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PathoPhysiology > Exam Two - Pain Management > Flashcards

Exam Two - Pain Management Flashcards

1
Q

NSAID stands for

A

Non-Steroidal Anti-Inflammatory Drugs

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2
Q

What are NSAIDs different classes?

A
  • Salicylates
  • Propionic Acid Derivatives
  • Oxicams
  • Acetic acid derivatives
  • Cox-2 Inhibitor
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3
Q

Examples of salicylates

A

aspirin (ASA)

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4
Q

Examples of Propionic Acid Derivatives

A

Ibuprofen
naproxen
ketoprofen
fenoprofen

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5
Q

Examples of Oxicams

A

meloxicam
piroxican

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6
Q

Examples of acetic acid derivatives

A

indomethacin
sulindac
tolmetin
ketorolac
etodolac (COOH)
diclofenac (phenylacetic acid)

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7
Q

Examples of Cox-2 Inhibitors

A

celecoxib

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8
Q

Most NSAIDS inhibit the _________ AND ___________ pathways

A

COX-1
COX-2

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9
Q

COX-1 is responsible for…

A

cytoprotective prostaglandins
- protect gastric mucosa
- aid platelet aggregation

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10
Q

COX-2 is responsible for…

A

imflammatory prostaglandins
- recruit inflammatory cells
- sensitize skin pain receptors
- regulate hypothalamic temperature control

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11
Q

Adverse effects of NSAIDs

A
  • increased GI bleed/ulcer risk
  • decreased renal perfusion
  • increased blood pressure
  • increase CV event risk…. other than Aspirin
  • increased bleeding risk
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12
Q

Which NSAIDs is safest to use in patients with CVD?

A

Naproxen

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13
Q

How close to surgery do you stop taking aspirin?

A

1 week

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14
Q

How close to surgery do you stop taking other NSAIDs?

A

1-2 days

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15
Q

Use NSAIDs with caution in patients with what diseases?

A

CVD, renal patients, HTN

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16
Q

How long can you use ketorolac (toradol)?

A

5 days! Black box warning

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17
Q

When we stay steroids, most often we’re referring to which kind?

A

Glucocorticoids

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18
Q

Uses of corticosteroids:

A

anti-inflammatory
anti-allergy
anti-rejection
Tx of Addisons DZ
Neonatology lung maturation

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19
Q

What are the routes of administration for corticosteroids

A

oral
inhaled
IV
IM
topical
eye drops
ear drops
rectal
intra-articular injection

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20
Q

Corticosteroids ____________ circulating lymphocytes

A

decrease

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21
Q

corticosteroids ___________ basophils, eosinophils, monocytes

A

decrease

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22
Q

corticosteroids ______ swelling.erythema/secretions

A

decrease

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23
Q

corticosteroids _____ PMN, Plts, RBCs, HGb/HCT

A

increase

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24
Q

corticosteroids ___ plasma glucose (GLC)

A

increase
increase hepatic HLC production

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25
If you ______ mast cells, then you __________ histamine release
stabilize, decrease
26
if you __________ phospholipase A2, then you see a __________ in prostaglandins
inhibit, decrease
27
side effects for corticosteroids
hyperglycemia increase appetite steroid psychosis impaired wound healing hypertension and hypokalemia risk of infection osteoporosis weight gain/fluid retention
28
common corticosteroids you should recognize:
prednisone (deltasone) 5mg prednisolone (Pediapred) 5mg Methyl-prednisolone (Solu-Medrol) 4mg Dexamethasone (decadron) 1mg triamcinolone (kenalog) hydrocortisone (Solu-cortef) betamethasone (celestone)
29
spasmolytic
agent to treat spasticity resulting from upper motor neuron lesions such as MS, CP, CVA, spinal cord injuries, etc.
30
anti-spasmodic
agent to treat spasms resulting from peripheral skeletal muscle conditions (local tissue injury)
31
spasms =
muscle weakness related to sustained involuntary contraction of skeletal muscles, stiffness, impaired movement and increased basal muscle tone. May interfere with mobility and/or speech
32
Spasmolytic agents you should know
- baclofen (lioresal) - benzodiazepines (esp. diazepam) - tizanidine (zanaflex) alpha-2 agonist
33
SE/risks of spasmolytics
fall, drowsiness/dizziness, N/V, impaired PT session
34
centrally-acting anti-spasmodic agents you should recognize
- cyclobenzaprine (flexeril) - methocarbamol (robaxin) - carisoprodol (Soma C-IV)
35
Which two centrally-acting anti-spasmodic drugs are strong CNS depressors, incite drug seeking behavior, works at brainstem level, and are ineffective on spasms related to spinal cord injury or CP?
Methocarbamol (Robaxin) and carisoprodol (Soma C-IV)
36
Which centrally acting anti-spasmodic drug has high abuse rates and patients ask for it by name?
Carisoprodol (Soma-IV)
37
What is the MOA for centrally-acting anti-spasmodic agents?
still don't know... general CNS depression?
38
opiate
drug derived from the alkaloids of the opium poppy
39
opioid
drugs that includes opiates, opiopeptins, and all synthetic/semisynthetic drugs that mimic the action of opiates
40
opioid peptides
endogenous peptides that act on opioid receptors
41
opioid agonist
drug that activates some or all opioid receptors and does not block any
42
opioid partial agonist
drugs that can activate an opioid receptor to elicit a submaximal response
43
opioid antagonist
drug that blocks some or all opioid receptors
44
mixed agonist-antagonist
drug that activates some opioid receptors and blocks others
45
narcotic
psychoactive compound with sedative properties, used in legal context to refer to substances with abuse/addictive potential
46
What are the 3 types of opioid receptors?
mu kappa delta
47
Mu receptors are responsible for...
analgesia respiratory depression euphoria sedation physical dependence glowed GI tract miosis modulation of hormone & NT release
48
kappa receptors are responsible for
analgesia minimal respiratory depression dysphoria mild sedation glowed GI transit miosis psychomimetic effects
49
delta receptors responsible for
analgesia modulation of hormone and &NT release
50
Opiate overdose can kill why?
respiratory depression
51
What are some CNS effects of opiates?
analgesia euphoria sedation respiratory depression cough suppression miosis truncal rigidity N/V reduced shivering may increase ICP
52
what are some PNS effects of opiates
bradycardia hypotension constipation biliary colic urinary retention prolong labor stimulate release of ADH, prolactin, somatotropin, and inhibit release of LH pruritus (itching) hives (increase HA release)
53
What are the strong morphine like side effects?
respiratory depression constipation sedation emesis N/V! elevation of intracranial pressure urinary retention orthostatic hypotension miosis (pinpoint pupils) pruritus
54
Morephine mnemonic stands for...
miosis orthostatic hypotension respiratory depression physical dependency histamine release increased ICP Nausea Euphoria Sedation
55
Tolerance
a higher dose of drug is needed to achieve the same response
56
What side effects of opiates have low tolerance build?
miosis and constipation
57
Physical dependence
withdrawal symptoms occur if drug is abruptly stopped, should taper
58
Opioid antagonist MOA?
antagonists at mu and kappa receptors
59
What are examples of opioid antagonists?
naloxone (narcan) - short acting naltrexone (ReVia) - oral nalmefene (Revex) - long acting
60
What are examples of common types of chronic neuropathic pain?
- diabetic neuropathy - post-herpectic neuralgia - phantom limb pain - fibromyalgia
61
What drugs are used to help chronic neuropathic pain?
- TCA: tri-cyclic anti-depressants - SSRI (anti-depressant) -SNRI (anti-depressant) - Pregabalin (lyrica) anti-epileptic - Gabapentin (Neurontin) anti-ep
62
Which drug has the longest track history in treating neuropathic pain?
TCA
63
Which drugs are most commonly prescribed for neuropathic pain today?
pregabalin (lyrica) and gabapentin (neurontin)
64
What is the MOA of TCA?
blocks re-uptake of NE, also blocks 5HT, alpha, HA and muscarinic receptors, analgesic actions still not clear - Fall risks and narrow TI
65
gabapentin (Neurontin) MOA?
increases CNS GABA availability
66
SE of gabapentin?
DZ, ataxia, sedation, mood changes, tremors
67
Pregabalin (lyrica) MOA
MOA: similar to gabapentin
68
How is pregabalin (lyrica) different from gabapentin?
much better bioavailability (F) = 0.9
69
SNRIs appear ______ than SSRIs for chronic pain
more effective MOA: inhibit reuptake of 5HT and NE

PathoPhysiology (29 decks)

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