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Chapter 26 Flashcards

1
Q

A fibers

A

large diameter nerve fibers that carry peripherial impulses associated with temp and touch to spinal cord
*do not transmit pain
*backrubs stimulate

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2
Q

A delta fibers

A

Small Myelinated nerve fibers that carry peripheral impulses associated with pain to the spinal cord
*Respond quickly to acute pain

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3
Q

C fibers

A

Unmyelinated slow conducting fibers that carry peripheral impulses associated with pain to the spinal cord

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4
Q

Ergot derivative

A

drug that causes vascular constriction in the brain & periphery, relieves or prevents migraine headaches but is associated with many adverse effects

*reduce hyperperfuson and basilar artery vascular bed

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5
Q

Gate control theory

A

transmission of a nerve impulse can be modulated at various points along its path by descending fibers from the brain that close the gate and block transmission of pain information

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6
Q

MIgraine headache

A

headache charaterized by server, unilateral, pulsating head pain associated with systemic effects, GI upset, sensitivity to light & sound

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7
Q

Opioids

A

drugs derived from opium that react iwth specific opioid receptors throughout body

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8
Q

opioid agonists

A

drug that react at opioid receptor sites to cause analgesia, sedation or euphoria
*controlled substances

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9
Q

opioid agonist-antagonists

A

drugs stimulate or block the activity of certain opioid receptors
*less abuse potential but similar analgesic effect

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10
Q

opioid antagonist

A

drugs that block opioid receptor sites
*used to counteract the effects or treat overdose

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11
Q

opioid receptors

A

receptor sites that react to naturally occurring peptides, endorphins and enkephalins, which are receptive to opioid drugs
*found in CNS, nerves n periphery, cells in GI tract

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12
Q

Pain

A

sensory and emotional experience associated with actual or potential tissue damage

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13
Q

spinothalamic tract

A

nerve pathway from the spine to the thalamus along with pain impulses are carried to the brain

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14
Q

triptan

A

Selective serotonin receptor blocker that causes a vascular constriction of cranial vessels, used to treat acute migraine attacks

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15
Q

What are the 2 agents that can change perception and tolerance of pain?

A

Opioids & opioid antagonists
anti-inflammatory agents

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16
Q

Pain can be further classified by an originating source, such as

A

nociceptive - direct stimulus to pain recpto
neuropathic - caused by nerve injury
psychogenic - associ w/ emotional, psychological, behavioral

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17
Q

What do opioid receptors in the brainstem and spinal cord/thalamus do?

A

**In brainstem -control BP, pupil diameter, GI secretions, chemoreceptor trigger zone
***in spinal cord and thalamus - integrate and relate incoming info about pain

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18
Q

Endorphins are released during _____ to block the sensation of?

A

Stress
Pain

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19
Q

What are some non-pharmacological methods to treat pain?

A

warmth
massage
positioning
acupuncture
meditation

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20
Q

What are the 2 opioid recptors and what do they do?

A

mu (m) - pain blocking -respiratory depression, euphoria, decreased GI activity, pupil constriction, physical dependence

kappa (k) - some analgesia, pupillary constriction, sedation, dysphoria

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21
Q

What are the opioids that have an established pediatric dose?

A

codeine, fentanyl (not transdermal), hydrocodone, meperidine, morphine

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22
Q

What opioids are not recommended for children?

A

levorphanol, oxymorphone, oxycodone, methadone

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23
Q

Child <13 yrs requires a opioid-agnost-antagonist, what is used?

A

buprenorphine

24
Q

What is the drug of choice in children for reversal of opioid effects and overdosE?

25
What are the analgesics used during labor
morphine, meperidine, oxymorhone
26
WHat drugs are opioid agonists
Alfentanil hydrocodone Codeine Fentanyl hydrocodone hydromorphone levorphanol Meperidine Methadone morphine opium oxycodone oxymorphone remifentanil sufentanil tapentadol tramadol
27
What are the therapeutic actions for opioid agonists?
Act on specific opioid receptor sites in CNS to produce analgesia, sedation, and sense of well being *also as antitussives
28
What are the pharmacokinetics for opioids
IV - most reliable IM and Subcut - varying rates of absoprtion/absoprtion slower in females Hepatic metabolism, excreted in urine and bile half life vary Cross placenta
29
What are the contraindications for opioid agonists
Allergy diarrhea caused by toxic poisons after biliary surgery or surgical anastomoses CAUTION Respiratory dysfunction GI surgery ulcerative colitis head injuries, alcoholism, TD's Renal/liver dysfunction
30
What is the pregnancy category for opioid agonists
Oxycodone category B All others C
31
What are the adverse effects of opioid agonists?
Respiratory depression, cardiac arrests, shock Orthostatic hypotensions GI effects, nausea, vomit, constipation Lightheaded, dizziness, anxiety dear
32
What are opioid agonists drug to drug interactions?
Barbiturate or MAOI - increased respiratory depression, hypotension, sedation or coma **Tapentadol - avoid - SSRI, MAOT, TCA and st johns wart - due to an increase of serotonin syndrome
33
What are the opioid agonists-antagonists drugs
Bupernorphine butorphanol nalbuphine pentazocine
34
What are the therapeutic actions of opioid agonists-antagonists?
Act at specific sites in CNS to produce analgesia, sedation, euphoria and hallucinations *Also block receptors that may be stimulated by other opioids
35
What are the indications for opioid agonists-antagonists?
Relief of moderate to severe pain adjuncts to general anesthesia Relief of pain during labor
36
What are the pharmacokinetics for opioid agonists-antagonists
readily absorbed after IM admin Reach peak rapidly in IV MEtabolized in liver, excreted in urine or feces Cross placenta and milk
37
What are the contraindication and cautions for opioid agonists-antagonists?
allergy Nalbuphone should not be give to allergic to sulfites Caution physical dependence Chronic obstructive pulmonary disease MI, CAD, hypertensionon
38
What are the adverse effects of opioid agonists-antagonists
respiratory depression, supression of cough reflext, nausea, vomit, constipation, light headed, dizzy, anxiety, fear, hallucination, loss of libido
39
What are the opioid agonists-antagonists drug to drug interactions
Barbiturate - avoid Previously recieved opiods Pentazocine w/ tripelennamine (ts and blues) abused
40
What drugs are the opioid antagonists?
naloxone naltrexone
41
What are the therapeutic actions of opioid antagonists
reverse effects of opioids including respiratory depression, sedation and hypotension *treatment for OD
42
What are the contraindications and cautions for opioid antagonists
Allergy pregnancy opioid addiction CV disease
43
What are the adverse effects of opioid antagonists
Acute opioid abstince syndrome - nausea, vomit, sweat, tachycardia, hypertension, anxiety CNS excitement, tachycardia, bP changes, pulmonary edema
44
What is the difference between a migraine headache and a cluster headache?
MIgraine - occur during sleep, sharp eye pain, 15-90 min, sweating, nasal congestions Tension - times of stress, dull band pain around head 30 mins - 1week. Fatique, mild intolderant to light or sound
45
What are common migraines? What are classic migraines?
Common - occur w/out aura, cause severe pulsating pain w/ nausea, vomit, light & sound sentiviity. Aggrevated by physical activity Classic - preceded by an aura, occurs 30 min beforepain occurs.PAin same as common
46
What migraine drugs are recommended in children?
none -- to many adverse effects Topamax - 12* older
47
What are the ergot derivative drugs?
dihydroergotamine ergotaminie
48
What are the therapeutic actions of ergot derivative
block alpha-adrenergic and serotonin receptor sites in brain to cause constriction of cranial vessels Prevention of migraine or vascular headaches
49
What are the pharmacokinetics of ergot derivative
rapidly absorbed from many routes onset of action 15-30 mins Metabolized in liver, excreted in bile Dihydroergotamine - nasal spray or IM or IV Egotamine - sublingual
50
What are the contraindication and cautions for ergot derivative
allergy CAD, hypertension, peripheral vascular disease impaired liver pregnancy
51
What are the adverse effects of ergot derivative
vascular constriction numbness tingling muscle pain weakness, chest pain, itching GI upset, nausea, vomitting
52
What are the drug to drug interactions with ergot derivative
beta blockers - peripheral ischemia and gangrene is increased
53
What are the triptan drugs?
almotriptan eletriptan frovatriptan naratriptan rizatriptan sumatriptan Zolmitriptan
54
What are the therapeutic actions of triptan
bind to selective serotonin receptor sites to cause vasoconstriction of cranial vessels *treatment of acute not for prevention
55
What are the pharmacokinetics for triptan
rapidly absorbed from many sites metabolized in liver, excreted in urine cross placenta
56
What are the contraindications for triptan
allergy CAD Caution with elderly renal or hepatic dysfunction
57
What are the adverse effects of triptan
numbness, tingling, coldness or strangeness, dizzy, weak, vertigo, GI discomfort,

Pharm (16 decks)

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