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pharmacology 2 > Analgesics > Flashcards

Analgesics Flashcards

1
Q

describe acute / nociceptive pain

A

short term pain with easily identifiable cause. warning of present damage to tissue

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2
Q

describe chronic/ neuropathic pain

A

pain persists
constant/ intermittent
pain has outlived its purpose

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3
Q

describe allodynia pain

A

pain from stimulus that doesn’t normally cause pain eg. blanket on diabetic foot

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4
Q

describe parasthesis pain

A

painful feelings eg. pins and needles with no apparent stimulus

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5
Q

describe the body’s own analgesic system

A

pain is detected and relayed to brain, brain uses inhibitory pathways stimulated by opiods, serotonin and noradrenaline to secrete local analgesics (opiod, y-aminobutyric acid, encephalins)

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6
Q

name the classes of drugs which are used in analgesia

A

opiods
antidepressants
antiepileptic’s
local anaesthetic

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7
Q

what is the mechanism of action of opioids?

A

blocks pain signals going up to the brain - decreases neurotransmitter release / blocks postsynaptic receptors
enhances body’s own analgesic effect at inhibitory pathways

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8
Q

what are the side effects of opioids?

A 
N & V
constipation
drowsiness
resp. depression
hypotension
sedation
dependency
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9
Q

what are the cautions /contraindications of opioids?

A

acute resp. depression
acute alcoholism
head injury

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10
Q

what are the interactions with opioids?

A

alcohol - increased hypotension
MAOI - increased CNS excitation/ inhibition
SSRI/ TCA - increased sedation
carbamazepine - decreased plasma conc. of methadone
cimetidine - inhibit opioids

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11
Q

what do opioids mimic?

A

endogenous ligard “enkephalins” - beta-endorphin, leu-enkeplin, met-enkepalin, dynorphin

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12
Q

name the 3 opioid receptor types that opioids agonise and the subtypes

A

nu, kappa, delta

nu, kappa 1,2,3, delta 1,2

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13
Q

which opioid receptor is responsible for most analgesic effects?

A

nu - CNS, spinal cord, peripheral sensory neurons, GI tract

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14
Q

name a pure opioid agonist

A

morphine - high affinity to nu (low for kappa and sigma)

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15
Q

name a mixed opioid agonist

A

nalorphine - mixed effects on nu receptors

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16
Q

name to partial opioid agonists

A

pentazocine

cyclazocine - (-) effect at nu but partial (+) at sigma and kappa receptors

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17
Q

name 2 opioid antagonist and describe when it would be used

A

naloxone
naltrexone - blocks actions of opioids
used in heroin and morphine overdose

18
Q

name 2 types of antidepressants used as analgesics

A

serotonin and noradrenaline reuptake inhibitors (SNRI)

selective serotonin reuptake inhibitors (SSRI)

19
Q

describe the mechanism of action of SNRI and SSRI

A

inhibiting the reuptake of neurotransmitters released naturally in response to pain the effect can be prolonged
mediate descending inhibition of ascending pain pathway

20
Q

what type of pain are SNRI effective in treating?

A

neuropathic pain (doesn’t work for all)

21
Q

what type of pain are SSRI effective at treating?

A

diabetic or HIV neuropathy

22
Q

name 2 SNRI

A

venlafaxine

duloxetine

23
Q

name 2 SSRI

A

paroxetine

citalopram

24
Q

what type of pain is duloxetine used to treat and what are the side effects?

A 
peripheral neuropathy (esp. diabetic neuropathy)
SE: nausea, somnolence, insomnia, dizziness
25
Q

what type of pain is venlafaxine used to treat and what are the side effects?

A

diabetic neuropathy

SE: nausea, sedation, headache, dizziness

26
Q

what are the cautions of used SNRI

A

epilepsy, cardiac disease, diabetes, angle closure glaucoma, pregnancy, b/feeding

27
Q

what do SNRI interact with?

A

alcohol - increase sedation
NSAIDs/ aspirin - increase bleeding
tramadol - increase CNS toxicity
increased sedation with opoiods

28
Q

why should SSRI not be given with antiepileptic medication?

A

antagonise effect

29
Q

what is the mechanism of action of antiepileptic’s used as analgesics?

A

inhibit voltage gated Na+ and Ca+ channels
inhibit glumate, y-aminobutyric acid (GABA), glycine receptors
inhibit action potential firing - prevent nerve transmission
limit neuronal excitation - enhance neuronal inhibition

30
Q

name 2 antiepileptic’s used as analgesics

A

carbamazepine

gabapentin

31
Q

what types of pain is carbamazepine used to treat?

A

glossopharyngeal neuralgia
postherpetic neuralgia (nerve damaged caused by varicella zoster virus)
trigeminal neuralgia
diabetic neuropathies

32
Q

what types of pain is gabapentin used to treat?

A 
neuropathic pain: 
complex regional pain syndrome
neuropathy of face
postherpetic neuralgia
sciatic pain
33
Q

what are the side effects of carbamazepine?

A 
dizziness 
diplopsia
fatigue
nausea
hepatotoxicity
renal impair
34
Q

what cautions are there when using carbamazepine?

A

renal impairment
cardiac disease
pregnancy

35
Q

what are the side effects of gabapentin?

A

anorexia
dyspepsia
tremor

36
Q

what cautions are there when using gabapentin?

A

elderly
renal failure
diabetes
pregnancy

37
Q

name 2 local anaesthetics used as analgesics

A

lidocaine

ketamine

38
Q

what is the mechanism of action of local anaesthetics?

A

inhibits voltage gated Na+ channels and NMDA receptors - prevent nerve to nerve communication
inhibit firing - prevent impulse transmission

39
Q

what type of pain are local anaesthetics useful for treating?

A

severe intractable pain or crescendo neuropathic pain

40
Q

what is the route of administration and the side effects of lidocaine?

A 
IV
CNS effects (confusion)
depression
convulsions
hypotension
bradycardia
41
Q

what are the cautions when using lidocaine?

A 
epilepsy
hepatic/ resp. impairment
atrial fibrillation
heart block
heart failure
42
Q

what is the route of administration and the side effects of ketamine?

A 
injectable
hypertension
tachycardia
tremor
diplopia
myocardial depression

pharmacology 2 (11 decks)

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