Opioids Flashcards
What is the definition of pain defined by the WHO?
An unpleasent sensory and emotional experience associated with actual or potential tissue damage described in terms of such damage.
What is the ladder of medication used in pain?
- 1 - Non-opioid analgesics
- 2 - Weak opioids
- 3 - Strong opioids
List weak opiods:
Loperamide, codeine, tramadol
List strong opioids:
Morphine, buprenorphine, fentanyl
List non-opioid analgesics:
Acetaminophen - prostaglandin inhibitor
COX-1-inhibitors - Aspirin, Indomethacin - NOT RELEVANT
COX-2-inhibitors - Celecoxib, Meloxican
Non-specific COX inhibitors - Naproxen, ibuprofen
COX-1 vs COX-2 functions:
- COX-1 - Mainly functions in mucosal protection, renal blood flow, platelet aggregation, endothelium
- COX- 2 - Mediate pain and inflammation
How do opioids work:
- Bind mule, kappa and gamma receptors
- Mule
- main receptor involved in pain
- Inhibits release of neurotrnasmitters like Substance P and glutamate which is involved in transmitting pain signals
- Activation of inhibitory descending pathways
- Modulation of pain perception
- Peripheral effects - Inhibition of nociceptors, modualtion of inflammatory response
What are the side effects of Non-opioid analgesics?
Gastric and duodenal ulcers
Incresed risk of heart attack and stroke
Renal function impairment
Aplastic anemia
Liver toxicity (rare)
Allergic reaction
Fluid retention and anemia
Headache and dizziness
Reye syndrome (aspirin)
What are the side effects of opioids?
Constipation
Nausea
Vomitng
Drowsiness and sedation
Respiratory depression
Itching
Sweating
Dry mouth
Confusion and cognitive impairment
Hypotension
Tolerance and dependance
Addiction
Overdose
What are the uses of opioids?
Pain
Anesthesia
Cough
Diarrhea
Adjuvant drugs:
Antidepressants, neuroleptics, antispasmodics, corticosteroids, anticonvulsants
How do NSAIDs work?
COX inhibition
stops ceonversion of arachidonic acid into prostaglandins
They decrease sensatization of onciceptors to mechanical and chemical stimuli
