Opioids and Pain Flashcards
What are the two types of organic pain?
Nociceptive which is somatic (peripheral) or visceral (inner area organs leading to referred pain
Neuropathic which is injury to nerves
What is idiopathic pain
Isn’t associated with any causes but could be psychological
What are three types of peripheral nociceptive pain?
Osteoarthritis, rheumatoid arthritis and cancer pain
What are the causes of peripheral nociceptive pain and how do you treat it?
Inflammation or mechanical damage to tissue- tx with NSAIDs and opioids
What do you use to treat neuropathic pain?
NSAIDs, opioids, sodium channel blockers, antidepressants, neuroactive compounds
What are causes of central non nociceptive pain
Fibromyalgia, IBS, tension headache, idiopathic low back pain
What are the nociceptive somatic pain sensations
Stabbing aching or throbbing
What are some examples of nociceptive somatic pain?
Post postoperative pain, sickle cell crisis, sports, or exercise, injury, and arthritis
What are some examples of nociceptive visceral pain sensations?
Dull or crampy
What are examples of visceral pain causes?
Bowl and bladder distention and metastasis
What are the sensations of neuropathic pain?
Burning tingling electric shock
What is the four types of neuropathic pain?
Dysesthesia, paresthesia, hyperalgia, allodynia
What are the four types of neuropathic pain?
Peripheral neuropathy of diabetes, postherpetic neuralgia, phantom, limb pain, reflex sympathetic dystrophy
What patients can get reflex, sympathetic dystrophy
Phantom Lim pain and paraplegic or quadriplegic patients
What is transduction of pain?
A stimulus is converted into nerve impulse
What is the transmission of pain?
The impulse’s are carried to the brain
What is modulation of pain?
The brain and signals that caused the pain signals from the periphery to the be suppressed or amplified
What is perception of pain?
Messages from the periphery that are interpreted by the brain
Which category of pain may be described by the terms, burning tingling or electric shock
Neuropathic pain
What are the two subgroups of nociceptive pain?
Somatic pain and visceral pain
What category is pain from osteoarthritis?
Nociceptive pain, the subgroup of somatic pain
How is an analgesic described
A substance that relieves pain without causing loss of consciousness
What is the WHO pain relief ladder
Step one is non-opioids plus adjuvants step two is opioids from mild to moderate pain plus non-opioids plus advents step three is opioids from moderate to severe pain plus non-opioids plus adjuvants step four is invasive and mentally invasive treatments
Which strong opioid agonist is not recommended for chronic pain
Demerol or meperidine because it can cause CNS excitability (not allowed in cancer pain)
Where are the mu 1 receptors located and what type of pain are they responsible for?
Supraspinal and they’re responsible for the central interpretation of pain
Where are MU 2 receptors located and what type of paint are they responsible for?
In the CNS and they control respiratory depression, spinal analgesia, euphoria, and physical dependence
What are the characteristics of Kappa receptors?
Minimal respiratory depression, little dependence, they treat visceral pain and activation, may antagonize mu receptors
What are the characteristics of Delta receptors?
They have less analgesia than MU receptors, but without respiratory depression and they are novel target for antidepressants
T or F oral morphine has a significant first pass effect
T
When is peak analgesia reached with morphine?
PO 30 min IR or 90 min ER
rectal 20-60 minn
SC and IM 50-90 min
IV 20 min
How is morphine excreted?
Renal
How much of the oral morphine dose reaches the CNS after first past metabolism
40-50%
What are the two rare drug drug interactions with morphine?
Rifampin and ranitidine
What are the physical and psychological signs of dependence on morphine?
Restlessness, irritability, increased salivation, lacrimation, sweating muscle, cramps, vomiting, and diarrhea
What are the Biliary effects of morphine?
Increases the tone of the Billary sphincter of oddi which results in exacerbation of pain with Billary dysfunction or gallbladder attack
What are the neuroendocrine effects of morphine?
Stimulates the release of anti-Diuretic hormone and prolactin and inhibits release of a CTH and gonadotropic hormone
How does morphine affect the immune system?
It’s across his activity of lymphocytes, including natural killer cells after long-term use
What is pseudo addiction to morphine?
Caused by under treatment of pain and results in clock watching to take next dose. Appears to be drug seeking behaviors, but in fact, it’s just the patient in pain.
True or false acetaminophen has anti-inflammatory antipyretic and analgesic properties
False it is not anti-inflammatory
What is the name of the receptor that morphine binds to in the body?
MU receptor
Name at least two medication classes that are considered adjuvant pain medication
Steroids, anxiolytics, antidepressants, hypnotics, anticonvulsant, GABA agonist membrane, stabilizer, sodium chain, blockers, and MDA antagonist and cannabinoids
What term is used to Describe the phenomenon of a person whose pain is untreated.
Pseudo addiction
