Drugs For Control Of Pain Flashcards
F
F
Neuropathic Pain
Constant
Direct nerve injury
Nociceptive Pain
Stimulation of free nerve endings responsible for pain
Usually acute
Somatic vs visceral
Somatic pain
A delta nerve fibers
Myelinated->quick nerve response (sharp)
Visceral pain
C nerve fibers
Unmyelinated-> slow pain response (dull)
Substance P
Transmission of pain message to brain
Neurotransmitter in brain
Endogenous opioids
Endorphins,dynorphins, enkephalins
Counteract effects of substance P
Opioid analgesics
Act within CNS
Opioid receptors (+)
Non-opioid analgesics
Act on nociceptor level
Anti-inflammatory
Drugs for Pain:Opioids
Morphine-like molecules
Opiate-natural, from poppy plant
Opiods- natural/synthetic drug
Narcotic- opioids that produce analgesia+ cns depression
Opioid receptors
Mu, kappa, and delta
*mu and kappa are major drug targets for analgesia
High efficacy opioid agonist drugs
Morphine(astramorph,duramorph)
Fentanyl(duragesic)
Hydromorphone(dilaudid)
Methadone(dolophine)
Morphine(astramorph,duramorph)
Fentanyl(duragesic) moa
Strong mu receptor agonist
Very potent and metabolized quickly
Hydromorphone(dilaudid) moa
Strong mu receptor agonist
Only used for acute pain bc of addiction potential
Methadone(dolophine) moa
Strong mu receptor agonist
Tx opioid addiction and detoxification bc of long duration of action
Low eficacy opioid agonist drug
Codeine
Mu receptor (+)
Weak pro-drug of morphine
Mixed efficacy opioid agonist drug
Buprenorphine(suboxone)
Partial mu (+) kappa (-)
Tx opioid dependence
Opioid side effects
Decr GI motility
Nausea/emesis
Sedation/respiratory depression
Euphoria
Combination Drugs
Opioid agonist with centrally-acting analgesic
Vicodin (hydrocodone/acetaminophen)
Percocet (oxycodone/acetaminophen)
-mod/severe pain
Tylenol T3 (acetaminophen/codeine) -used after appendectomy or wisdom teeth removal
Opioid withdrawal
Physical dependence lasts about 7 days and symptoms include diarrhea, nausea/vomiting, myalagia
Psychological dependence is the intense craving
Methadone maintenance
Not as eiphoria inducing as morphine/heroin
Does not cure dependency
Buprenorphine (suboxone) withdrawl tx
Addition of naloxone prevents pt from abusing again which causes withdrawal symptoms
Opiod antagonist
Naloxegal (movantik)
Naloxome (Narcan)
Naloxegal (movantik) moa
PEGylated mu receptor (-)
Knocks other opioids of mu receptors in the gut
Tx opioid induced constipation bc of dec gi motility
Naloxone (Narcan) moa
(-) all opioid receptors
Tx: opioid overdose
Other causes of pain
Prostoglandins -tissue damage
Histamine -inflammation
NSAIDS moa/drugs
COX 1 and 2 inhibitors
Naproxen sodium (aleve) Aspirin (acetylsalicylic acid) Ibuprofen (advil, motrin) Diclofenac (voltaren) Indomethacin (indocin) ketolorac (toradol)
Selective Cox 2 (-)
Celecoxib (celebrex)
Tx arthritis
Acetaminophen (tylenol) moa
Unclear, thought to inhibit COX in CNS
Centrally acting
Tension Headaches drugs
Aspirin
Ibuprofen
Acetaminophen(tylenol)
Migraine Drugs
Triptans: sumatriptan(imitrex)
Moa- 5HT 1 (+) which constricts blood vessels in brain
Ergot alkaloids: ergotamine (ergostat)
Moa- 5HT 1 (+) which constricts blood vessels in brain
Intractable Pain Drugs
Not easy to relieve, usually nerve/neuropathic pain/ SZ drugs
Carbamazepine (tegretol)
Gabapentin (neurotonin)
Pregabalin (lyrica)
Valporic acid (depakene)
Carbamazepine (tegretol) moa
Na+ channel blocker
Gabapentin (neurotonin) moa
Blocks voltage gated Ca+ channels
Pregabalin (lyrica) moa
Blocks voltage gated Ca+ channels
Valporic acid (depakene) moa
Na+ channel desensitization
(+) GABA
(-) Ca+ channels
Other Drugs for Pain Management
Anaesthetic nerve blockers
Corticosteroids
Tricyclic antidepressants-amitriptyline (Elavil) moa: (-) NET and SERT and positive ion channel blockade
