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Pharmacology > Non opiods > Flashcards

Non opiods Flashcards

1
Q

Endorphins, enkephalins

A

provide a natural amount of pain relief

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2
Q

Norepinephrine, serotonin

A

play an inhibitory role in the descending tract, explains why antidepressants can be used for pain control

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3
Q

glutamate, GABA

A

several receptor provide many targets for combo therapy for pain control

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4
Q

Somatic pain

A

constant, well localized, aching, throbbing; analgesic, nerve block

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5
Q

Visceral pain

A

diffuse, deep, dull, cramping, squeezing, referred, analgesic, neurological procedures

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6
Q

neuropathic pain

A

altered sensations, stabbing, burned, constant or intermittent, sharp, shooting, antidepressant, anticonvulsants, neurological procedures, not opioids

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7
Q

types of chronic pain

A

pain that persists beyond expected healing time, related to chronic disease, w/out an identifiable cause, , chronic+acute associated with CA

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8
Q

Tolerance

A

reduced effect w/ same dose, need to increase dose to get same effect, not addiction

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9
Q

Pseudotolerance

A

a need to increase the dose, but only because of disease progression, new source of pain, drug interaction

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10
Q

Physical dependance

A

described as the occurence of withdrawal symptoms when the opioid is stopped all at once or without proper tapering

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11
Q

Addiction

A

a psychologically dependent state, they exhibit drug seeking behavior, compulsive use for their psychic effects

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12
Q

Pseudoaddiction

A

can present as addiction, but is a function of poorly controlled pain, once adequately controlled, their drug seeding tendencies disappear

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13
Q

Non-pharmacological approaches to pain pain control

A

remove source, psychotherapy, weight reduction, surgery, behavioral modification, rest/exercise, nerve block, massage therapy, acupuncture, hypnosis, heat, ice, pt

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14
Q

NSAIDs MOA

A

inhibition of the enzyme COX which prevents prostaglandin synthesis

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15
Q

Do NSAIDs produce tolerance

A

they do not tolerance, physical dependence, or psychological dependence

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16
Q

Ceiling effects of NSAIDs

A

analgesia has ceiling effect, less of ceiling effect to anti-inflammatory response, increased doses will still provide additional results

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17
Q

Popular NSAIDs

A

Diclofenac ER (Voltaren), Ibuprofen (Motrin, Advil), Naproxin (Naprosyn), Noproxen Sodium (Aleve, Anaprox), Meloxicam (Mobic), Indomethacin (Indocin), Ketorolac (Toradol)

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18
Q

Less popular NSAIDs

A

Etodolac (Lodine), Sulindac (Clinoril), Tometin (Tolectin), Oxaprozin (Daypro), Ketoprofen (Orudis), Piroxicam (Feldene), Nabumetone (Relafen)

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19
Q

NSAID characteristics that distinguish them from narcotics

A

antipyretic, anti-inflammatory, ceiling effect to analgesia, do NOT cause tolerance, do NOT cause physical or psychological dependence, potentcy, time of onset, duration of action

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20
Q

NSAID clinical uses

A

acute pain of skeletal muscle or dental pain, pain and inflammation associated with osteoarthritis and RA, chronic malignaant pain as an addititve affect to narcotic analgestics, pain related to bone metastases

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21
Q

ADRs of NSAIDs

A

Renal dysfunction (can be reversed), fluid retention, increase BP, avoid in CHF, GI are most concerning, bleeding risk

22
Q

Ibuprofen (Motrin, Advil)

A

initial choice by many for acute pain due to cost and safety, available OTC, prescription and IV, safe in peds as suspension

23
Q

IV ibuprofen

A

used for infants with patent ductus arteriosis, Caldolar is new product used for management of acute pain and fever

24
Q

Ketorolac (Toradol)

A

First parenteral available in US, quick onset, use limited to

25
Q

IV Ketorolac (Toradol)

A

considered by many to be equally efficacious to opiods for severe acute piain, due to GI adrs cannot get that level of relief with oral ketorolac, caution with post op

26
Q

Naproxen (Aleve, Anaprox, Naprosyn)

A

BID dosing, OTC, PO, inc GI bleed?

27
Q

Meloxicam (Mobic)

A

daily dosing, more selective for COX, better for long term, prescription only, $$

28
Q

COX 2 inhibitors MOA

A

selectively inhibit COX2, no more efficacious, less GI irritation, less anti-platelt effects, all other ADRs similar to NSAIDs, well tolerated

29
Q

2 drugs pulled from the market

A

Valdecoxib (Bextra), Rofecoxib (Vioxx) pulled for cardiovascular disease

30
Q

Celecoxib (Celebrex)

A

the only one left, used for low cardio risk who require long term NSAIDs and at risk for GI toxicity, not for acute pain, not PRN

31
Q

Acetaminophen

A

APAP, no one really knows for sure how it works, analgesic and antipyretic effects, no anti-inflammatory effects, max dose 3 grams, combo

32
Q

APAP uses and ADRs

A

recommended as 1st line therapy for ostoeoarthritis, fever, mild pain, aches; hepatic necrosis at high doses for prolonged periods of time or with a toxic doses, decreases opioid requirements

33
Q

Apap available as

A

tablets, caplet, liquid, suppository, and IV, safe in peds

34
Q

APAP IV

A

Ofirmev, very controversial

35
Q

APAP overdoses

A

caused by exhaustion of glutathione stores which function to neurtralize toxic metabolites for removal, monitor w/ APAP levels in relation to time of ingestion, can be a medical ER in most severe cases

36
Q

Treatment of APAP overdose

A

fluids, gastric lavage, activated charcoal, acetylcysteine (Mucomyst) given IV to replenish glutathione, need to treat within 8 hours

37
Q

APAP physical findings

A

usually asymptomatic for first 24 hours, then nausea, vomiting, jaundice, abd pain, renal injury, coagulopathy, hepatic encephalopathy, cerebral edema, hypotension

38
Q

Acetylcysteine indications

A

meets criteria on the Rumack-Matthew nomogram, single ingestion of >150 mg, unknown time of ingestion and a serum aceta > 10 mcg, history of ingestion and any evidence of liver injury, Pt with delayed presentation have less success

39
Q

Aspirin

A

oldest analgesics and prototype of non-opioids, not used for pain but antiplatelet

40
Q

Aspirin mechanism

A

irreversibly inhibits COX which dec prostaglandin synthesis, inhibits COX prevents formation of thromboxane A2

41
Q

ADRs of aspirin

A

gastric disturbances and bleeding, tinnitus, rhinitis, asthma, nasal polyps, edema, hypotension, shock, Reye’s syndrome

42
Q

Aspirin clearance

A

contingent on urine pH, pH becomes more acidic, renal excretion increases because aspirin is in ionized form

43
Q

Other non-opioid approaches to pain

A

muscle relaxants, bisphosphonates, steroids, Clonidine, ketamine

44
Q

Conditions associated with neuropathic pain

A

diabetic neuropathies, post herpetic neuralgia, back pain, trigeminal neuralgia, HIV, CA, HA, spinal cord injury, phantom limb

45
Q

General approach to neuropathic pain

A

initiate one drug at a time, use more favorable ADR profiles, start dosing low, slowly increase, always investigate alternative agents in setting of therapeutic failures, drugs have a longer onset

46
Q

Antidepressant options

A

specifically focusing on agent that have activity with regards to norepinephrine and serotonin, TCAs, SSRIs, Duloxetine (Cymbalta)

47
Q

Anticonvulsant options

A

Gabapentin (Neurontin) never used as anticonvulsant anymore, for chronic use, should titrate up, very sedating, Pregabalin (Lyrica), Carbamazepine, topiramate

48
Q

Capsaicin Cream

A

substance P inhibitor, available OTC for chronic management, not PRN, not as monotherapy

49
Q

Lidocaine options

A

patches-DOC for post herpetic neuralgia, apply x12 hours, then remove 12 hours, can be cut!, apply up to 3 patches, injections also but rare

50
Q

Treatment of Fibromyalgia

A

antidepressants, cyclobenzaprine (Fleceril), Duloxetine (Cymbalta), venlafaxine (Effexor), Tramadol (Ultram), exercise, cognitive behavioral therapy

Pharmacology (61 decks)

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