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Pharm 2 Exam 2 > Non-Opioids and Opiods > Flashcards

Non-Opioids and Opiods Flashcards

1
Q

How does the WHO define pain?

A

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage”

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2
Q

Further Defining pain

Physical Well-Being:

A 
Stamina/strength
Appetite
Sleep
Elimination
functional capacity
comfort
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3
Q

Further Defining Pain

Psychologica Well-being:

A 
Coping
Control
Concentration
Enjoyment/happiness
Sense of usefulness
Anxiety/depression/fear
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4
Q

Further Defining Pain

Social Well-being:

A 
Social support/family
sexuality/affection
employment
finances
appearances
roles and relationships
Isolation/dependence/burden
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5
Q

Further Defining Pain

Spiritual well-being:

A 
Religion
Sense of purpose/meaning
Hopefulness
Uncertainty
Suffering
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6
Q

Pain Pathway:

What is Transduction?

A

A physiological process whereby a noxious mechanical, chemical or thermal stimulus is transduced via specialed receptors on primary afferents into an electrical impulse up to the brain.

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7
Q

Pain Pathway

What is transmission?

A

Once transduced and generated, nerve impulses are conducted to the central nervous system using specific sodium channels. - Opioids try to prevent transmission to the brain.

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8
Q

Pain Pathway

What is perception?

A

The process by which a noxious event is recognized as pain by a conscious person

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9
Q

Pain Pathway

What is descending modulation?

A

Inhibition of nociceptive impulses. Descending input from the brainstem influences central nociceptive transmission in the spinal cord. Neurons from the brain stem release 5 HT and NE.
EX: Tricyclic antidepressants enhance normal modulation by interfering with reuptake of 5 HT and NE. In turn, decreases the perception of pain.

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10
Q

Categorizing Pain

What is Visceral Pain? + example

A

Visceral pain is referred, colicky, diffuse in organs such as gallbladder, liver, intestines
*squeezing, cramping, bloating

EX: US, cholecystitis, peptic ulcer

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11
Q

Categorizing Pain:

What is somatic pain?

A

Somatic pain is well-localized pain caused by tissue damage to skin, soft tissue, muscle or bone.
*Stabbing, aching, sharp

Ex: trauma and arthritis

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12
Q

Categorizing Pain:

What is Neuropathic pain?

A

Neuropathic pain is injury or inflammation of nerves. Often coexists with somatic and or visceral pain.
*Radicular, stocking-like, burning numb, electric, tingling.
Ex: phantom limb syndrome, diabetic neuropathy, postherpetic neuralgia.

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13
Q

What is Acute Pain?

A
  • Less than 3 months

- Changes in vital signs, brief duration, subsides with healing, treated with PRN medications

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14
Q

What is Chronic pain?

A
  • Greater than 3 months

- Vital sign within normal limits, continuous duration, treated with around-the-clock medications

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15
Q

Pediatric pain

When is the nociceptor system functional by?

A

24 weeks gestation

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16
Q

Pediatric Pain

What are pediatric indicators of pain:

A

vocalizations, social withdrawal, changes in sleep pattern, poor feeding, increased HR and RR

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17
Q

Pediatric Pain

What can be used for pediatric pain control?

A 
Sucrose
Acetaminophen
Aspirin
NSAIDS
Opioids
Topical analgesia/local analgesia
Psychotropic medications
Nonpharmacologic measures
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18
Q

Pediatric Pain: Sucrose

When is used as an effective pain medication?
When should it be given?

A

Most effective under 1 month of age, but some up to 6 months.

Should be given 2 minutes before painful procedure

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19
Q

Aging and Pain:

What should you take into consideration with the elderly?

A
  • Increase in pain threshold (skin thickness changes, peripheral neuropathies
  • Reduced pain tolerance
  • changes in the metabolism of drugs
  • comorbidities causing pain
  • comorbidities impacting the pharmacokinetics of prescribing
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20
Q

What is the structured pain protocol?

A
  1. Complete pain assessment (OLDCART)
  2. Match appropriate durg to pain type
  3. Consider potential side effects and risks
  4. Assess safest route of delivery. Provide clear instructions
  5. Determine financial burden and access
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21
Q

WHO Pain ladder:

What is Step 1 of the ladder?

A

Mild to moderate pain:

treat with non-opioid +/- adjuvant

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22
Q

WHO Pain ladder:

What is Step 2 of the ladder?

A

Moderate to severe pain or fail Step 1:

  • use oral opioid + non-opioid
  • +/- adjuvant
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23
Q

WHO Pain ladder:

What is Step 3 of the ladder?

A

Severe pain or fail Step 2:
-Treat with opioid for severe pain with or without non-opioid
-Practice around-the-clock dosing
Adjuvant medications

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24
Q

Acetaminophen:

Use and MOA

A

Mild pain treatment; for moderate pain would combine with oxy or hydro
Believed to inhibit the synthesis of prostaglandins in teh central nervous system and work peripherally to block pain impulse generation

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25
Q

Acetaminophen:

Dosage

A

Max: 4g in 24 with monitoring. 3 g in 24 with no monitoring
Pediatric: 10-15 mg/kg/ dose every 4-6 hours

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26
Q

Acetaminophen:

Safe In: Pregnancy? Lactation? Elderly?

A

Yes to all 3

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27
Q

Acetaminophen:

Side Effects

A

Skin rash
Increased ALT
Increased bilirubin

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28
Q

Acetaminophen:

Monitoring

A

LFT

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29
Q

Acetaminophen:

Contraindications

A

Liver impairment

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30
Q

NSAIDS:

Use and MOA

A

Mild pain treatment; for moderate pain would combine with oxy or hydro

MOA: reversibly inhibits COX 1 and COX 2 enzymes, which results in decreased formation of prostaglandin precursors.

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31
Q

NSAIDS:

Dose

A

Max: 3,200 mg /day
Naproxin is 1,250 mg/day
KIDS: 2,400 mg/day

Pediatric: 5-10 mg/kg/dose every 4-6 hours

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32
Q

NSAIDS:

Side Effects

A

Edema
skin rash
epigastric
heartburn

33
Q

NSAIDS:

Monitoring parameters

A

Renal panel
CBC
GI disturbances

34
Q

NSAIDS:

Caution in what patients

A

Hypertension - Ace and Arbs
Renal Disease -
Blood disorder - affects plts
Avoid in pregnancy- preterm labor

35
Q

Local Anesthetics:

What is EMLA?

A

Topical eutectic mixture of lidocaine and prilocaine

36
Q

Local Anesthetics:

When should EMLA be placed on infants and children?

A

Infants: 1 hour before

Older children: Up to 4 hours

37
Q

Local Anesthetics:

SE of EMLA?

A

Neonates: Methemoglobinemia

Redness and blistering with circumcision

38
Q

Local Anesthetics:

Indication for EMLA?

A

anesthetizes skin before painful procedures

39
Q

Local Anesthetics:

What is Voltaren Gel?

A

NSAID gel

40
Q

Local Anesthetics:

Indication for Voltaren Gel?

A

Acute pain related to sprains, strains

Osteoarthritis

41
Q

Local Anesthetics:

How often can Voltaren gel be used?

A

4 times per day

42
Q

List adjuvant medications

A

Antidepressants - Cymbalta and Effexor, Amitriptyline

Anticonvulsants - Gabapentin, Pregabalin

43
Q

Serotonin and NE reuptake inhibitors (SNRI’s)

MOA:

A

MOA of SNRI’s: Cymbalta and Effexor

Potent inhibitor of neuronal serotonin and NE reuptake and a weak inhibitor of dopamine reuptake

44
Q

Serotonin and NE reuptake inhibitors (SNRI’s)

Side Effects:

A

Nausea
HA
Drowsiness
Xerostomia - dry mouth

45
Q

Serotonin and NE reuptake inhibitors (SNRI’s)

Clinical Indication:

A

Neuropathic pain

Chronic MS pain

46
Q 
Tricyclic antidepressants (TCA's): Amitriptyline
MOA
A

MOA of TCA’s: Amitriptyline

Central inhibition of NE and serotonin reuptake

47
Q 
Tricyclic antidepressants (TCA's): Amitriptyline
Side Effects
A 
Sedation
Anticholinergic effects
Postural Hypotension
Cognitive impairment
**Avoid in Elderly: check EKG for conduction ABN prior to initiation
48
Q 
Tricyclic antidepressants (TCA's): Amitriptyline
Monitoring parameters:
A

Mental status
Suicidal ideation
HR
BP

49
Q 
Tricyclic antidepressants (TCA's): Amitriptyline
Clinical Indication
A

Neuropathic pain

Chronic pain

50
Q

Anticonvulsants: Gabapentin

MOA

A

Anticonvulsants: Gabapentin
MOA: high affinity-binding sites are located throughout the brain; sites correspond to the presence of voltage-gated calcium channels which may modulate the release of excitatory neurotransmitters which participate in norcicption

51
Q

Anticonvulsants: Gabapentin

Side effects

A 
Dizziness
Drowsiness
ATaxia - muscle coordination
fatigue
peripheral edema
52
Q

Anticonvulsants: Gabapentin

Monitoring parameters

A

Sedation
Renal function
Suicidality

53
Q

Anticonvulsants: Gabapentin

Clinical indications

A

Neuropathic pain

54
Q

Anticonvulsants: Pregabalin

MOA

A

Anticonvulsants: Pregabalin
MOA: exerts antinociceptive and anticonvulsant activity; may also affect descending noradrenergic and serotonergic pain transmission pathways from the brainstem to the spinal cord

55
Q

Anticonvulsants: Pregabalin

Side Effects

A 
Peripheral edema
Dizziness
drowsiness
HA
Fatigue
56
Q

Anticonvulsants: Pregabalin

Monitoring parameters

A

Sedation
Weight gain
Suicidality

57
Q

Anticonvulsants: Pregabalin

Clinical indication:

A

Neuropathic pain

58
Q

Tramadol

Use

A

Moderate pain option that is a non-opioid that works on the opioid receptor

59
Q

Tramadol MOA

A

Tramadol and its active metabolite M1 binds to mu-opioid receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain: also inhibits the reuptake of NE and serotonin, which are neurotransmitters involved in the descending inhibitory pain pathway responsible for pain relief.

60
Q

Tramadol Side Effects

A 
Can lower seizure threshold
Flushing
Dizziness
HA
Nause
Constipation
61
Q

Tramadol Monitoring parameters:

A

Sedation

Suicidal ideation

62
Q

Tramadol Cautions

A

Risk for serotonin syndrome when combined with TCA’s, SSRIs, SNRIs, triptans

**Needs to be tapered if will be discontinued after chronic use

63
Q

Opioid MOA

A

Binds to opioid receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of an response to pain; produces generalized CNS depression

64
Q

Opioid Major receptor subtypes:

A

mu, kappa, mu is primary receptor

65
Q

Opioid Side Effects

A 
Sedation
respiratory depression
nausea
vomiting
constipation
urinary retention
pruritus
confusion
hypotension
66
Q

Opioid Special considerations

A

Morphine, Dilaudid, and codeine have active metabolites can accumulate in renal impairment
Fentanyl is NOT to be used in opioid-naive patients.

67
Q

Naloxone MOA

A

Pure opioid antagonist that competes and displaces opioid at opioid receptor sites

68
Q

Naloxone Dose

A

Naloxone 0.4-2 mg may need to repeat doses every 2-3 minutes

69
Q

Naloxone side effects

A

Flushing
Hypertension
Tachycardia
agitation

70
Q

Naloxone monitoring parameters:

A 
RR
HR
BP
Temp
LOC
ABG's or SpO2
71
Q

Naloxone Caution

A

patients with CV disease

72
Q

What is Incomplete Cross-Tolerance

A

A patient who is tolerant to the effects and side effects of one opioid may not be equally tolerant to the effects and side effects of another opioid

Decrease equianalgesic dose by 1/3 to 1/2 because of incomplete cross-tolerance.

73
Q

What types of meds should be used for constipation caused by opioids? Give Examples

A

Prophylactic motility-focused laxatives for patients on opioid therapy Like:
Senna
Dulcolax
Miralax

74
Q

What types of meds for constipation should be avoided by opioid users? Give Examples

A

Bulk-forming laxatives including Metamucil, Citrucel

75
Q

Define addiction:

A

Psychological dependence on the drug.
Using drug for psychic effects
Often associated with drug-seeking behaviors
Drug use continues despite negative legal, social and economic effects.

76
Q

Define Tolerance:

A

Tolerance: Expected effect of chronic opioid use
Presents as decreased duration of analgesia
Need of more frequent dosing and or higher doses to maintain analgesia

77
Q

Define: Physical dependence:

A
  • Expected effect of chronic use
  • Not a sign of addiction.
  • Withdrawal symptoms; when opioid dose is markedly decreased or stopped abruptly.
  • Symptoms: increased pain, anxiety, lacrimation, rhinorrhea, nausea or diarrhea.
78
Q

What are some Alternative Treatments for pain?

A 
RICE
massage
Heat application
Physical therapy
TENS therapy (Transcutaneous Electrical Nerve Stimulator)
Acupuncture
Reiki
Distraction/relaxation/music therapy/medication
Yoga

Pharm 2 Exam 2 (9 decks)

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