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Pharmacology (HEB) > Analgesics > Flashcards

Analgesics Flashcards

1
Q

Aspirin MoA?

A

Non-competitive, irreversible inhibition of COX1 and COX2, preventing synthesis of prostaglandins.

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2
Q

Indications for aspirin?

A
  • Inhibition of platelet aggregation
  • Mild-mod pain
  • Fever / Rheumatic fever
  • Migraine
  • RA
  • Kawasaki disease
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3
Q

When should precautions be taken with aspirin?

A
  • Allergic rxn to aspirin / NSAID
  • Heart failure / HTN
  • Asthma
  • Gout
  • G6PD deficiency
  • PUD
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4
Q

Common adverse effects of aspirin?

A
  • N/V
  • Headache / dizziness / tinnitus
  • GI ulceration / bleeding
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5
Q

Adult dosage of aspirin for pain?

A

300 - 900 mg every 4-6h.

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6
Q

What is nociception?

A

Detection, transduction and transmission of noxious stimuli.

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7
Q

What are the equilavent dosages of opioids? (based on 10mg morphine)

A
  • 10mg morphine
  • 100mg codeine PO
  • 5mg oxycodone
  • 2mg hydromorphone
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8
Q

In which pts should NSAIDs be used with caution?

A
  • Asthma
  • Coagulopathy
  • GI ulcer
  • Renal insufficiency
  • Pregnancy, 3rd trimester
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9
Q

What are the side effects of opioids?

A

CHARMEN

  • Constipation
  • Histamine release (itching / urticaria / bronchoconstriction => morphine only)
  • Addiction / dependence
  • Respiratory depression
  • Miosis
  • Euphoria
  • N/V
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10
Q

What should be considered when prescribing opioids?

A
  • Breakthrough dose
  • Anti-emetics
  • Laxative
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11
Q

What is the mechanism of action of paracetamol?

A

?COX 2 inhibitor / modulation of endogenous cannabinoid system

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12
Q

What is max dose of paracetamol?

A

4g / 24h

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13
Q

Side effects of paracetamol?

A
  • Hepatotoxicity
  • HTN risk in women
  • Nephrotoxicity
  • Mild coagulopathy
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14
Q

MoA NSAIDs?

A

Non-selevtive COX1 and COX2 inhibition reducing proinflammatory cytokine synthesis.

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15
Q

Side effects of NSAIDs?

A
  • GI ulceration/bleeding
  • Decreased renal perfusion
  • Photosensitivity
  • Premature closure of ductus arteriosus in pregnancy
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16
Q

What are the oral opioids?

A
  • Codeine
  • Oxycodone
  • Morphine
  • Hydromorphone
17
Q

Parenteral opioids?

A

Morphine, hydromorphone, fentanyl.

18
Q

MoA of opioids?

A
  • Dampens nociceptive transmission between 1st and 2nd order neurons in the dorsal horns
  • Activates ascending modulatory pathways releasing inhibitory neurotransmitters
  • Inhibits peripheral inflammatory response and hyperalgesia
  • Affects mood and anxiety - alleviates affective component of perceived pain
19
Q

What is the analgesic ceiling?

A

The maximum effect (pain relief) that can be induced in a tissue by a given drug, regardless of increasing doses.

20
Q

Which analgesics are subject to the ceiling effect?

A 
Paracetamol, NSAIDs, codeine.
NOT opioids (except codeine).
21
Q

How does opioid overdose primarily present?

A

CNS (e.g. respiratory depression). Manage ABCs

22
Q

MoA opioid antagonists?

A

Competitively inhibit opioid receptors, predominately u (mu) receptors.

23
Q

Duration of naloxone action?

A

T1/2 relatively short (60mins). May wear off with return of narcotic effect.

24
Q

Duration of naltrexone action?

A

Longer T1/2 than naloxone ==> 10h duration.

Less likely to have return of opioid effect

25
Q

Side effects of naloxone overdose?

A
  • Nausea/agitation/sweating
  • Tachycardia and HTN
  • re-emergence of pain
  • APO
  • Seizures (essentially opioid withdrawal)
26
Q

What is neuropathic pain?

A

Pain caused by PNS or CNS injury.

27
Q

How is neuropathic pain often described?

A

Burning / lancinating / shooting / tingling.

28
Q

What does neuropathic pain result in?

A
  • Allodynia (pain to normal stimuli)

- Hyperalgesia (increased sensitivity to normally painless stimuli).

29
Q

Rx of neuropathic pain?

A

Consider anti-convulsants (gabapentin, pregabalin) or low dose TCAs.
Opioids are ineffective.

30
Q

What is chronic pain?

A

Pain of duration or intensity that persists beyond normal tissue healing and adversely effects functioning. May have nociceptive and neuropathic components.

31
Q

Indication for paracetamol?

A

Mild - mod pain

32
Q

Paracetamol dosage?

A

0.5 - 1g 4-6 hrly.

Max 4g / 24h

33
Q

MoA of tramadol?

A
  • Enhances central 5-HT and NA transmission (reuptake inhibitor)
  • Weak opioid receptor agonist
34
Q

Indications for tramdol?

A

Chronic pain

35
Q

Maximum parenteral concentration of morphine?

A

50mg/mL

36
Q

What is dilaudid?

A

Immediate release hydromorphone

Pharmacology (HEB) (17 decks)

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