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Neuro II Exam 2 > Drugs for Pain - Martin > Flashcards

Drugs for Pain - Martin Flashcards

1
Q

opiod full agonst

A

morphine

fentanyl

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2
Q

opiod partial agonist

A

codeine
hydrocodone
oxycodone

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3
Q

mixed agonist/antagonist at opiod

A

buprenorphine

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4
Q

opiod antagonist

A

naloxone

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5
Q

loss of pain perception

A

analgesia

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6
Q

morphine tx

A

aware of pain sensation - but not unpleasant

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7
Q

opiod to pt with no pain

A

nausea and vomiting

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8
Q

pain

A

sensory - component due to activation of pain receptors

reactive - altered by level of anxiety and stress

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9
Q

narcotic

A

any substance producing stupor and analgesia

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10
Q

opiate

A

any derivative of opium poppy

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11
Q

opioids

A

compounds that bind opioid receptors

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12
Q

endogenous opioid agonists

A

endorphins
enkephalins
dynorphins

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13
Q

synthesis of endogenous opioid peptides

A

from POMC

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14
Q

opioid receptors

A

mu - euphoria

kappa - dysphoria

delta

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15
Q

opioid receptor mechanism

A

all GPCRs

inhibit cAMP

modulate K channels - K efflux and hyperpolarization

reduce Ca influx - inhibit NT release - glutamate, substance P

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16
Q

spinal cord opiod receptors

A

pain signaling

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17
Q

limbic system

A

addiction potential

-with opioid receptors

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18
Q

heroin OD death

A

resp depression

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19
Q

euphoria

A

with mu receptors

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20
Q

adverse of opioids

A

constipation

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21
Q

opioid effects

A 
analgesia
euphoria/dysphoria
sedation
resp depression
cough suppression
22
Q

coma and resp depression with miosis

A

pupil constriction

hint that pt is drug user - opioids

dilated pupil - other types of coma

23
Q

if asphyxia develops with opioid overdose

A

get mydriasis - pupil dilation

24
Q

severe brain injury

A

CI for opioid use

because they increase CSF pressure

25
Q

constipation

A

with chronic therapy with opioids

26
Q

opioids and asthmatics

A

no - because release histamine

can result in bronchoconstriction

27
Q

morphine

A

binds all opioid receptor
-high affinity at mu

high abuse potential and analgesia

high addiction potential**

28
Q

pharmacokinetics of morphine

A

high first pass effect

need to give 4x oral vs. IV dose

distributed to tissues - even fetus - not during pregnancy

29
Q

fentanyl

A

start quickly and stop quickly

30
Q

severe constant pain tx

A

morphine

31
Q

sharp intermittent pain tx

A

NSAIDs

32
Q

pain and anxiety with MI

A

tx - morphine - 1st line

33
Q

relief of dyspnea from left ventricular failure and acute pulmonary edema

A

tx - morphine

  • anxiolytic
  • reduced perception of SOB
34
Q

cough suppression

A

dextromorphan and codeine

35
Q

diarrhea

A

loperamide
diphenoxylate
difenoxin

atropine added to dephenoxylate and difenoxin - to prevent addiction

36
Q

fentanyl

A

100x more potent than morphine

used in anesthesia

rapid onset of action and short duration of action

epidural - analgesia post op and during labor

37
Q

methadone

A

less euphoria and long duration of action

used for withdrawal of heroin or morphine users

oral

pt slowly weaned off methadone
-causes a withdrawal syndrome that is milder

38
Q

meperidine

A

OB/GYN use
-dilates pupils

less effect on smooth muscle - so can use in obstetrics

short term use only - toxins accumulate

39
Q

heroin

A

diacetylmorphine

  • schedule I
  • converted to morphine in body
40
Q

partial agonists

A

codeine
hydrocodone
oxycodone

combined with NSAIDs - increase analgesia

41
Q

outpatient analgesics

A 
tylenol with codeine
codeine/aspirin
hydrocodone/acetaminophen
oxycodone/acetaminophen
oxycodone/aspirin
42
Q

buphrenorphine

A

partial agonist at mu receptor

use - opioid detox

not as bad withdrawal as methadone

43
Q

tx opioid OD

A

naloxone
naltrexone

opioid antagonists

44
Q

antagonist to pt dependent on opioids

A

precipitates withdrawal syndromes

45
Q

opiate reward pathways

A

GABA and dopamine pathways

opiate agonist - reduce excitability and transmitter release

inhibit in VTA on GABA interneurons

increase outflow from ventral pallidum - correlated with positive reinforcing state

46
Q

opioid tolerance

A

to analgesia, resp depression, euphoria, and sedation

NOT to miosis and constipation

47
Q

cross-tolerance

A

to all opioid agonists

48
Q

withdrawal rom opioid sx

A

rhinorrhea, lacrimation, yawning, chills, piloerction, hyperventilation, hyperthermia, mydriasis, vomiting, diarrhea, anxiety

49
Q

tx of opioid withdrawal

A

supportive care

clonidine - alpha2 agonist
-reduce craving, anxiety, and sympathetic outflow

50
Q

opioid overdose

A

1 lethargy/coma
2 depression of respirations
3 pinpoint pupils

also - hypotension, hypothermia, pulmonary edema, convulsion, hypoxia - dilated pupils

51
Q

tx opioid OD

A

opioid antagonist - naloxone

Neuro II Exam 2 (20 decks)

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