Lecture 24 - Analgesics I

Question 1

Mew, kappa and delta opioid receptor functions?

Answer 1

all analgesia; kappa: dysphoria, mew 2: respiratory depression and euphoria

Question 2

Effects of opioids?

Answer 2

supraspinal/spinal analgesia, sedation (individual variability)

Question 3

Uses of opioids?

Answer 3

severe-moderate pain, ineffective for neuropathic pain

Question 4

Contraindication for opioids?

Answer 4

sleep apnaoe, COPD, elderly

Question 5

Mechanisms of action?

Answer 5

1: GPCR decreasing AC and Ca channel permeability and NT; 2: increase K+ conductace out of cell, hyperpol post-syn neuron, decreasing response

Question 6

Tissue damage effect?

Answer 6

DRG detects, initiates peripheral inflammation, increased opioid R’s, attracting endogenous opioids and allowing work from exogenous

Question 7

Pain monitoring spectrum?

Answer 7

mild: paracetemol and NSAIDS; moderate add oral opioids; severe: replace all with inject opioids

Question 8

Considerations when using opioids?

Answer 8

most effective and comfortable route, round the clock for mod-severe pain, interpatient variability, adjuvents

Question 9

Slow management of withdrawal?

Answer 9

cross-tolerance (methadone), clonidine, promethazine, diazepam, anti-diarrheal

Question 10

Rapid detoxification?

Answer 10

anaesthetic, high naltrexone dose, oral dose post-general anaesthesia to prevent relapse

Question 11

Co analgesics?

Answer 11

priary indication is seperate from pain relief, but demonstrate some analgesic effects; e.g. tricyclics, anxiolytics, anticonvulsants