Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharmacy > chpt 24 Pharmacologic approaches to pain management: controversies legal issues and ethical challenges > Flashcards

chpt 24 Pharmacologic approaches to pain management: controversies legal issues and ethical challenges Flashcards

1
Q

What is Pain

A

Generalized physiological and psychological
response to noxious stimuli.
Can warn us that some physiologic process has
gone awry.
Often serves no purpose other than to make a
person miserable
Alleviating pain and suffering is one of the most
basic tasks of any health care professional.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pain is a complex experience that consists of

two components, they are

A

pain as a physiological sensation
pain as an emotional and psychological reaction to
that sensation
Note: Of these, the psychological component
is the most important, because it represents
pain as “suffering”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

General Mechanistic Approaches to the

Pharmacologic Management of Pain

A
  1. Remove cause
  2. Decrease inflammation, irritation, and sensitivity of
    nerve endings (aspirin, nonsteroidal antiinflammatory
    drugs, and related agents).
  3. Block conduction of impulses by pain fibers (local
    anesthetics such as lidocaine).
  4. Modify the processing of pain information in the
    central nervous system (opioids such as morphine and
    related drugs; aspirin, acetaminophen, NSAIDs and
    related agents).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aspirin, ibuprofen, NSAIDs and
related agents are _____ of prostaglandin synthesis (COX-1 and
COX-2)

A

Inhibitors of prostaglandin synthesis (COX-1 and

COX-2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Aspirin, ibuprofen, NSAIDs and

related agents Alleviate pain by?

A

acting at nerve endings and in the

CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aspirin, ibuprofen, NSAIDs and

related agents have _______ effects may contribute to pain relief

A

Antiinflammatory effects may contribute to pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When using Aspirin, ibuprofen, NSAIDs and
related agents what is the “huge problem” (side effect) (1) and have the potential for serious other side effects such as ……(2)

A

(1) GI Side effects (irritation, bleeding, etc. are a huge
problem)
(2) potential for serious CV side effects
(hypertension, MI, stroke etc.).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aspirin, ibuprofen, NSAIDs and

related agents

A

Also, potential for serious CV side effects

hypertension, MI, stroke etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does increasing leukotrienes do/cause?

A

makes allergies and asthma worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Acetaminophen Inhibits _______ synthesis in nerve endings and CNS, but not in the _______.

A

prostaglandin

periphery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acetaminophen alleviates pain by acting at ____ _____ and in the ____.

A

Alleviates pain by acting at nerve endings and in
the CNS (exact mechanism of action is still not
clear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acetaminophen when compared to Aspirin, ibuprofen, NSAIDs and
related agents has 2 main differences

A

No antiinflammatory activity

No tendency to cause GI irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

at high doses Acetaminophen can cause __________

A

Potential for hepatotoxicity at high doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ketorolac is an Injectable _____ and has the tendency to cause ______ irritation.
It is useful alternative to opioids for pain. what would be the duration of time you would use this for?

A

Injectable NSAID
Tendency to cause GI irritation
OK for short term (<1-2 days) use but not
chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

celocoxib is the only _________ ______ on the market

A

Selective COX-2 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

COX-1 COX-2 produce what effects on the Periphery?

how good are the effects (how many +’s)

A

COX-1 N/A

COX-2 inflammation +++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

COX-1 COX-2 produce what effects on the CNS?

how good are the effects (how many +’s)

A

COX-1 pain ++

COX-2 pain ++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

COX-1 COX-2 produce what effects on the Stomach?

how good are the effects (how many +’s)

A

COX-1 increases mucus production and decreases acid secretion (both aid in gastric protection) +++
COX-2 NA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

COX-1 COX-2 produce what effects on the Kidney?

how good are the effects (how many +’s)

A

COX-1 increases renal perfusion (passage of fluid) +

COX-2 increases renal perfusion (passage of fluid) ++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

COX-1 COX-2 produce what effects on the Platelets?

how good are the effects (how many +’s)

A

COX-1 thromboxane A2 (causes platelet aggregation) +++

COX-2 NA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

COX-1 COX-2 produce what effects on the Coronary Vasculature?
how good are the effects (how many +’s)

A

COX-1 NA

COX-2 Increases prostacyclin which causes vasodilation and an DECREASE in platelet aggregation. +++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

which COX has an effect on platelet aggregation?

A

COX-1 thromboxane A2 (aggregation) +++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which COX has an effect on decreasing platelet aggregation?

A

COX-2 Increases prostacyclin which causes vasodilation and an DECREASE in platelet aggregation. +++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Marsha goes to get a filling. the dentist gives her Local Anesthetic (lidocaine and related agents) to ensure she does not feel pain during the procedure. How is this working to stop her from feeling pain?

A

Block sodium channels in nerve endings and axons and stop generation and conduction of action potentials.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Local Anesthetics (lidocaine and related agents) work best on neurons however which type of pain fiber, mylenated or unmylenated

A

Small, unmylenated pain fibers are most sensitive but

other neurons can be affected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Local Anesthetics (lidocaine and related agents) may provide Powerful pain relief with ____, ____ and ____ block techniques

A

spinal, regional and nerve block techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

using Local Anesthetics (lidocaine and related agents) for invasive procedures may affect……

A

Invasive procedures and may affect motor function and sensory modalities.

28
Q

To provide pain relief without affecting other tissues when using Local Anesthetics (lidocaine and related agents) what new dosages have been recommended?

A

Newer, low dose protocols provide more selective pain

relief without affecting other functions.

29
Q

What are the most effective drugs for most types of severe pain.

A

OPIOIDS

30
Q 
what drug class has there been increasing concern about its over-use 
of prescription
A

There has been increasing concern about the over-use
of prescription opioids and the current epidemic of
opioid addiction

31
Q

New CDC guidelines (?)discourage/encourage(?) the use of opioids for chronic pain.

A

New CDC guidelines discourage the use of opioids for chronic pain.

32
Q

Does dependence indicate addiction

A

Nope

33
Q

what is Drug dependence

A

Drug dependence is a physiologic state resulting

from chronic exposure to a drug

34
Q

what is Drug addiction

A

Drug addiction is a pattern of behavior in which the use of a drug assumes a central role in a person’s life

35
Q

Opioids Act as _____ at receptors

A

Act as agonists at receptors

36
Q

Opioids promote the release of ______ and _____

A

endorphins and

enkephalins

37
Q

Opioids act in the ____ ____ to uncouple the emotional component of pain from the physical sensation

A

They act in the limbic system to uncouple the emotional component of pain from the physical sensation

38
Q

Drugs acting on the ____ type opioid receptor are the most powerful analgesics but also have the greatest abuse potential

A

μ (mu)

39
Q

μ receptors are located primarily in the ______, ___ ____, and _____ areas and are thought to mediate supraspinal analgesia, some spinal analgesia, sedation, respiratory depression, euphoria and dependence

A

μ receptors are located primarily in the brainstem, spinal cord, and limbic
areas and are thought to mediate supraspinal analgesia, some spinal analgesia, sedation, respiratory depression, euphoria and dependence

40
Q

K receptors are located mainly in the _____ and _____ ____, and to a lesser extent, the ____ _____. They are thought to mediate some spinal analgesia, some supraspinal analgesia, meiosis, sedation, and dysphoria.

A

K receptors are located mainly in the brainstem and spinal cord, and to a lesser extent, the limbic system. They are thought to mediate some spinal analgesia, some supraspinal analgesia, meiosis, sedation, and dysphoria.

41
Q

how well does Morphine act on μ (mu) and K (kappa) receptors? (use -, +, ++, +++, or ?)
+ agonist activity
- antagonist activity
? not certain

A

μ (mu) +++

K (kappa) +

42
Q

how well does Hydromorphone act on μ (mu) and K (kappa) receptors? (use -, +, ++, +++, or ?)
+ agonist activity
- antagonist activity
? not certain

A

μ (mu) +++

K (kappa) +

43
Q

how well does Pentazocine act on μ (mu) and K (kappa) receptors? (use -, +, ++, +++, or ?)
+ agonist activity
- antagonist activity
? not certain

A

μ (mu) +/-

K (kappa) ++

44
Q

how well does Nalbuphine act on μ (mu) and K (kappa) receptors? (use -, +, ++, +++, or ?)
+ agonist activity
- antagonist activity
? not certain

A

μ (mu) -

K (kappa) ++

45
Q

how well does Buprenorphine act on μ (mu) and K (kappa) receptors? (use -, +, ++, +++, or ?)
+ agonist activity
- antagonist activity
? not certain

A

μ (mu) ++

K (kappa) -

46
Q

how well does Naloxone act on μ (mu) and K (kappa) receptors? (use -, +, ++, +++, or ?)
+ agonist activity
- antagonist activity
? not certain

A

μ (mu) -

K (kappa) -

47
Q

Tramadol may induce _____ and ____ dependence of the morphine-type (μ-opioid)

A

psychic and physical

48
Q

Clinical experience suggests that tramadol withdrawal symptoms may be relieved by…..

A

Clinical experience suggests that withdrawal
symptoms may be relieved by reinstitution of opioid therapy followed by a gradual, tapered dose reduction of the medication combined with symptomatic support.

49
Q

Methadone dosing can be difficult and needs to be done carefully however it is good for what 4 reasons?

A
  1. Good analgesic for severe pain
  2. Long –acting,
  3. orally-effective,
  4. little euphoria
50
Q

Vicodin = 5 mg ____?____ + 500 mg

___?____ (Do not exceed (?)/day)

A

Vicodin = 5 mg hydrocodone + 500 mg

acetaminophen (Do not exceed 8/day)

51
Q

10 mg morphine SC = ?

A

20 mg hydrocordone PO

52
Q

20 mg hydrocodone = ?

A

20 mg hydrocodone = 4 Vicodin

53
Q

4 Vicodin = ?

A

4 Vicodin = 2 g acetaminophen

54
Q

how many grams of acetaminophen per day are now considered dangerous

A

3 - 4

55
Q

Keys to Effective Use of Opioids Without Abuse

6

A
  • Healthcare provider must maintain control
  • Define outcomes and develop a therapeutic plan to achieve
  • Monitor patient to insure compliance with the plan and efficacy Periodic drug holidays to monitor level of pain and look for signs of dependence
  • Patient contracts
  • Drug screening
56
Q

Corticosteroids, Disease Modifying Antirheumatic Drugs (DMARDs) and Immunomodulators - act on various components of the ____ _____; they are useful in the treatment of ???
Corticosteroids can have powerful _____ effects.

A
  • immune system
  • inflammatory and autoimmune disorders (e.g. rheumatoid arthritis and lupus erythematosis).
  • Corticosteroids can have powerful analgesic effects.
57
Q

amitriptyline is a ______.

A

Antidepressant
can alleviate symptoms of depression that commonly occur in patients with chronic pain and they can enhance the analgesic effects of opioids. In addition, some are beneficial in the treatment of neurogenic pain

58
Q

Carbamazepine is a/an ________ drug that is useful in the management of various types of ____ ____

A

anticonvulsant drugs that are useful in the management of various types of neurogenic pain

59
Q

Gabapentin is a/an ________ drug that are useful in the management of various types of ____ ____

A

anticonvulsant drugs that are useful in the management of various types of neurogenic pain

60
Q

Pregabalin is a/an ________ drug that is useful in the management of various types of ____ ____

A

anticonvulsant drugs that are useful in the management of various types of neurogenic pain

61
Q

for Mild Pain - Any of the following may be
appropriate depending on the specific patient
(5)

A

acetaminophen
aspirin
ibuprofen, ketoprofen, naproxen

62
Q

arthritis, musculoskeletal, postsurgical and dental pain are all considered to be Moderate Pain - what should be used in this case?

A

Oral NSAIDs (especially for arthritis, musculoskeletal, postsurgical and dental pain)

63
Q

Moderate Pain - If drugs for mild pain are

inadequate and there are no NSAIDs what should you use for a patient who is experiencing moderate pain?

A

intermediate potency opioids (codeine, hydrocodone, etc.) usually in combination with acetaminophen or aspirin.

Mixed agonist antagonist opioids such as tramadol would also be appropriate.

64
Q

In the case of Severe Pain what types of opioids may be used?
(5)

A 
Strong opioids (morphine, oxycodone, hydromorphone, fentanyl, methadone, etc.) either alone or in combination with other agents. Keep in
mind that patients with severe pain may require higher than normal doses of opioids.
65
Q

For severe pain what types of drugs can be used?

3

A

NSAIDS

Adjuvant drugs such as antidepressants,
anticonvulsants, etc.

Strong opioids (morphine, oxycodone, hydromorphone, fentanyl, methadone, etc.) either alone or in combination with other agents. Keep in
mind that patients with severe pain may require higher than normal doses of opioids.

pharmacy (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions