Dementia & Pain Flashcards
What is Naproxen?
reversible non selective NSAID w/ longer 1/2 time that permits 1x/day dosing
for pts w/ CV issues
What are paresthesias?
abnormal sensation (numbness, pins & needles)
What do IV opioids, alpha2 agonists and general anesthetics module?
perception of pain
What is ziconotide?
last resort drug that blocks N-type voltage-sensitive Ca2+ channels on afferent nerves in dorsal horn
MOA of ketamine
noncompetitive NMDA receptor antagonist
IV anesthesia, lower doses for chronic pain
MOA of lasmiditan
5HT1F agonist to tx migraines & decrease trigeminal stimulation (w/o vasoconstriction)
What lethal effect caused by acetaminophen OD?
hepatotoxicity
MOA of aspirin
NSAID that irreversibly inhibits COX1, COX2, for lifetime in platelets
What is dysesthesia?
unpleasant abnormal sensation
MOA of ibuprofen
reversible NSAID
increase risk of MI, stroke
What risk increased w/ aspirin & warfarin use?
risk of BLEEDING
MOA of pregabalin
inhibits NT release @ nerve terminals
neuropathic pain (DM neuropathy, SC injury, postherpetic neuralgia)
MOA of donepezil
reversible noncompetitive inhibitor of AChE
prolongs signaling of ACh in synaptic cleft
What is hypoalgesia?
diminished response to normally painful stimulus
MOA of acetaminophen
NO tx of inflammation
monotherapy for fever reduction
temporary relief of mild to moderate pain
What is potentially lethal consequence of aspirin toxicity?
metabolic acidosis
MOA of dexmedetomidine
selective A2 receptor agonist
IV for sedation, analgesia
MOA of capsaicin
stimulates TRPV1 receptors
depletes substance P from neurons tx nociceptive & neuropathic pain
What is added to acetaminophen to extend its utility in management of moderate to severe pain?
opioids (stimulate mu receptors)
What is cardiac effect of donepezil?
QT prolongation
can lead to Torsades
MOA of celecoxib
COX2 selective inhibitor
acute pain & inflammation
serious risk of thrombotic events
MOA of sumatriptan
selective 5HT1B, D agonist
tx mod to severe migraines by decrease neurogenic inflam
MOA of lasmiditan
5HT1F agonist
tx of migraine
What is an important mediator of sensory pain?
substance P (from terminals of sensory nerves in response to noxious stimuli)
What drug class used off-label to tx many forms of dementia besides Alzheimers?
AChE inhibitor
What tract is the ascending pain pathway?
spinothalamic tract
What are common indications for NSAIDs?
HA, fever, menstrual pain
MOA of gabapentin
binds A2D subunit of Ca2+ channels to modulate Ca2+ influx
Level of what can increase in serum w/ NSAID use?
serum Cr (esp if low GFR)
MOA of tapentadol
moderate to strong mu agonist, blocks NE reuptake
tx pain
MOA of galantamine
AChE inhibitor
tx dementia
What is a common clinical problem in pts w/ advanced dementia?
recurrent infection
What are triptans?
5HT agonists used to tx HA
AE of QT prolong, coronary vasospasm (MI, stroke)
What sxs are worsened by donepezil?
bradycardia
bronchoconstriction
MOA of dihydroergotamine
ergot alkaloid derivative
binds to vasoconstrictive receptors to tx migraine
Role of PGEs
mediators of pain sensation by nociceptors
cause sxs of inflammation
What drug causes salicylism?
aspirin
tinnitus, N/V
MOA of tramadol
partial agonist @ mu opioid receptors & blocks NE/5HT reuptake
used for pain relief
What drugs have limited efficacy & increased mortality in pts w/ dementia?
anti psychotic agents
What is neuropathic pain?
pain due to abnormal neural activity from disease, injury, or dysfxn of nervous system
MOA of rivastigmine
AChE inhibitor for dementia
TRANSDERMAL PATCH
MOA of memantine
blocks excessive glutamate (excitatory) activity thought to contribute to Alzheimer dz progression
MOA of duloxetine
SNRI
tx neuropathic pain (fibromyalgia, DM, chemotherapy)
MOA of amitriptyline
TCA for neuropathic pain
What is black box concern for NSAID use by pregnant Fs?
oligohydramnios
MOA of clonidine
A2 agonist
intrathecal for pain
How to tx apathy in Alzheimer dz?
low dose methylphenidate & antidepressant
MOA of citalopram
SSRI to tx depression assoc w/ Alzheimer dz
What are analgesics?
drugs that relieve pain w/o LOC