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Pharm Exam 3 > Pain > Flashcards

Pain Flashcards

1
Q

how do local anesthetics work along the axon of a neuron

A

they block Na+ channels in the axonal membrane

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2
Q

why are local anesthetics considered local?

A

are considered nonselective and the small/ unmyelinated neurons are easier to block

administed at their site of action!

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3
Q

what is an ester

A 
a class within local anesthetics 
this class has higher allergic run rates 
this class metabolites more rapidly
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4
Q

what is an amide?

A

a class of local athletics
has less allergic rxns
metabolized by hepatic enzymes

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5
Q

why might a local aesthetic have CV effects?

A

because it is a Na+ channel blocker when there is high systemic concentrations

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6
Q

what is a unique adverse effect of benzocaine

A

methemoglobinemia

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7
Q

Name three types of esters

A

cocaine and procaine (chloroprocaine)

benzocaine

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8
Q

what is unique about cocaine

A

this drug blocks the NE reuptake and can be both a CNS / CV stimulant

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9
Q

why is unique about chloroprocaine

A

this is a type of ester that is not effective topically and has a short DOA

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10
Q

what is a type of amide

A

lidocaine

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11
Q

What are the signs and symptoms of local anesthetic toxicity?

A
  1. CNS stimulation = seizures or depression
  2. CV effects = remember the NA+ channel blocker = bradycardia and vasodilation
  3. allergic reactions
  4. methemoglobin (benzocaine )
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12
Q

How do inhalation anesthetics reach their site of action? Where is their therapeutic site of action?

A

Lung uptake and goes into alveoli which than blood takes up drug when it is flowing through the lungs. distribution occurs in the lungs as well

goal is to get to CNS

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13
Q

what is MAC

A

Minimum alveolar concentration

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14
Q

what does it mean to have a low MAC

A

means that it is a very potent drug

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15
Q

what does it mean to have a high MAC

A

means not a potent drug

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16
Q

what is anthesisia

A

LOC

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17
Q

what is. analgesia

A

pain relief

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18
Q

What are the 5 types of IV anesthetics

A
  1. Barbituates
  2. Benodiazepines
  3. Propofol
  4. Etomidate
  5. Ketamine
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19
Q

how do barbiturates work

A

Increase GABA transmission
Quick onset (10-20seconds)
Highly lipid soluble

an adverse effect here is CV and respiratory depression

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20
Q

how do benzodiazepines work

A

Increase GABA transmission
Used for low doses for sedation and in very high doses for anesthesia

less CV and respiratory depression seen BUT synergistic when used with other opioids
Anterograde amnesia
Anixiolysis

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21
Q

what is the MOA of all IV anesthetics, except one (name the one)

A

Increase GABA transmission in most except ketamine and this relates to NMDA

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22
Q

when might you use etomidate over a different IV anesthetic

A

those who have CV depression

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23
Q

what is the one type of IV anesthetic that has a different MOA and what is the MOA

A

ketamine = Increase NMDA transmission

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24
Q

what IV anesthetic leads to Anterograde amnesia and Anixiolysis with A/E

A

Benzodiazepines

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25
Q

what drug would you not want to use due to profound respiratory depression and hypotension

A

propofol

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26
Q

what is mu and kappa agonism related to

A

thinking about analgesics and pain control

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27
Q

what are the effects of MU agonism

A 
analgesic 
resp depression 
sedation 
euphoria 
physical dependence 
decreased GI motility
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28
Q

what are the effects of KAPPA agonism

A

analgesic
sedation
decreased GI motility

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29
Q

what is a opiod agonist MOA

A

agonize mu and kappa receptors

30
Q

what is an example of a pure opiod agonist

A

morphine
fentanyl
oxycodone

31
Q

what is the MOA of a agonist - antagonist opiod

A

most with antagonize mu while agonizing kappa

32
Q

which agonist-antagonist opiod partially agonizes mu

A

buprenophrine

not on drug list

33
Q

why might you use an agonist - antagonist opioid over a pure agonist opioid

A

less respiratory depression
less ephors
and lower abuse potential !!

34
Q

what class of drugs is used to reverse most of the effects of opioids

A

opioid antagonist aka naloxone

35
Q

what is the MOA opioid antagonist

A

antagonizes mu and kappa receptors

36
Q

what effect of opioid agonist on the head

A

analgesic and euphoria

37
Q

what is the effect on the respiratory system with opioid agonists

A

respiratory depression

38
Q

what is tolerance?

A

prolonged use = need to increase dose

39
Q

what physical dependance ?

A

ago through withdrawal
tapering withdrawal
abstinence syndrome

40
Q

nursing assessment before and after opioid administration

A

need to check HR, breathing LOC, BP to make

41
Q

how is methadone different from other opioids

A

prolongation of QTc torsades, EKG prior to administration. Avoid admin if QT >500msec, accumulation can occur

42
Q

how does codeine different from other opioids

A

Same effects/AE as morphine, but lower analgesia, resp depression, lower abuse, Very effective as a cough suppressant! 10% of the dose is converted to morphine in liver via CYP2D6. Some people lack this gene = cannot gain analgesic effects, Some people are “ultrarapid metabolizers” – have multiple copies of this gene

43
Q

how is meperidine

A

Toxic metabolite is produced with metabolism (can build-up with prolonged use)

44
Q

Opioid antagonists are used for three different things. What are they? What is an example of a drug that does each?

A 
Reverses effects (seen with the drug naloxone)
Mu inhibition (seen with the drug methylnaltrexone)
Block euphoric effects (seen with the drug naltrexone)
45
Q

what opioid antagonist blocks euphoric effects

A

naltrexone

46
Q

what opioid antagonist blocks MU inhibition

A

methylnaltrexone

47
Q

what opioid antagonist reverses effects

A

naloxone

48
Q

How is tramadol different than other opioids?

A

It’s a weak mu agonist, it is a NON-OPIOID

49
Q

How does a PCA work?

A

Patient is hooked up to a line- the button can be pushed every so often depending on the settings. There is normally pain medication in the PCA. Anytime the PT needs to use it they can. The issue is sometimes they fall asleep and forget and then have pain when they wake up. Only the Pt can press the button.

50
Q

How do goals of cancer pain treatment vary from other types of pain treatment?

A

Goal is to maximize relief with few adverse effects, manage pain, maximize quality of life the patient has left

51
Q

How does pain management pharmacology change in older adults & young infants?

A

Kids: avoid nsaids, immature BBB -> limit opioid dosing,
Adults: pain is undertreated, heightened drug sensitivity, Inc. adverse effects risk

52
Q

what is abortive drug therapy for headaches

A

aspirins, triptans (first line of attack), serotonin 1Fs, ergots (second line), CHRPs

53
Q

what are preventative drug therapy for headache

A

beta blockers, antiepileptic drugs, TCA, CGRP receptor antibodies, estrogens, triptans , Botox -> we use when PT has many attacks over 3+ months

54
Q

Why do we avoid ergot alkaloids & triptans together?

A

avoid w/in 24hrs to avoid excessive vasospasm!!

55
Q

cocaine

A

local anesthetic
ester
blocks NE reuptake

56
Q

chloroprocaine

A

local anestehtic
ester
can not give topically and has a short DOA

57
Q

benzocaine

A

local anestehtic
ester
metheglobinema

58
Q

nitrous oxide

A

general anesthetic
inhalation anesthetic
lungs–> to blood –> CNS

59
Q

benzodiazepines

A

general anesthetic
iv anesthetic
increases GABA transmission
pros of this drug include having less respiratory/Cv depression
interesting about this drug is the retrograde amnesia and anixiolysis

60
Q

Mizlazolam

A

benzodiazepine

61
Q

diazepam

A

benzodiazepines

62
Q

LORAZEPAM

A

benzodiazepines

63
Q

nalbuphine

A

opiod

agonist - antagonist

64
Q

butorphanol

A

opioid

agonist - antagonist

65
Q

serotonin receptor agonists

- triptans

A

1st line of attack when thinking about abortive migraine therapy

66
Q

sumatriptan

A

serotonin receptor agonist

migraine abortive relief

67
Q

serotonin IF receptor agonist

-ditans

A

abortive migrane relief

68
Q

lasmiditin

A

serotonin IF receptor agonist

abortive migraine relief

69
Q

ergot alkaloids

A

second line of attack for migraine abortive relief

70
Q

ergotaime

A

abortive migraine relief related to ergot alkaloids

do not mix with the triptans

Pharm Exam 3 (5 decks)

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