Exam 4 Flashcards
Nociception
the physiologic process by which information about tissue damage is communicated to the central nervous system (CNS).
Primary afferent fibers
Nerves that carry pain impulses from the periphery to the spinal cord are called primary afferent fibers. These include a-delta and C fibers. Each is responsible for a different pain sensation.primary afferent fibers end in the dorsal horn of the spinal cord
Meperidine
Meperidine: not recommended for long-term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures
Use opioids with extreme caution in patients with:
Respiratory insufficiency
Elevated intracranial pressure
Morbid obesity or sleep apnea
Paralytic ileus
Pregnancy
Severe Asthma: also contraindicated
Opioid analgesia interactions
Alcohol
Antihistamines
Barbiturates
Benzodiazepines
Monoamine oxidase inhibitors
Respiratory depression AND
Seizures
hypotension
Codeine Sulfate
Opioid agonist
Natural opiate alkaloid (Schedule II) obtained from opium
—Morphine like- 10% metabolized into morphine
Ceiling effect
Often combined with acetaminophen
—Schedule III
More commonly used as an antitussive drug
Most common adverse effect: GI disturbance
Fentanyl
Synthetic opioid (Schedule II) used to treat moderate to severe pain
Parenteral injections, transdermal patches (Duragesic), buccal lozenges (Fentora), and buccal lozenges on a stick (Actiq)
Fentanyl in a dose of 0.1 mg intravenously is roughly equivalent to 10 mg of morphine intravenously.
Fentanyl patch for chronic, long-term pain management
Meperidine
Synthetic opioid analgesic (Schedule II)
Caution with use in elderly or those with kidney dysfunction
Active metabolite (normeperidine) can accumulate to toxic levels and cause seizures
Rarely used and not recommended for long-term pain treatment
Use:
—Migraine treatment
—Post-op shivering
Methadone Hydrochloride (Dolophine)
Synthetic opioid analgesic (Schedule II)
Opioid of choice for the detoxification treatment of opioid addicts in methadone maintenance programs
—Absorbed by GI tract. Peak onset 4 hrs. Half life is longer than duration of action dt binding in tissues of liver, kidneys, and brain. Repeated doses store and deliver 24 hr coverage
—Safer for renal impairments dt excretion by liver
Prolonged half-life of the drug: cause of unintentional overdoses and deaths
Cardiac dysrhythmias
Morphine Sulfate
Naturally occurring alkaloid derived from the opium poppy
Drug prototype for all opioid drugs; Schedule II controlled substance
Indication: severe pain
High abuse potential
Oral, injectable, and rectal dosage forms; also extended-release forms
MS contin
Breaks down into metabolite morphine -6- glucuronide- toxic to kidneys
Oxycodone hydrochloride
Analgesic agent structurally related to morphine
Class II
Comparable analgesic activity to morphine
Often combined with acetaminophen (Percocet) or with aspirin (Percodan)
IR = immediate release
SR = sustained release
Hydrocodone (weaker) often combined with acetaminophen (Vicodin, Norco)
Tramadol Hydrochloride
Trade name: Ultram
Centrally acting analgesic with a dual mechanism of action
—Weak bond to mu opioid receptors
—Inhibits the reuptake of norepinephrine and serotonin)
Indicated for moderate to moderately severe pain
Adverse effects similar to those of opioids
Careful use in patients taking SSRIs, MAOIs, neuroleptics
absorption not affected by food intake
AE: similar to opioids drowsiness, dizziness, HA,nausea, respiratory depression, Seizures
Contraindicated – for drug allergy to itself or other opioids dt is cross reactivity.
Implications- not recommended for >75 yo
SNRI Antidepressant
These agents include venlafaxine, desvenlafaxine (Pristiq), milnacipran (Savella), and bupropion.
Nuclear Family
A nuclear family consists of two adults (and sometimes one or more children).
Extended Family
An extended family includes relatives (grandparents, aunts, uncles, and cousins) in addition to the nuclear family.
