Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology 2 > Modern Arsenal of Pain Control > Flashcards

Modern Arsenal of Pain Control Flashcards

1
Q

What do norepinephrine and serotonin do?

A

Inhibit pain signals from reaching the higher levels of brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do tricyclic antidepressants (TCAs) work?

A

Increases serotonin and or norepinephrine in the synapse by inhibiting reuptake
May have anticholinergic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long does it take for TCAs to begin working?

A

1-3 weeks for pain control so used for chronic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some examples of TCAs?

A

Notriptyline and Amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are TCAs more effective for treatment of?

A

Diabetic neuropathy, moreso than other antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do selective serotonin reuptake inhibitors (SSRIs) work?

A

Specific inhibitors of serotonin reuptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some examples of SSRIs?

A

Paroxetine (Paxil), Fluoxetine (Prozac), Sertraline (Zoloft)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some side effects of SSRIs?

A

Suicidality, impaired platelet aggregation, CNS depression, QT prolongation, serotonin syndrome, hyponatremia, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do serotonin and norepinephrine reuptake inhibitors (SNRIs) work?

A

Potent inhibitor of neuronal serotonin and norepinephrine reuptake and weak dopamine reuptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some side effects of SNRIs?

A

Suicidality, serotonin syndrome, rest are same as SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some examples of SNRIs?

A

Venlafaxine (effexor), duloxetine (cymbalta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is venlafaxine used for?

A

Neuropathic pain, diabetic neuropathy

Onset 1-2 weeks, max 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some adverse reactions from venlafaxine?

A

Nausea, dizziness, drowsiness, hyperhidrosis, hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is duloxetine used for?

A

Diabetic neuropathy, fibromyalgia, chronic MSK pain

60-120 mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some adverse reactions of duloxetine?

A

Sedation, nausea, constipation, ataxia, dry mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do alpha adrenergic agonist work?

A

Stimulates alpha adrenoreceptors in the brainstem, activating inhibitory neuron, reducing the sympathetic outflow of CNS (prevents pain signal transmission)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some examples of alpha adrenergic agonists?

A

Clonidine (last line of treatment)

Tizanidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is clonidine used for?

A

Neuropathic pain that is not responding to other treatment

Unlabelled: Heroin or nicotine withdrawal, dysmenorrhea, menopausal vasomotor symptoms, migraine prophylaxis

19
Q

What are some adverse effects of clonidine?

A

Bradycardia, CNS and respiratory depression, hypotension

20
Q

What is tizanidine used for?

A

Tension-type headache, back pain, neuropathic pain and myofascial pains
Less likely to cause hypotension than clonidine

21
Q

What is peripheral sensitivity?

A

Neuropathic pain triggered by spontaneous peripheral nerve activity mediated by sodium channels caused by local tissue injury, ischemia releasing inflammatory factors, increasing Na channels

22
Q

What medications are used for peripheral sensitivity?

A

Carbamazepine, tricyclic antidepressants, topiramate, lidocaine

23
Q

What does carbamazepine do?

A

An anticonvulsant that limits the influx of sodium ions across the cell membrane

24
Q

What is carbamazepine used for?

A

Trigeminal or glossopharyngeal neuralgia and neuropathic pain
Monitor drug levels (reach a steady state in 2-5 days)

25
Q

What does topiramate do?

A

An anticonvulsant that limits the influx of sodium ions and antagonizes glutamate receptors

26
Q

What are some adverse reactions of topiramate?

A

Dizziness, ataxia, somnolence, psychomotor slowing, paresthesia, weight loss

27
Q

What should be monitored while on topiramate?

A

Electrolytes and kidney function

28
Q

How does lidocaine work?

A

Topical application reduces discharge of small afferent nerve fibres by blocking voltage-gated sodium channels (decrease membrane permeability)
Gel or patch (will only work in area applied, max 3 patches to area every 24 hours)

29
Q

What is lidocaine used for?

A

Post-herpetic neuralgia or peripheral neuropathies or other etiologies

30
Q

What are some side effects of lidocaine?

A

Arrythmias, seizures, coma, respiratory depression or death

Patch: Erythema, swelling, burning or discomfort of the application site

31
Q

How does central sensitivity occur (GABA, Ca)?

A

Occurs in dorsal horn of the spinal cord with the release of excitatory neurotransmitters (glutamate, substance P) and increased calcium transport (spontaneous impulses)

32
Q

Which medications decrease calcium channel activity?

A

Gabapentin and Pregablin

33
Q

How do gabapentin and pregablin work?

A

Modulate voltage gated Ca channels by binding alpha2-delta subunit of presynaptic neurons to regulate excitatory neurotransmitters

34
Q

What is gabapentin used for?

A

Diabetic neuropathy and neuropathic pain

35
Q

What are the adverse reactions of gabapentin and pregablin?

A

Somnolence, dizziness, peripheral edema

36
Q

What is pregablin used for?

A

Neuropathic pain/diabetic neuropathy, spinal cord injury neuropathic pain

37
Q

Which medications are NMDA antagonists (decrease nerve impulse)?

A

Ketamine, dextromethorphan, methadone

38
Q

How does ketamine work?

A

Decreases central sensitization and modulation by lowering the threshold for nerve transduction and reduces the effects of substance P
Also is a dissociative agent that targets the opioid receptor, Na and K channels to reduce pain

39
Q

What are some adverse reactions to ketamine?

A

Local skin reactions

40
Q

How does dextromethorphan work?

A

Low affinity uncompetitive NMDA antagonist (high doses needed), also binds opioid receptors
Very short half-life

41
Q

What some side effects of dexomethorphan?

A

Serotonin syndrome (if in combination with other antidepressants), rash, nausea, drowsiness, constipation/diarrhea, confusion, nervousness, closed-eye hallucinations

42
Q

How does methadone work?

A

Mu and delta opioid agonist that also blocks the NMDA receptor and inhibits the reuptake of norepinephrine

43
Q

What makes methadone better than morphine?

A

1 mg=10 mg morphine

Less need for opioid escalation, no active metabolites (less side effects), highly lipophilic (high bioavailability)

44
Q

What are some side effects of methadone?

A

CNS and respiratory depression, QT prolongation, constipation, nausea and vomiting, dizziness and disorientation

Pharmacology 2 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions