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Applied Pharmacology > Analgesics in Cancer Treatment > Flashcards

Analgesics in Cancer Treatment Flashcards

1
Q

What antidepressants are used in analgesia?

A
  • Selective Serotonin Re-uptake Inhibitors (SSRIs) - Paroxetine, citalopram, fluoxetine, sertraline
  • Serotonin and Noradrenaline Re-uptake Inhibitors (SNRIs) - Venlafaxine
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2
Q

What anti-epileptics are used in analgesia?

A
  • Carbamazepine
  • Gabapentin
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3
Q

What anaesthetics are used in analgesia?

A
  • Lidocaine
  • Ketamine
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4
Q

What opioids are using in alalgesia?

A
  • Purine Agonists
  • Morphine-like drugs
  • Partial Agonists
  • Nalorphine, Pentazocine, Cyclazocine
  • Antagonists
  • Naloxone, Naltrexone
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5
Q

How do antidepressants work for analgesia?

A
  • SSRI - Paroxetine, Citalopram, Sertraline, Fluoxetine
  • Not particularly effective for analgesia (why include it then, Tristan?)
  • Appear to work well in disease environment such as in diabetes or HIV-related neuropathy.
  • Both prevent the recycling of neurotransmitters and enhance the signal.
  • SNRI - Duloxetine, Venlafaxine
  • Highly effective for neuropathic pain (not in all patients)
  • Side effects - nausea, somnolence, insomnia, dizziness, sedation, headache.
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6
Q

What are the contradictions and interactions for antidepressants in the use of analgesia?

A
  • Contradictions - epilepsy, cardiac disease, diabetes, glaucoma, pregnancy/breast feeding.
  • Interactions - Alcohol (increased sedation), NSAIDs/Aspirin (increased risk of CNA toxicity), increase in sedative effectiveness when given with opioid analgesics and SSRIs antagonise anticonvulsant effects of antiepileptics.
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7
Q

How do antiepileptics work in analgesia?

A
  • Inhibit voltage fated Na+ and Ca+ channels.
  • Inhibit glutamine, GABA and Glycine receptors.
  • Inhibit action potential firing.
  • Prevent impulse transmission
  • Limit neuronal excitation
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8
Q

How does carbamazepine work in analgesia? (antiepileptics)

A
  • For glossopharyngeal neuralgia, post-herpetic neuralgia, trigeminal neuralgia and diabetic neuropathies.
  • Side effects - dizziness, diplopia, drowsiness, fatigue, nausea, hepatotoxicity, renal impairment, skin reactions, anorexia, dyspepsie, tremor.
  • Cautions/contradictions - hepatic/renal impairment, cardiac disease, skin reactions, glaucoma, pregnancy, history of bone marrow depression.
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9
Q

How does Gabapentin work in analgesia? (antiepileptics)

A
  • Complex regional pain syndrome, neuropathy of the face, post herpatic neuralgia, sciatic type pain neuropathy.
  • Side effects - Anorexia, dyspepsia, tremor
  • Cautions/contradictions - elderly, renal impairment, diabetes, pregnancy.
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10
Q

How is Lidocaine used in analegia? (local anaesthetic)

A
  • Na+ chanel blocker - effective in non-cancer patients (IV)
  • Side effects - CNS effects (confusion), respiratory depression, convulsions, hypotension, bradycardia.
  • Cautions/Contradictions - Epilepsy, hepatic/respiratory impairment, atrial fibrillation, heart block, heart failure.
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11
Q

How is Ketamine used in analgesia? (anaesthetic)

A
  • Blocks glutamine receptors
  • Injectible but not favoured due to side effects.
  • Side Effects - hypertension, tachycardia tremor, diplopia, myocardial depression
  • Cautions/Contradictions - hypertension, angina, heart failure, aneurysms, cerebral trauma, psychotic disorders.
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12
Q

How do opioids work in analgesia?

A
  • Modify the transmission of pain signals and the subjective perception of pain.
  • Decrease neurotransmitter release.
  • Block postsynaptic receptors.
  • Activate inhibitory pathway.
  • Highly effective - variety of routes.
  • Side effects - nausea, vomiting, constipation, respiratory depression, hypotension, sedation
  • Cautions/Contradictions - acute respiratory depression, acute alcoholism, head injury.
  • Interactions - Alcohol (increases hypotensive and sedative effects), MAOI (increased CNA excitation/inhibition), SSRI/TCA (increased sedation), Carbamazepine (decreased plasma concentration of methadone), Cimetidine (ulcer healing -inhibit opioids metabolism)
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13
Q

Which of the following antiemetic drugs is the “drug of choice” for the treatment of Post-Operative Nausea and Vomiting (PONV) and Chemotherapy-Induced Nausea & Vomiting (CINV)?

A

Ondansetron

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14
Q

Which of the following is NOT associated with emesis?

A

The sympathetic pathway

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15
Q

Which of the following statements applies to morphine?

A

It can be antagonised by naloxone

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16
Q

Which of the following endogenous chemicals do(es) NOT have analgesic properties?

A

Substance P

Applied Pharmacology (12 decks)

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