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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
More MU receptors lead to less or more pain
Less because MU receptors are opioid receptors so more MU receptors lead to more opioid affecting the body leading to less pain
25
Pain modulation
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.
26
What does massages reduce the pain
Large sensory A nerve fibers inhibit transmission to the brain causing the gate to be closed
27
Treatment of Pain in Special Situations
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
28
What is Adjuvant analgesics drugs
Drugs from chemical categories either than opioids. Often assist primary drugs in relieving pain
29
Categories of adjuvant analgesics drugs
NSAID, antidepressants, anticonvulsants, corticosteroids
30
Examples of Adjuvant drugs for neuropathic pain
Amitriptyline(antidepressant) Gabapentin or pregabalin (anticonvulsants)
31
Three step analgesic Ladder
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
Opioids
Synthetic drugs bind to opiate receptors to relieve pain
33
Mild opioid drugs
Codeine, hydrocodone
34
Strong opioid drugs
Morphine, hydromorphone hydrochloride, oxycodone, meperidine, fentanyl, methadone
35
Meperidine
Not for long term use as an accumulation can cause neurotoxic metabolite, normeperidine which can cause seizures
36
Opioid ceiling effect
When the drug reaches a max analgesics effect no matter how much more you give them.
37
Drugs that have a ceiling effect
Codeine phosphate, pentazocine, nalbuphine
38
Opioid analgesics three types
Agonists, agonists-antagonists, antagonists (nonantigenic)
39
agonists Opiates
Bind to an opioid drug receptor in the brain causing an analgesic effect. ex- morphine, codeine, fentanyl
40
Agonists antagonists opiate
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
Antagonists opiate
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
equianalgesia
Ability to provide equivalent pain relief by calculating dosages of different drugs or routes to provide adequate analgesia
43
Examples of Equianalgesia
Morphine, hydromorphone, oxycodone, hydrocodone bitartrate, fentanyl Continuous release vs immediate release
44
opioid analgesics Indications
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
opioid analgesics contraindications
allergy, asthma, Cation with respiratory insufficiency, elevated intercranial pressure, obesity or sleep apnea, paralytic ileus, pregnancy
46
opioid analgesics Adverse effects
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
Opioid Tolerance
A common result of long term opioid use leading to a larger dose needed to maintain the same level of analgesia
48
Physical dependence
common effect of common opioid use. Physiological adaptation of the body to the presence of an opioid
49
psychological dependence: addiction
Compulsive drug use shown through craving for opiates and the need to use the opioid for effects other than pain relief
50
When should an opioid antagonist be given
withdrawal symptoms but more importantly when respiratory depression occurs
51
How long does it take of opiate use to be effected by opioid withdrawal
occurs in 2 wks in opioid naive patients
52
How to help someone who is dependent on an opioid to get off it without withdrawl
Gradual dosage reduction after chronic opioid use
53
Opioid Analgesics: Interactions
Alcohol Antihistamines Barbiturates Benzodiazepines Promethazine Monoamine oxidase inhibitors Others
54
Codeine sulphate
A natural opiate alkaloid obtained from opium, not as effective, has a ceiling effect, most commonly used as an antitussive drug
55
Fentanyl
Synthetic opioid used to treat moderate/severe pain.
56
Fentanyl routes
Parenteral injections, transdermal patches, sublingual effervescent tablets
57
Hydromorphone
Very potent opioid analgesic 1 mg of IV/IM is = 7 mg of morphine
58
Methadone hydrochloride
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
Morphine sulphate
Naturally occuring alkaloid derived from the opium poppy (drug prototype, schedule 1). For severe pain
60
Morphine routes
Oral, injectable, rectal, extended release forms
61
Oxycodone hydrochloride
Similar structure to morphine, synthetic
62
What is percocets made of
often combined with typically 325 mg of acetaminophen and 5 mg of oxycodone
63
Naloxone hydrochloride
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
Acetaminophen
Analgesic and antipyretic with little to no anti inflammatory effects by blocking the pain impulses peripherally inhibiting prostaglandin synthesis
65
Indications of acetominphen
Milt to moderate pain, fever and inability to take aspirin products
66
Max dose of acetaminophen
4g/day
67
Max dose for older adults with liver diseases
2g/day
68
Acetaminophen: contraindication and interactions
Should not be in the presence of the a drug allergy, liver dysfunction, liver failure. If taken with alcohol drugs are hepatoxic
69
Managing long term or overdose of acetaminophen
Acetylcysteine regiment
70
71
Examples of acetaminophen's overdose symptom's
whether intentional or resulting from chronic unintentional misuse, causes hepatic necrosis: hepatotoxicity.
72
tramadol hydrochloride
Central analgesic with a treatment for 3 hours
73
Adverse effects of tramadol hydrochloride
seziurse, serotonin syndrome
74
What is tramacet made of
Acetaminophen and tramadol
75
What is a Tramacet
Tramadol with acetaminophen
76
Feverfew
Anti-inflammatory properties, used to treat migraines with a headache, mensural cramps, inflammatory, and fever
77
When to withhold and contact physician
Respitory depression is less than 10 breaths per min
78

pharm (21 decks)

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