Drugs- Opioids and pain management (martin) Flashcards
what does ibuprofen have that acetaminophen doesn’t
anti-inflammatory effects
Vicodin, Norco, Lortab
acetaminophen pluse hydrocodone (partial agonist)
Percocet
acetaminophen plus oxycodone
Empirin compound
aspirin plus codeine
percoden
aspirin and oxycodone
ultram/tramadol
weak mu opioid agonist and 5HT and NE reuptake blocker
what is the drug of first choice for treatment of severe acute pain
morphine
low oral dose availability
Dilaudid
Hydromorphone
full agonist
Meperidine
used in obstetrics b/c it has less effects on smooth muscle
toxic metabolite can build up and cause seizures
causes dilation of pupils
full agonist
buprenorphine
mixed agonist/antagonist
used for opioid detoxification
what are three weak/partial opioid agonist
codeine
hydrocodone- only used orally
oxycodone - only used orally
methadone
full agonist
has less euphoria and longer duration of action than morphine
used for heroin addicts
fentanyl
full agonist
very lipophilic and more potent than morphine
good for anesthesia - short duration and quick onset
not used orally
Naloxone (Narcan)
antagonist
used to treat opioid overdose
M.S. is a 29-year-old female who has come to the clinic limping and complaining of pain in her right ankle after falling while playing tennis. Physical examination is unremarkable except for a slightly swollen ankle, tender to the touch. X-rays reveal no bone damage.
- What types of medication are appropriate for the treatment of pain in this case?
- Which medications have an anti-inflammatory effect as well as an analgesic effect?
1.A.2. Acetaminophen (Tylenol) has analgesic and antipyretic properties, but has no anti-inflammatory effects. In addition, acetaminophen does not affect platelet function or increase blood clotting time, and lacks many of the other side effects of aspirin such as GI irritation.
All the NSAIDs have analgesic activity at doses below those required for anti-inflammatory activity.
C.C., a 53-year-old woman with a history of peptic ulcer disease, enters the emergency room with a chief complaint of sever upper abdominal distress and black stools. She states that she has been having severe headaches and has recently increased her daily aspirin intake to about 18 tablets.
- How does aspirin affect the gastrointestinal tract?
1B.1. Aspirin has three major gastrointestinal effects, dyspepsia, occult blood loss, and active GI hemorrhage. C.C. is experiencing the first two effects.
Dyspepsia: not necessarily associated with blood loss but is a common problem with aspirin. It is most likely due to local irritation from undissolved tablet particles and to inhibition of the protective effects of prostaglandins. Patients should be instructed to drink large quantities of warm water or to take a liquid antacid with the aspirin (or use a non-aspirin pain reliever). Enteric-coated aspirin also has a slightly decreased incidence of GI irritation, but still carries a risk of serious GI complications GI Blood Loss: Aspirin ingestion is associated with a six to eleven fold increase in daily GI blood loss in normal subjects. The amount of blood loss is highly variable among patients but generally is dose-related. At equal analgesic doses, aspirin causes more occult blood loss than other NSAIDs. The ingestion of aspirin with food does not alter the incidence or degree of occult blood loss.
Acute GI hemorrhage: is a possibility and should be especially avoided in patients with a prior history of peptic ulcer disease.
- Do newer NSAIDs have fewer GI side effects?
1.B.2. The most frequent side effects of the NSAID analgesics are gastritis, nausea, vomiting, gastric bleeding, and hemorrhage. Nonselective NSAIDs, other than aspirin, have produced mixed results in their GI side effect profiles when compared to aspirin. Celecoxib has a much lower potential for GI irritation and bleeding complications and would be the preferred agent in a patient with a history of GI bleeding.
- What effects do aspirin and other NSAIDs have on platelet and renal function?
Aspirin inhibits platelet aggregation, depresses platelet adhesion to connective tissue, and prolongs bleeding time. These effects of aspirin occur at a very low dose (< 1 standard tablet). Other nonselective NSAIDs also prolong bleeding time, but unlike the irreversible effect of aspirin, the platelet effects of these drugs are reversible upon discontinuation of the drug. Celecoxib has no effect on platelet function.
Effects on Renal Function
Clinically relevant, adverse effects on renal function have been well recognized with the use of nonselective NSAIDs; recent evidence suggests that selective COX-2 inhibitors also have the propensity to cause such effects. NSAIDs have little effect on renal function in normal patients. However, these drugs decrease renal blood flow and the rate of glomerular filtration in patients with CHF, hepatic cirrhosis with ascites, chronic renal disease, or in those who are hypovolemic. Acute renal failure can be precipitated under these circumstances. In individuals with these clinical conditions, renal perfusion is more dependent than in normal individuals upon prostaglandins that cause vasodilation and thus oppose the increased vasoconstrictive influences of norepinephrine and angiotensin II that result from the activation of pressor reflexes.
what are the relative contraindications for morphine
Pregnancy- resp distress in neonate
renal and hepatic disease
compromised resp function
head injury
pt’s with hypotension
what re the symptoms of regular opioid withdrawal
craving restless irritability nausea, cramps muscle aches dysphoric mood insomnia anxiety
what are the signs of opioid withdrawal
pupillary dilation sweating piloerection (goosebumps) tachycardia vomiting/diarrhea increased blood pressure yawning fever
if a person is physically dependent on opioids what can happen if an antagonist is given - like Narcan
Administration of an opioid receptor antagonist in a subject physically dependent on opioids can precipitate an explosive abstinence syndrome, i.e., antagonist-precipitated withdrawal. Signs and symptoms of withdrawal can be seen within 3 minutes of injecting an antagonist.
use of clonidine in association with opioids?
centrally acting alpha 2 agonist
decreases sympathetic outflow
decreases many of the autonomic–mediated symptoms of withdrawal such as nausea, vomiting, cramps, sweating, tachycardia, and hypertension.
Clonidine does not suppress generalized aches and opioid craving.
what does a partial agonist do
stabilizes both the inhibited and activated form
what is analgesia
Attenuation of pain perception without the loss of consciousness.
Analgesia is accomplished by raising the pain threshold at the level of the spinal cord and altering the brain’s perception of pain
Patients treated with morphine are still aware of the presence of pain, but the sensation is not unpleasant.
Given to a person who does not have pain, the effects may be unpleasant and may cause nausea and vomiting
