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Neurology > Neuropharmacology: Neurology, Pain And Analgesia > Flashcards

Neuropharmacology: Neurology, Pain And Analgesia Flashcards

1
Q

What is the definition of pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

What are the types of pain

A
  1. Nociceptive
  2. Neuropathic
  3. Psychogenic
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3
Q

What is a nociceptive pain

A

Caused by stimulation of intact primary afferent nerves responding to stimuli approachin or exceedin the harmful intestiny (nociceptors)

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4
Q

What is a neuropathic pain

A

Pain signal generated ectopically and often in the absence of ongoing noxious events by pathologic processes in the peripheral or central nervous system e.g diabetic get neuropathic pain

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5
Q

What is pyscgogenic pain

A

Pain with no apparent organic bassis/strict diagnostic criteria

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6
Q

What are pharmacological targets for pain

A 
Source of pain
Nociceptive substance (prostaglandins and cytokines)
Nerve transmitter substance (serotonin)
Modulators in spinal cord and brain
Emotional reaction to pain
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7
Q

What is the WHO pain ladder

A

Step 1: non opiod drug e.g paracetamol
Step 2: weak opiod if pain insists e.g codeine with non opiod
Step 3: strong opiod e.g morphine with non opiod

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8
Q

What is the mechanism of paracetamol

A

Unknown but probably inhibits prostaglandins in CNS or modulates endogenous cannibinoids

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9
Q

Does paracetomal have anti inflammatory action

A

No

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10
Q

What is the mechanism of action of NSAIDs

A

Inhibitos of prostaglanding synthetase (cyclo-oxygenase)

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11
Q

What are the 2 types of cyclo-oxygenase

A

Cox 1

Cox 2

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12
Q

Where is cox 1 found

A

In the stomach it protects gastric mucosa

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13
Q

Where is cox 2 found

A

Inducible inflammatory found in the renal tract

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14
Q

Which enzyme inhibition are we intrested in for pain

A

Cox 2 that is involved in nociceptive pain

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15
Q

What are the common NSAID examples

A

Ibuprofen

Diclofenac

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16
Q

From the examples of NSAIDs which one is more stronger

A

Diclofenac

17
Q

What drugs can NSAIDs interact with

A

Anti-platelets and anticoagulants- increased risk of bleeding
Nephrotoxins- increased risk of acute kidney injury

18
Q

What are the side effects of NSAIDs

A

Cardiovascular risk
Renal dysfunction- AKI
Gastrointestinal bleding or gastritis
Hypersensitivity reaction: rashes, angioedema and bronchospasm

19
Q

In patients with a previous or active peptic ulcer what should NSAIDs be prescribed with

A

PPI

20
Q

What are examples of weak opiods

A

Codeine phosphate

Dihydrocodeine

21
Q

What is the mechanism of action for opiods

A

Act on the CNS to alter the perecepton of pain

22
Q

Do opiods have anti inflammatory affects

A

no

23
Q

What are the adverse effects of opoids

A

Nausea

Constipation

24
Q

Can codeine be used in children

A

No it is contraindicted

25
Q

What is tramadol

A

An opiod analgesic

26
Q

What is the mechanism of action of tramadol

A

Enhances 5HT and andregenic pathway

27
Q

What are the side effects of tramadol

A

Subject to abuse
Respiratory Depression
Hypotension
Drowsiness

28
Q

What are examples of strong opiods

A

Morphine
Fentanyl
Oxycodone
Pethidine

29
Q

What are the mechanism of action of strong opiods

A

Act on mu and kappa receptors in the cns

30
Q

Which group of patients should strong opiods be avoided in

A 
Respiratory depression (type 2 respiratory failure)
Hypotension
Liver impairment (avoid in the elderly)
31
Q

What are adjuvant agents

A

Drugs that are intended for indication other than pain but are analgesics in certain circumstances

32
Q

At which step is adjuvant agents considered

A

Every step of the WHO ladder

33
Q

What are examples of adjuvant agents

A

Tricyclic anti depressants e.g amitryptiline
Anti epileptic agents e.g pregabalin, gabapentin, carbamazepine
Anxiolytics: diazepam

34
Q

What are the other modalities of pain management

A

Acunpuncture
Transcutaenous electrical nerve stimulation (TENS)
Topical anaesthesia
Nerve block epidural

35
Q

In liver failure which drugs do we need to be aware of

A

NSAIDs- risk of bleeding

Opiods: can be slowly metabolised can precipitate encephalopathy in liver failure

36
Q

In renal disease which drug do we need to be aware of

A

NSAID- can lead to further impairment

37
Q

What is an issue with opiods

A

Dependence

Neurology (9 decks)

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