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pharm midterm > analgesics > Flashcards

analgesics Flashcards

1
Q

how can analgesics be broadly divided?

A

opioids and non-opioids

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2
Q

What is included in the opioid class?

A

naturally occurring agents (opium alkaloids) and synthetic opioid agonists that elicit morphine like activity, including: codeine, oxycodone, methadone, morphine, hydromorphone, meperidine and fentanyl

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3
Q

What is the mechanism of action for analgesics?

A

via spinal or supraspinal activation of receptors within the CNS, decrease neurotransmitter release form nociceptive neurons altering perception and pain response

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4
Q

Where do opioid receptors exist outside the CNS?

A

in the dorsal root ganglia and the peripheral terminal of primary afferent neurons

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5
Q

What is the WHO analgesic ladder?

A

a generally accepted guideline for the supply of analgesics

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6
Q

How should mild pain be treated?

A

with non-opioids (tylenol, NSAIDs)

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7
Q

How should severe pain be treated?

A

usually reserve opioids for moderate to severe pain in our population; fentanyl or morphine

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8
Q

How should moderate pain be treated?

A

with weaker opioids or combination products

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9
Q

What are other uses of analgesics?

A

to treat pain/stress r/t mech vent, surgical procedures or pain

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10
Q

What are the adverse effects of opioids?

A 
respiratory depression
hypotension
glottic and chest wall rigidity
constipation- with chronic use
urinary retention
seizures
sedation
bradycardia
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11
Q

How can s/e be minimized with opioid administration?

A

selecting the appropriate product & dosing, continuous monitoring, continual assessment and VS obtained

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12
Q

What is naloxone?

A

narcan; a competitive opioid/narcotic agonist that reverses many of the s/e; antagonizes the endorphin effects

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13
Q

When is naloxone indicated?

A

as an adjunct tx for opioid induced respiratory depression

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14
Q

Which patient population should not receive naloxone?

A

not to babies who have been exposed to narcotics chronically; case reports of seizures secondary to acute withdrawal

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15
Q

Is naloxone safe to use in the DR?

A

not recommended in typical resuscitation; if it is needed in DR first establish color, normal HR and perfusion first via PPV

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16
Q

What is the most common opioid?

A

morphine

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17
Q

what is the solubility of morphine?

A

soluble in water, lipid solubility is poor

18
Q

How is morphine cleared from the body?

A

metabolites cleared by the kidneys and partly by biliary excretion

19
Q

What is the net effect of a renally impaired newborn with long term morphine administration?

A

lead to accumulation of MS

20
Q

what is the preferred route of administration of morphine?

A

IV, IM is painful and with noted variability of rectal absorption

21
Q

What differences are there between bolus and continuous MS?

A

no difference in analgesic effect

22
Q

When does morphine CL improve in the newborn?

A

CL improves with postconceptual age, approaches adult levels by 6-12 mo of age

23
Q

What responses are typically seen in patients that have been administered MS rapidly?

A

hypotension, bradycardia and flushing (r/t histamine response)

24
Q

What is the effect of MS on BP?

A

may cause hypotension but probably dependent on actual dosing and GA

25
Q

How does naloxone reverse respiratory depression?

A

by competing for the CNS opioid receptor sites

26
Q

What is the onset of action of naloxone?

A

variable from minutes (s/p IV) to 1 hour (s/p IM)

27
Q

What is the T 1/2 of naloxone?

A

~70 min; T 1/2 of naloxone may be shorter than the T 1/2 of the narcotic

28
Q

When are the peak effects of morphine felt and how long is the period of duration?

A

peak : 45-90min

duration: 4-5 hr

29
Q

What is methadone?

A

a synthetic opioid with an analgesic potency similar to morphine

30
Q

When is treatment with methadone indicated?

A

widely used for the tx of opioid withdrawal in neonates; has a more rapid distribution and slower elimination than MS

31
Q

What is fentanyl?

A

a synthetic opioid with 50-100 fold greater potency than morphine

32
Q

What makes fentanyl a good choice as an analgesic agent in the neonatal population?

A 
wide margin of safety
rapid onset (3-4 min), shorter duration (30 min)- may be r/t lipid solubility and molecular confirmation allowing penetrance of BBB
33
Q

How is fentanyl metabolized?

A

hepatically; pts with dec hepatic perfusion or impaired fx may have dec fentanyl CL

34
Q

What is the Rx of choice for procedural pain?

A

fentanyl; because of rapid onet and short duration

35
Q

In what pt population is fentanyl the preferred analgesic?

A

pts with hemodynamic instability, pts with MS tolerance, pts with s/s of histamine response with MS admin

36
Q

when do patients develop a tolerance to narcotics?

A

synthetic opioids show a more rapid tolerance 93-5 d) v MS (2-3 wk)

37
Q

When is midazolam indicated?

A

a benzodiazepine that offers sedation, anxiolysis, hypnosis and amnesia, NOT ANALGESIA

38
Q

Why does versed have a rapid onset of action?

A

versed penetrates the BBB very quickly

39
Q

what are adverse effects of versed?

A

may cause respiratory depression (if given too quickly), hypotension or seizure like myoclonus activity (for patients on cont infusions)

40
Q

When is Acetaminophen indicated?

A

widely used in the management of pain and fever but LACKS anti-inflammatory effects; for the tx of mild pain; no longer recommended to be given with irritability a/w immunizations

41
Q

When are NSAIDs indicated?

A

antipyretic, analgesic and anti-inflammatory effects; can interfere with platelet aggregation (is reversible)

42
Q

What are some nonpharmacologic interventions?

A 
sucrose
nonnutritive sucking
sucrose + nonnutritive sucking
kangaroo care
facilitated tucking
music therapy
breast milk
breastfeeding
multisensorial stimulation

pharm midterm (5 decks)

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