q

What is the MOA of Ibuprofen (NSAID)

A

Non-selective reversible inhibition of COX 1 and CoX 2 enzymes resulting in decrease pain

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2
Q

What are some ADRs of Ibuprofen (NSIAD)

A

Gastric irritation
Reduction in GFR leading to fluid retention
Prolonged bleeding time
Increased risk of MI and Asthma attacks

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3
Q

What is some patient education when giving Ibuprofen

A

Take with food
Do not administer with Aspirin
NSAIDs can alter the effect of other drugs eg digoxin, warfarin

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4
Q

What is the MOA of paracetamol

A

Has both local and central action
Local action – COX inhibition
Central action- inhibition of prostaglandin synthesis in the CNS

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5
Q

What are some ADRs of paracetamol

A

ADRs are rare but potential - weak inflammatory effect

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6
Q

What is some patient education when giving paracetamol

A

Lots of other over the counter medications contain paracetamol in them e.g cold and flu - caution with exceeding daily dose

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7
Q

What is an Opioid agonist

A

Morphine

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8
Q

What is an Opioid antagonist

A

Naloxone

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9
Q

What is the MOA of Morphine

A

activation of descending inhibitory pathways of the CNS as well as inhibition of the nociceptive afferent neurons of the PNS

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10
Q

What are some ADRs of Morphine

A

resp. depression, excessive sedation, dysphoria, constipation, nausea and vomiting, tolerance and dependence

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11
Q

What does Naloxone do?

A

Reverse the effect of an opioid

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12
Q

What assessments should be taken prior to prescribing Ibuprofen and what findings may led to a prescription being contraindicated

A

History of ulcer disease or GI bleeding
use of anticoagulants, steroids or other NSAIDS
Significant co-morbidities

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13
Q

What is the analgesic ladder

A

flowchart for the step-wise pharmacological management of pain
Step 1: 1-3 mild pain
Step 2: 4-6 moderate pain
Step 3: 7-10 severe pain

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14
Q

What are the different types of pain

A

Acute- sudden onset
Chronic - reoccurring difficult to treat
Nociceptive- Stimulation of receptors
Neurogenic - lesions orPNS/CNS
Psychogen

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15
Q

What serious adverse effect is possible from too much morphine. What is to be given?

A

Sedation and resp. depression. Naloxone should be given

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16
Q

Your patient feels sick and may vomit while on Morphine, what antiemetic should ideally be prescribed?

A

Metocloprimide, works on increasing gut motility along with central effect as dopamine antagonist
Avoid ondansetron - leads to constipation as does the opioid

17
Q

What does opioid Sparing mean?

A

Refers to the fact that with a non-opioid is combined with an opioid, the opioid dose can be lowered without compromising pain relief

18
Q

What is the MOA of tramadol

A

Stimulates mu receptors
Also Inhibits the reuptake of nor adrenaline and serotonin

19
Q

What are some contraindications for Naloxone

A

Patient hypersensitivity to drug

20
Q

What are the contraindications of tramadol and Morphine

A

Conditions associated with increased intracranial pressure
Head injuries

21
Q

What are some contraindications to Ibuprofen

A

Hypersensitivity to aspirin or other NSAIDs
Severe HF
Hx of GI ulceration

22
Q

What are some contraindications for paracetamol

A

Severe hepatocellular insufficiency, hepatic failure, acute liver disease

23
Q

What is some patient education for Morphine and Tramadol

A

Avoid drinking alcohol, drowsiness avoid driving, addictive

24
Q

What is the MOA of Loperamide

A

Binds to opiate receptor in gut wall, reducing propulsive peristalsis, increasing intestinal transit time and enhancing resorption of water and electrolytes

25
What are some ADRs of loperamide
nausea, abdominal cramps, dizziness, drowsiness,
26
What are some contraindication of loperamide
conditions where peristalsis should be avoided
27
What is some patient education when taking loperamide
take as directed Can be taken with and with our food Laxatives may react with loperamide
28
What does Endogenous morphine
Elicits changes in endorphins
29
Once a patient is given Naloxone what do you watch for
Vital signs, sedation score, VIP score
30
Endogenous ligand
A small molecule that elicits a conformational change upon binding