Chapter 2.1 Flashcards
- Identify the three families of endogenous opioids
a. Endorphins
b. Enkephalins
c. Dynorphins
- List the functions of endogenous opioids
a. Help regulate the immune system, GI function, and cardiovasculature response
b. Involved in aspects of behavior, response to stress, eating/drinking behavior and psychological addiction
- List the functions of the three primary classes of opioid receptors
a. Mu, kappa and delta
- State the indications for the use of opioid (narcotic)
a. Acute pain (surgery or some trauma)
b. Chronic pain (Long-term conditions, chronic MSK pain, advanced CXs)
- Classify the following opioids as strong agonist, moderate agonist, antagonist
Strong agonist
morphine, fentanyl, tramadol
moderate agonist
codeine, oxycodone
antagonist
naloxone, naltrexone
mixed agonist/antagonist
butorphanol, and nalbuphine
- State the primary and secondary mechanisms of action of the opioids
a. Primary: effects certain pain pathways (dorsal horn of the spinal cord)
b. Secondary: effects the sensitivity of the peripheral neurons
- Identify the sites of opioid effects in the human body
a. Spinal cord
b. Brain
c. Peripheral tissues
- State the relationship between dosing schedule and the clinical effectiveness of opioid analgesics
a. Orally administered opioids are more effective when given at regularly scheduled intervals rather than when the pt. feels the need for them
b. Provides optimal pain relief (plasma concentrations will be maintained this way)
- Identify the relatively minor and more serious adverse effects associated with opioid analgesics
a. Minor: mental slowing, sedation, mood changes, drowsiness, confusion, GI distress, vomiting, constipation
b. Major: respiratory depression, orthostatic hypertension, severe constipation, addiction
- Define the following terms: tolerance, dependence, and addiction.
a. Tolerance: the need to progressively increase the dosage of a drug to achieve a therapeutic effect when the drug is used for a prolonged period
b. Dependence: the onset of withdrawal symptoms when the drug is abruptly removed
c. Addiction: when a pt. repeatedly ingests certain substances for mood-altering and pleasurable experiences
- List the physical symptoms of opioid withdrawal
a. Body aches, diarrhea, fever, gooseflesh, insomnia, irritability, loss of appetite, nausea, runny nose, shivering, sneezing, stomach cramps, leg cramps, sweating, tachycardia, uncontrollable yawning, fatigue
- State the time course of withdrawal symptoms after the discontinuation of an opioid analgesic in a patient who is physically dependent on the opioid
a. Withdrawal symptoms occur 6-10 hrs after the last dose of the drug
b. Symptoms reach their peak in the 2nd/3rd day of stopping
c. Symptoms can last approx. 5 days
- State the role of the following agents in the management of opioid withdrawal and addiction: clonidine
symptomatic treatment, brainstem, slows down sympathetic outflow. Dials people down as well
methadone
primary pharmacological intervention. Strong opioid agonist; treating opioid addiction w/ another opioid. This drug is substituted and is then slowly withdrawn
buprenorphine
mixed agonist/antagonist. Partially stimulates mu opioid receptors/strongly antagonizes kappa opioid receptors.
naloxone
opioid antagonist. Can be combined w/ Buprenorphine for addiction treatment
- State factors associated with risk for addiction to opioid analgesics
a. Genetic predisposition
b. History of addiction (including alcohol abuse)
- List the factors indicating minimal risk for addiction to opioid analgesics.
a. Pt. does not have history of substance abuse
b. Pain is “psychological”
c. Dosage matches pts pain levels
- State the pharmacokinetic basis for using patient-controlled analgesia (PCA
a. Analgesic drugs should be delivered into the bloodstream via IV or other target tissue
- Define the following terms and concepts used in PCA: loading dose
a single large dose that is given to establish analgesia
demand dose
how much of the drug is given each time the pump is activated (usually very small doses)
lockout interval
how much time has to elapse before the pump can be activated again (usually short periods)
background infusion rate
a small amount of the drug is infused continuously to maintain the level of analgesia
successful versus total demands
Tells the PCPs whether the pt. is wanting to get high, or if the dosage is not good enough
1- and 4-hour limits
some PCS systems can be set to limit the total amount of drug given in a 1- or 4- hour period
- Describe the following administration routes used for PCA: IV PCA
most common, administered by inserting a needle into the peripheral vein and then connecting the needle to a catheter/IV line
epidural PCA
inserted into the area outside of the meninges surrounding the spinal cord by inserting a small catheter so the tip lies in the epidural space
spinal (or intrathecal) PCA
same as above, however the tip of the catheter is placed in the subarachnoid space
regional PCA
medication administered directly into a specific site such as a joint, peripheral nerve, or into a wound. Very localized
transdermal PCA
medication is delivered through the skin transdermally into the systemic circulation. Electrical burst facilitates this
- State the benefits of PCA
a. Allow better pain control w/ fewer side effects
b. Less sedation, tolerance, dependence
c. Increases pt. satisfaction
- Define opioid-induced hyperalgesia.
a. Opioids may be ineffective or increase pain in certain pts.
b. Why this happens is unclear
- State the concerns of a physical therapist working with a patient whose pain is managed by opioid analgesics administered orally, intravenously, or via PCA.
a. Be alert from orthostatic hypotension
b. Monitor signs of respiration depression
c. Monitor pain levels
d. Watch for signs of abuse of the drug
