Lecture 8 (Quiz 2) Flashcards
What are the three types of pain and what do they deal with?
- Somatic: Musculoskeletal (bone/soft tissue)
- Inflammatory: Soft tissue sensitivity
- Visceral: Organs and stretch receptors
What is the pathway from the Stimulus to affecting the Prostaglandins???
- Stimuli –> Membrane Phospholipids –> Arachidonic Acid –> Cyclo-oxigenase –> COX-1 -OR- COX-2 –> Prostaglandins???
What are the two types of NSAIDs (Non-Steroidal Anti-Inflammatary Drugs), and what drugs belong to each category? What is an example of a Non-NSAID?
- Non-selective COX 1 and 2 Inhibitors:
- Salicylates (Aspirin)
- Ibuprofen-like
- Selective COX 2 Inhibitors:
- Celebrex
- Acetaminophen
What is another name for a pain reliever? What is an opioid and some examples? **Don’t need to know, just good to know
- Analgesics
- Substances that act on opioid receptors to produce morphine-like effects. (Morphine, Tramadol, Oxycodone, Fentanyl, Methadone, Hydrocodone/paracetamol, Oxycodone/paracetamol)
What class of drug do Salicylates belong to? What are the main two examples? What type of pain should they be used for? What effects does this drug have and what are the amounts? **(Don’t need to know exact numbers, just know what requires more and what requires less) What is the duration? What are these drugs combined with? What are the side effects associated with these types of medication?
- NSAIDs: Non-selective COX 1 and 2 inhibitors
- Excedrin and Aspirin
- Mild to moderate somatic pain. (Can help diagnose the difference if it is referred pain)
- • Analgesia (Pain) ~ 600 mg • Antiinflammation ~ 1 gm • Antipyretic (Fever) ~300-600 mg
- Duration: 4 hours
- Combined with caffeine, acetaminophen or opioids these can help analgesia under some conditions.
- Side Effects:
Reyes syndrome in children (colds/flu), NEVER give to children!!!
Anti-clotting (last up to 1-2 weeks)
Ringing in ears (tinnitis)
G.I. irritation and erosion
What class of drug do Ibuprofen type drugs belong to? What are the main two examples? What type of pain should they be used for? What effects does this drug have and what are the amounts? **(Don’t need to know exact numbers, just know what requires more and what requires less) What is the duration? What are the side effects associated with these types of medication?
- NSAIDs: Non-selective COX 1 and 2 inhibitors
- Ibuprofen and Advil (Motrin)
- Mild to moderate somatic pain. (Usually more effective than Salicylates)
- • Analgesia (Pain) ~400 mg (better than Salicylates) • Anti-inflammation ~ 800 mg (better than Salicylates)• Antipyretic (Fever) ~400mg (not usually objective/more worse than Salicylates)
- Duration: 4 hours
- Side Effects: GI ulcers –less than aspirin, Anti-clotting-less than aspirin and Cardiovascular effects.
What is an ibuprofen-like NSAID that is prescription only and is effective at much lower doses? What is an ibuprofen-like NSAID that lasts longer and is slow reacting? What is an ibuprofen-like NSAID that is prescription only, has the same analgesic effect as ibuprofen, does not have GI or anti-clotting action, but has cardiovascular side effects (don’t give to someone with heart problems), and is a COX-2 selective antagonist? What is a potent non-selective
NSAID, but due to side effects (causes kidney problems) not a common analgesic? What preferentially inhibits COX-2 more than COX-1, and therefor causes less GI problems? What is related to salicylates and is supposed to be good for bone pain and therefor often is prescribed by dentists after wisdom teeth extractions?
- Ketoprofen
- Naproxen (Aleve)
- Celecoxib
- Indomethacin
- Meloxicam
- Diflunisal
What is not a COX-1 or COX-2 inhibitor, is not an anti-inflammatory, but inhibits COX-3 enzymes or Serotonin? What are some properties of these types of drugs? What is the major side effects of this drug?
- Acetaminophen (Tylenol) - is a Non-NSAID
- • Analgesia not quite as good as aspirin • Good antipyretic (good for use in children) • Stable in solution • No GI problem • No effect on clotting • No Reye’s syndrome • Little anti-inflammatory action.
- If taken in high quantities can cause Liver failure (should not be used with alcoholics)
What are some Analgesic (pain reducer) uses of NSAIDs? What are the side effects of these drugs (4)?
- Somatic Pain (most dental pain, headaches, muscle/joint pain, and earaches), cause a mild-moderate effect, but have a plateau effect, and have an anti-inflammatory (pyretic) effect.
- Act as an Anticoagulant (more bleeding, not good for heart conditions/hemophiliacs, can cause Ulcerations in the GI tract, can cause Reye’s Syndrome in children, and are prone to allergic reactions.
What are the benefits of using Opioid Narcotics? There are two major types of Opioid Narcotics (those with a Hydroxy group [OH] and those with an Acetyl group [CH3]), which are more potent and what are examples of each? What is the most potent class of Opioid narcotics?
- Strong Analgesic for Somatic AND Visceral, Moderate to Severe pain. *(Don’t have a plateau effect, but can kill you if taken in high quantities, such as Meth). Act as an Antitussive (decreases cough), and Antidiarrheal (cause constipation).
- Hydroxy Group Opioids are more potent
- Hydroxy Group: Morphine, Hydromorphone (Dilaudid), and Oxomorphone (Numorphan).
- Acetyl Group: Codeine, Hydrocodone (Lortab/Vicodin), Oxycodone (OxyCotin/Percodan)
- Fentanyl
What kind of drug is Meperidine? What acts as a mixed agonist/antagonist, which discourages abuse, and is used for moderate pain? What is used as a moderate to severe analgesic and is used to treat opioid addiction? What is a moderate analgesic that is a mixed agonist/antagonist that is also used to treat opioid addictions?
- Opioid narcotic used for moderate pain.
- Pentazocine
- Methadone
- Buprenorphine
What are the side effects of Opioid Analgesics?
- Respiratory depression/decreased pulmonary reflex.
- Constipation/ slow bowel movement.
- Sedation additive or synergistic with other CNS depressants (e.g., alcohol, anti anxiety, sleep aids and natural sleep)
- Euphoria (happiness)/dependence/addiction
What is used as a treatment when someone has overdosed on an opioid? When should you start using an opioid?
- Naloxone or Narcan injection (can cause withdrawals)
- If NSAIDs are not effective, then use opioids (Start low and go slow)
When trying to manage neuropathic (chronic) pain, such as Trigeminal Neuralgia, which drugs should be used as a first line treatment? What should be used as a next line of treatment and is considered to be a non-opioid?
- First Line:
- Gabapentin (antiseizure-Lyrica)
- Duloxetine (antidepressant)
- Nortriptyline (antidepressant) - Non-Opioid:
- Tramadol
All opioids have ‘Scheduling’ which dictates the severity of the prescription, what scheduling are most opioids? Are drug addiction and drug dependence the same thing? How many overdose deaths were there in Utah? A majority of prescription drug abuse comes from what source? Where do you get your licensing from to provide prescription medications?
- Schedule II
- NO!!!
- 300/ year
- Friends/Relatives (66%) *(Doctors account for about 20%)
- Division of Occupational and Professional Licensing (DOPL)
