Last Lecture Flashcards
What is adjuvant analgesic therapy
-Meds that have a different classification but can enhance analgesic effects
-allow for reduced opioid doses and lessen adverse effects (particularly GI)
What does adjuvant therapy treat?
-Refractory Pain: pain that isn’t alleviated by other meds
-neuropathic pain: burning, shocking or tingling
-nerve compression: injury to the nerve
Skeletal Muscle relaxants
-treat muscle spasms d/t injury or musculoskeletal conditions (back pain from injury)
-muscle spasms cause pain and stiffness
Name some muscle relaxants
-Carisoprodol (Soma)
-cyclbenzaprine (flexerol)
-Lioresol (baclofen)
What other meds are used as muscle relaxants?
Benzodiazepines: diazepam, lorazepam
-these are anti-anxiety but have a muscle relaxing effect
-they are Gaba promotors which having a calming effect
-muscle spasms worsen with stress
(Ppl with insomnia have a production issue with Gaba)
What type of pain do antidepressants treat?
-Neuropathic and chronic
-main ones used are tricyclics and SSRIs
Antidepressants used and why they work
-Amitriptaline (TCA) : blocks the reuptake and transport of NE & serotonin in the presynaptuc nerve terminals
-Sertraline, Citalopram (SSRI): block the reuptake of serotonin
both of these allow neurotransmitters to remain in the cleft longer which increase absorbtion**
-also inhibit the transmission of pain signals
What are anti-seizure meds used to treat?
-manage peripheral neuropathy, post-herpetic neuralgia (shingles), fibromyalgia
-given mainly for neuropathic pain
What’s some special info on corticosteroid use
-it’s suppress WBCs so they don’t respond as well
-inhibits some insulin secretion and inhibits muscles cells from pulling glucose from the blood (why hyperglycemia occurs)
-also influences collagen in the skin which is why there’s bruising
-also influences prostaglandin release so it can be used for cancer
Elderly physiological changes in brain, heart and lungs
-higher prevalence of cognitive impairment
-reduced ability to assess pain (use faces)
-reduced CO: reduced absorption and distribution of drugs
-reduced muscle strength: reduced lung expansion and reduced response to hypoxia
Elderly physiological changes in Liver and kidneys
-less liver perfusion and albumin sites:Prolonged duration of action and increased risk of toxicity
-loss of nephrons and reduced blood flow and elimination
-further increase in duration of action bc of the kidney
Explain the eaqualanagesic chart
Lists the equivalents in dosing when transition between routes from oral to parenteral
Name some antiseizure meds
gabapentin: unknown how it works but the theory is that it controls calcium channels; offlabel uses for RLS and migraines
-pregabalin (lyrica) binds to alpha unit on calcium channels and
reduced number of impulses
Shingles
Rash that usually appears on the abdomen initially (follows nerve tracts)
-comes from the chicken pox virus that stays dormant in the body until agitated by something (unknown what)
What do corticosteroids treat?
-Used to manage acute and chronic cancer pain
-spinal cord compression, -inflammatory joint pain syndrome (RA)
-they suppress inflammation and immune response
