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Pharmacology > Analgesics > Flashcards

Analgesics Flashcards

0
Q

What 3 reasons can be pain be useful for?

A

Warning individual there is a problem
Assisting clinician in localising pain
May help with diagnosis

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1
Q

What is a common and distressing symptom of many illnesses and diseases?

A

Pain

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2
Q

What uses a receptor to detect it and also needs pathways to the brain to inform the patient that there is a stimulus causing it?

A

Pain

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3
Q

What are nociceptors?

A

Receptors that detect pain

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4
Q

What are receptors that detect pain called?

A

Nociceptors

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5
Q

Do nociceptors have high or low thresholds?

Why?

A

High - so only detect stimulus that is potentially tissue damaging

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6
Q

What 3 types of damage do nociceptors detect?

A

Mechanical
Thermal
Chemical

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7
Q

What are the 3 sensory afferents?

A

AO Fibres
C Fibres
AB Fibres

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8
Q

What type of damage do AO Fibres detect?

A

Mechanical, thermal and chemical

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9
Q

What type of damage do C fibres detect?

A

Mechanical, thermal and chemical

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10
Q

Which fibres detect pressure, touch and position?

A

AB fibres

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11
Q

Which fibre detects sharp, well-localised pain?

A

AO fibres

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12
Q

Which fibre detects dull pain?

A

C fibres

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13
Q

What happens to AO and C fibre pathways when the AB pathway is stimulated?

A

It can marginally interfere with the others - modulating pain

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14
Q

What is the gate control theory of pain?

A

Rubbing an area - this stimulates the AB pathway and modulates pain caused by the other two pathways

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15
Q

What is the thickest/biggest and fastest sensory afferent pathway?
Which is the slowest and smallest?

A 
AB is fastest (touch)
Then AO (sharp localised pain)
Then C (dull pain)
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16
Q

Which sensory afferent pathways are myelinated?

A

AO and AB

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17
Q

How does the pain/touch stimulus reach the sensory cortex?

A

It goes to the dorsal horn, spinothalamic tract, ventral posterior lateral nucleus (thalamus) then the sensory cortex

Horn-Tract-Thalamus-Sensory Cortex

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18
Q

What are the main 4 things that activate action potentials and cause inflammation, as a response to pain?
B5PH

A

Bradykinin
5-HT
Prostaglandins
Histamine

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19
Q

What do nociceptors release to cause inflammation, that act on the mast cells to produces histamine and blood vessels to produce oedema?

A

CGRP

Substance P

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20
Q

What would reducing the production of Bradykinin, 5-HT, Prostaglandins and Histamine do?

A

Prevent/reduce inflammation

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21
Q

What is the main part of the inflammatory ‘soup’ that we need to inhibit in order to stop the action of other mediators?

A

Prostaglandins

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22
Q

What sensitises afferent C fibres to bradykinin?

A

Prostaglandins

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23
Q

What drugs inhibit prostaglandin production?

A

NSAIDs

Non-Steroidal Anti-Inflammatory Drugs

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24
Q

What do NSAIDs need to inhibit in order to inhibit the production of prostaglandins?

A

COX 1 and COX 2 - as they are needed to produce them

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25
Q

Which COX enzyme is responsible for pain and inflammation?

A

COX2

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26
Q

What are the 4 pharmacological reactions of NSAIDs?

A

Antipyretic
Analgesic
Anti-inflammatory
Musculoskeletal Pain

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27
Q

What drugs can be used as antipyretic, analgesics, anti-inflammatory and to combat musculoskeletal pain?

A

NSAIDs

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28
Q

What does antipyretic mean?

A

To reduce body temperature during fever

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29
Q

What is the name for when a drug reduces body temperature during fever?

A

Antipyretic

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30
Q

When we say a drug provides the relief of pain associated with the increased production of PGs (such as arthritic, muscular, dental pain etc) what do we say it is?

A

An analgesic

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31
Q

What are arthritic, muscular, dental pain, post-partum and bone cancer pain examples of?
What treats it?

A

Pain produced by increased prostaglandins.

NSAIDs can act as an analgesic for this

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32
Q

When a drug reduces oedema and the sensitisation of nociceptors, what do we call this and what drug can do this?

A

Anti-inflammatory

NSAIDs

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33
Q

What is chronic treatment?

A

An increased dosage of drug or prolonged treatment

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34
Q

What are the side effects of NSAIDs if they are used as a chronic treatment?
(e.g. for chronic arthritis)
DINVUG

A

Indigestion, diarrhoea, nausea, vomiting, gastric bleeding and ulceration

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35
Q

What area do the negative side effects of NSAIDs tend to affect?

A

The GI Tract

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36
Q

Explain how long-term NSAID use can cause GI tract side effects:

A

NSAIDs inhibit COX 1, which synthesises certain prostaglandins (PGI2 and PGE2) that are important for mucus and HCO3/bicarbonate secretion - these help decrease acid secretion and increase blood flow to the stomach to protect it.
Inhibiting COX1 stops this protection = ulcers etc

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37
Q

NSAIDs bind to COX 1 and COX 2 - what are the results of this?

A

COX 2 = reduces pain and inflammation - good

COX1 = reduces mucus and bicarbonate secretion = more acid and less blood flow in stomach - bad? GI side effects

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38
Q

What are celecoxib and etoricoxib?
Pay attention to COX in name.
What is good about them?

A

They are NSAIDs that only inhibit the COX2 enzyme - reducing side effects.
Can cause MI however.

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39
Q

Most NSAIDs inhibit both the COX 1 and 2 Enzyme.
What 3 ways can reduce the negative side effects of this?

E P P

A

Enteric Coating of Tablets (protects stomach lining from effects)

Protective Agent - give with another drug: Misoprostol (prostaglandin analogue) or Omeprazole (Proton Pump Inhibitor)

Pro-Drugs - must be metabolised before it works
e.g. sulindac, nabumetone, fenbufen

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40
Q

Why would you give misoprostol with NSAIDs?

A

To act as a protective agent as it is a PGE1 analogue

41
Q

Why would you give Omeprazole with NSAIDs?

A

It is a proton pump inhibitor and acts as a protector against the side effects

42
Q

Name 2 drugs that can act as a protective agent with NSAIDs

A

Misoprostol and Omeprazole

43
Q

Why does an enteric-coating on NSAIDs reduce side effects?

A

It protects the stomach lining from the tablets effects

44
Q

Why do pro-drugs reduce NSAID side effects?

A

They have to be metabolised in the liver before they become active, reducing the impact on the stomach

45
Q

What are sulindac, nabutemone and fenbufen examples of?

A

NSAID Pro-drugs

46
Q

What type of drug is aspirin?

A

An NSAID

47
Q

What NSAID is effective against mild pain and fever, and is a non-selective COX inhibitor?

A

Aspirin

48
Q

What is Reye’s syndrome and what is it associated with?

A

A fatal disease associated with giving aspirin to children with viral illnesses such as chicken pox

49
Q

What 5 groups of patient should aspirin not be given to?

CPBAL

A

Children (under 16)
Those with history of peptic ulcer (think GI side effects)
Those with Haemophilia or other bleeding disorders (anti-coagulant)
Patients on Anti-coagulant drugs
Those with liver disease

50
Q

What could happen if you give aspirin to someone with a bleeding disorder or on an anti-coagulant drug?

A

It could make the effects worse

51
Q

Why should you not give aspirin to people with a history of peptic ulcers?

A

They have negative effects on the GI Tract

52
Q

What type of drug is ibuprofen?

A

An NSAID

53
Q

What is the first choice NSAID drug and why?

A

Ibuprofen as it is slightly more specific to COX2, thus lower risk of side effects

54
Q

What is naproxen?

A

An NSAID similar to ibuprofen but it is more potent and longer lasting - it has a longer half life = fewer doses

55
Q

Name an NSAID similar to ibuprofen with a longer half life:

A

Naproxen

56
Q

What are dexibuprofen, fenbufen, ketoprofen, diclofenac, indometacin, mefenamic acid and piroxicam examples of?
What are they similar to?

A

NSAIDs similar to ibuprofen

Most have fen in the name

57
Q

What drug do we not know the mechanism of action for, that acts as an excellent antipyretic, and also as an analgesic?
(not a very good anti-inflammatory)…

A

Paracetamol

58
Q

What drug do we use to reduce pain and fever?

A

Paracetamol

59
Q

What drug can be used to treat children and also with ibuprofen?

A

Paracetamol

60
Q

What 2 things does paracetamol mainly act as?

A

Antipyretic

Analgesic

61
Q

Why do we give combined NSAIDs and opioid analgesics, even though they do not give greater relief than the opioid alone?

A

Less chance of dependence on the opioid

62
Q

Which NSAIDs do we tend to combine with a weak opiate?

A

Aspirin or Paracetamol

63
Q

What are co-codaprin and co-codamol examples of?

A

Combined NSAIDs and opioid analgesics

64
Q

What does co-codaprin contain?

A

Aspirin and Coedine Phosphate

65
Q

What drug contains paracetamol and coedine phosphate?

A

Co-codamol

66
Q

Are co-codaprin and co-codamol available over the counter?

A

Yes

67
Q

What is the drawback to combining NSAIDs with opioid analgesics?

A

Increased number of side effects

68
Q

What drugs cause euphoria, analgesia and sleep?

A

Opioid Analgesics

69
Q

Opioid Analgesics are from opium (poppy juice).

What 3 things can they induce?

A

Euphoria, analgesia and sleep

70
Q

What are enkephalins, endorphins and dynorphins?

Opioid analgesics mimic them

A

3 chemicals naturally produced in the body that bind to opioid receptors
Natural ‘feel good’ chemicals

71
Q

What type of pain are opioid analgesics used for?

A

Pain of visceral origin

72
Q

What do we call pain resulting from surgery or terminal illness?
What do we use as an analgesic in this situation?

A

Pain of Visceral Origin

Opioid Analgesics

73
Q

The dorsal horn releases enkephalin which usually binds to …………… receptors on the AO/C fibre. This then releases substance P which goes to the thalamus then spinothalamic tract causing pain. What drug stops this and how does it work?

A

Opioid receptors.

Opioids inhibit substance P release and this inhibits calcium influx needed to send the action potential up the tract to the thalamus

74
Q

What is the gold standard opioid?

A

Morphine

75
Q

What are coedine, dihyrocoedine and meptazinol used for?

What are they?

A

Opioids used for mild to moderate pain

76
Q

What drugs do we use for mild to moderate pain?

A

Coedine, dihydrocoedine and meptazinol (opioids)

77
Q

What drugs do we use for moderate to severe pain?

MDPBine and Tol

A

Morphine, diamorphine (heroin), pethidine, buprenorphine and tramadol (opioids)

78
Q

What are morphine, diamorphine, pethidine, buprenorphine and tramadol used for?

A

Opioids used for moderate to severe pain

79
Q

What drugs do we use for intraoperative analgesia?

during surgery

A

Fentanyl, alfentanil

80
Q

When do we use fentanyl and alfentanil?

A

For inoperative analgesia

81
Q

What do we use for postoperative analgesia?

A

Morphine

82
Q

When do we use naloxone?

A

To combat an overdose of opioids - it binds to the opioid receptors to stop them binding more

83
Q

What drug do we use to combat opioid overdose?

A

Naloxone

84
Q

What type of drug do we use for acute and chronic pain (palliative care)?
What state does it put the patient in?

A

Euphoria and mental detachment

Morphine

85
Q

What 5 ways can morphine be administered?

A 
Intravenously
Intramuscularly
Subcutaneous
Rectal
Slow absorption in mouth
86
Q

Why is morphine good for chronic pain? (Other than its pain relieving and euphoric effects)

A

It releases over time - sustained release

87
Q

When morphine is infused by a syringe pump operated by the patient, what do we tend to call this?

A

Patient controlled anasthesia

88
Q

What drug has the common side effects of constipation, nausea and vomiting, sedation, coughing, and confusion, nightmares and hallucinations?

A

Morphine

89
Q

Morphine always produces which side effect?

A

Constipation (good for surgery)

90
Q

What side effect results from morphine stimulating the chemoreceptor trigger zone in the brain stem?

A

Nausea and vomiting

91
Q

What drug can patients potentially become dependent to or tolerant of, that can also result in respiratory depression (due to its effect on the medulla respiratory control centre)?

A

Morphine

92
Q

When morphine is used in a therapeutic dose it can cause respiratory depression. In this scenario why is it not a bad thing?

A

You breathe fast when in pain anyway

93
Q

What do you do if a patient starts to become tolerant to morphine?

A

Give a higher dose

94
Q

Which sensory fibres are of small diameter and therefore more sensitive?

A

AO and C

95
Q

How are lipid-insoluble local anaesthetics administered?

Why?

A

They are injected into the nerve axon as they can’t pass through the membrane

96
Q

How are lipid soluble local anaesthetics administered?

A

Topically to skin or mucosal surfaces

97
Q

When administering a local anaesthetic by subcutaneous injection to nerve endings with a vasoconstrictor - what should you beware of?

A

Being too close to peripheral areas such a finger tips - could result in tissue damage

98
Q

What do we call the process where local anaesthetic is infiltrated around a nerve?

A

Nerve block

99
Q

What is an uncommon method of administration for local anaesthetic in today’s hospitals?

A

Intravenous regional anaesthesia

100
Q

What are lidocaine, bupivicaine, prilocaine and tetracaine examples of?

A

Local Anaesthetics - CAINE

101
Q

What should we take caution to when administering analgesics?

A

Administering (where - which drug best)
Side-effects
Dependence

Pharmacology (13 decks)

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