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pharm > Analgesics > Flashcards

Analgesics Flashcards

1
Q

Analgesics

A

Medication that relive pain without losing consciousness

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2
Q

What is pain?

A

A unpleasant sensory and emotional experience associate with actual or potential tissue damage

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3
Q

Who determines if there’s pain

A

the patient

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4
Q

Nociceptor receptors

A

Sensory nerve fibers that sense pain and transmit signals from various body regions to the spinal cord and brain

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5
Q

Pain threshold

A

Level of stimulus needed to produce perception of pain

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6
Q

Pain tolerance

A

The amount of pain one can endure without it affecting normal function (varies from person to person)

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7
Q

What affects pain tolerance

A

Attitude, personality, environment, culture, ethnicity

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7
Q

how is pain classified

A

Onset and duration

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8
Q

Types of pain

A

Acute pain
Persistent pain (chronic)
Referred
Neuropathic
Phantom
Cancer
Central
Vascular

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9
Q

Acute pain

A

Sudden onset and is limited (has an end)

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10
Q

Persistent/chronic pain

A

recurring, lasts 3-6 months, more difficult to treat, can lead to build of tolerance

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11
Q

Referred pain

A

an injury in one area but pain in another

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12
Q

Neuropathic pain

A

Health conditions affecting the nerves sending signals to the brain (shooting, burning, stabbing pain)

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13
Q

Phantom pain

A

Occurs after an amputation. Sending pain signals from a body part that is not there

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14
Q

Cancer pain

A

Pain caused by cancer

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15
Q

Central pain

A

Pain caused a neurological dysfunction of the CNS such as a stroke

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16
Q

Vascular pain

A

Pain caused by an interruption of blood flow

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17
Q

Gate theory of pain transmission

A

Analogy of a gate to describe how impulses from damaged tissue are sensed in the brain. How the CNS may “close the gate” to limit the sensation of pain. The gate is the dorsal horn

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18
Q

Four distinct processes pain

A

Transduction
Transmission
Perception
Modulation

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19
Q

Transduction

A

Transformation of stimuli into electrochemical energy releasing pain causing chemicals

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20
Q

Tissue injury release_______ which stimulate nerve endings starting the process

A

Bradykinin, histamine, potassium, prostaglandins, serotonin, substance P

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21
Q

Pain transmission

A

Transmits pain from the site, to the spinal cord, down to the brain

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22
Q

two types of nociceptor pain fibres

A

large diameter, a delta fibres and small diameter C fibres

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23
Q

Pain perception

A

is subjective and is different per individual. The number of MU receptors in the dorsal horn also play in pain perception.

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24
Q

More MU receptors lead to less or more pain

A

Less because MU receptors are opioid receptors so more MU receptors lead to more opioid affecting the body leading to less pain

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25
Q

Pain modulation

A

Process of altering the pain signals in the transmission both peripheral and central. Is the process of the pain signals going from the brainstem down releasing enkephalins and endorphins changing the perception of pain.

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26
Q

What does massages reduce the pain

A

Large sensory A nerve fibers inhibit transmission to the brain causing the gate to be closed

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27
Q

Treatment of Pain in Special Situations

A

Patient-controlled analgesia (PCA)
Patient comfort versus fear of drug addiction
Opioid tolerance
Use of placebos
Recognizing patients who are opioid tolerant
Breakthrough pain
Synergistic effects

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28
Q

What is Adjuvant analgesics drugs

A

Drugs from chemical categories either than opioids. Often assist primary drugs in relieving pain

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29
Q

Categories of adjuvant analgesics drugs

A

NSAID, antidepressants, anticonvulsants, corticosteroids

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30
Q

Examples of Adjuvant drugs for neuropathic pain

A

Amitriptyline(antidepressant)
Gabapentin or pregabalin (anticonvulsants)

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31
Q

Three step analgesic Ladder

A
  1. Nonopioids with or without adjuvant medications
  2. Opioids with or without nonopioids with ot without adjuvants
  3. Opioids for moderate/severe pain with or without nonopioids with ot without adjuvants
32
Q

Opioids

A

Synthetic drugs bind to opiate receptors to relieve pain

33
Q

Mild opioid drugs

A

Codeine, hydrocodone

34
Q

Strong opioid drugs

A

Morphine, hydromorphone hydrochloride, oxycodone, meperidine, fentanyl, methadone

35
Q

Meperidine

A

Not for long term use as an accumulation can cause neurotoxic metabolite, normeperidine which can cause seizures

36
Q

Opioid ceiling effect

A

When the drug reaches a max analgesics effect no matter how much more you give them.

37
Q

Drugs that have a ceiling effect

A

Codeine phosphate, pentazocine, nalbuphine

38
Q

Opioid analgesics three types

A

Agonists, agonists-antagonists, antagonists (nonantigenic)

39
Q

agonists Opiates

A

Bind to an opioid drug receptor in the brain causing an analgesic effect. ex- morphine, codeine, fentanyl

40
Q

Agonists antagonists opiate

A

Bind to a pain receptor causing a weaker pain response than full. For those who need painkiller but do not want to overdose ex- pentazocine

41
Q

Antagonists opiate

A

Reverse the effects of these drug on pain receptors. Compete with agonists opiates for spots on the receptor. When these drug attach, it exerts no response.ex- nalaoxone

42
Q

equianalgesia

A

Ability to provide equivalent pain relief by calculating dosages of different drugs or routes to provide adequate analgesia

43
Q

Examples of Equianalgesia

A

Morphine, hydromorphone, oxycodone, hydrocodone bitartrate, fentanyl
Continuous release vs immediate release

44
Q

opioid analgesics Indications

A

For moderate to severe pain, first line for immediate post operative setting, given with adjuvant drugs to assist, balanced anaesthesia, cough suppression and treatment of diarrhea

45
Q

opioid analgesics contraindications

A

allergy, asthma,
Cation with respiratory insufficiency, elevated intercranial pressure, obesity or sleep apnea, paralytic ileus, pregnancy

46
Q

opioid analgesics Adverse effects

A

CNS depression( respiratory depression), nausea, vomiting, constipation, biliary tract spasm, urinary retention, hypotension, palpitations, flushing, itching, rash, wheal formation, pinpoint pupils indication of overdose

47
Q

Opioid Tolerance

A

A common result of long term opioid use leading to a larger dose needed to maintain the same level of analgesia

48
Q

Physical dependence

A

common effect of common opioid use. Physiological adaptation of the body to the presence of an opioid

49
Q

psychological dependence: addiction

A

Compulsive drug use shown through craving for opiates and the need to use the opioid for effects other than pain relief

50
Q

When should an opioid antagonist be given

A

withdrawal symptoms but more importantly when respiratory depression occurs

51
Q

How long does it take of opiate use to be effected by opioid withdrawal

A

occurs in 2 wks in opioid naive patients

52
Q

How to help someone who is dependent on an opioid to get off it without withdrawl

A

Gradual dosage reduction after chronic opioid use

53
Q

Opioid Analgesics: Interactions

A

Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Promethazine
Monoamine oxidase inhibitors
Others

54
Q

Codeine sulphate

A

A natural opiate alkaloid obtained from opium, not as effective, has a ceiling effect, most commonly used as an antitussive drug

55
Q

Fentanyl

A

Synthetic opioid used to treat moderate/severe pain.

56
Q

Fentanyl routes

A

Parenteral injections, transdermal patches, sublingual effervescent tablets

57
Q

Hydromorphone

A

Very potent opioid analgesic 1 mg of IV/IM is = 7 mg of morphine

58
Q

Methadone hydrochloride

A

synthetic opioid analgesic used for detoxification treatment of opioid addicts in methadone maintenance programs. Has a prolonged half life which may cause unintentional overdose

59
Q

Morphine sulphate

A

Naturally occuring alkaloid derived from the opium poppy (drug prototype, schedule 1). For severe pain

60
Q

Morphine routes

A

Oral, injectable, rectal, extended release forms

61
Q

Oxycodone hydrochloride

A

Similar structure to morphine, synthetic

62
Q

What is percocets made of

A

often combined with typically 325 mg of acetaminophen and 5 mg of oxycodone

63
Q

Naloxone hydrochloride

A

Is an opioid antagonists and is often the drug of choice for overdose and respiratory depression from opiates. Failure of drug to reverse the overdose indicates that it may not be related to opioid overdose

64
Q

Acetaminophen

A

Analgesic and antipyretic with little to no anti inflammatory effects by blocking the pain impulses peripherally inhibiting prostaglandin synthesis

65
Q

Indications of acetominphen

A

Milt to moderate pain, fever and inability to take aspirin products

66
Q

Max dose of acetaminophen

A

4g/day

67
Q

Max dose for older adults with liver diseases

A

2g/day

68
Q

Acetaminophen: contraindication and interactions

A

Should not be in the presence of the a drug allergy, liver dysfunction, liver failure. If taken with alcohol drugs are hepatoxic

69
Q

Managing long term or overdose of acetaminophen

A

Acetylcysteine regiment

70
Q
A
71
Q

Examples of acetaminophen’s overdose symptom’s

A

whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity.

72
Q

tramadol hydrochloride

A

Central analgesic with a treatment for 3 hours

73
Q

Adverse effects of tramadol hydrochloride

A

seziurse, serotonin syndrome

74
Q

What is tramacet made of

A

Acetaminophen and tramadol

75
Q

What is a Tramacet

A

Tramadol with acetaminophen

76
Q

Feverfew

A

Anti-inflammatory properties, used to treat migraines with a headache, mensural cramps, inflammatory, and fever

77
Q

When to withhold and contact physician

A

Respitory depression is less than 10 breaths per min

78
Q
A

pharm (21 decks)

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