Pain

Question 1

Morphine

Answer 1

Opiate agonist
Indicated for acute/chronic severe pain
Observe for tolerance (dif than addiction)

ADRs:

• resp. depression most serious ADR&raquo_space;> monitor RR; HOLD if RR <12
• orthostatic hypotension&raquo_space;> monitor BP; HOLD if SBP <90
• Constipation, urinart retention, N/V, sedation
• INTERACTS with any CNS/resp. depressant
• can build tolerance, no dose limit
• habit forming

Question 2

Inflammatory neurotransmitters

Answer 2

Histamine
Prostaglandins
Bradykinins
Nitric oxide
NE

Question 3

Excitatory/fast neurotransmitters

Answer 3

Glutamate
Aspartate
Inflammatory neuro-Ts

Question 4

Inhibitory/slow neuro-Ts

Answer 4

GABA
Glycine
DA
Serotonin
Endorphins

Question 5

A-delta fibers

Answer 5

Quick, myelinated
Well localized pain
Transmits somatic pain signals

Question 6

C-fibers

Answer 6

Unmyelinated, slow
Poorly localized
Transmits visceral pain signals

Question 7

Hyperalgesia

Answer 7

excessive pain sensitivity

Question 8

Allodynia

Answer 8

pain perception cause by non-painful stimuli

Question 9

Ectopic discharge

Answer 9

pain signaling in absence of stimuli

Question 10

Non-opioid analgesics

Answer 10

Acetaminophen
NSAIDS
Salicylates
COX-2 inhibitors (used for acute pain)

Question 11

Opioids in elderly

Answer 11

Common SE: confusion, renal impairment - cumulative effect if pt on antibx

Risk factors: resp. dx, sleep apnea

Question 12

Naloxone (Narcan)

Answer 12

• Opioid antagonist/antidote to opioid OD
• Blocks mu and kappa receptors
• Reverses CNS and resp. depression - puts pt into immediate withdrawal (tremor, hypervent.)
• Only effective for 20 mins, may have relapse of resp. depression

Question 13

Tramadol (Ultram)

Answer 13

Partial opioid agonists-antagonists (stim some receptors, antagonize others)

For moderate-severe pain

ADRs: sedation, constipation, tolerance/dependence, worse w/ etoh & benzos

Question 14

Opiate ADRs

Answer 14

Sedation, drowsiness, mental clouding
Constipation, N/V
Tolerance/dependence
ADRs worse w/ etoh or benzos

Question 15

COX inhibitors

Answer 15

Non-selective:
NSAIDS
Salicylates/aspirin

Selective:
Celexocib (Celebrex)

MOA: Inhibits PG formation
relieve mild-mod pain
antipyretic effects (tx fever)
anti-inflammatory effects (tx arthritis)
antiplatelet (tx MI, CVA)

Question 16

Celexocib (Celebrex)

Answer 16

Selective COX-2 inhibitor
Indications: pain, inflammation

Better than NSAIDs w/ GI irritation b/c doesn’t block all COX, only COX-2 (remember PGs needed for mucus lining in stomach)

Black box: incr risk MI, CVA, death

ADRs: GI bleeding, HTN, edema, renal insufficiency

Avoid use in pts with coronary artery bypass d/t black box (incr risk for MI)

Question 17

Ibuprofen

Answer 17

NSAID
Inhibits PG syn in CSN

ADRs: GI ulcers, renal failure

Question 18

Acetaminophen

Answer 18

Inhibits PG synthesis in CSN
Indicated for pain, fever
NOT anti-inflammatory, antiplatelet

Question 19

Drugs for neuropathic pain

Answer 19

Act on same neuro-Ts involved in pain signaling in CNS - can turn don volume of pain

Anti-epileptics: gabapentin (Neurontin)
- modulates pain perception

Antidepressants: 
TCA amitriptyline (Elavil)
SNRI duloxetine (Cymbalta)

Lidocaine

Question 20

Why use opioid/NSAID combo?

Answer 20

(2) different MOA targets pain

Have a synergistic effect: can give less of each drug and have fewer SE

NSAID acts on pain & inflammation and opioid works on pain

Question 21

Lidocaine

Answer 21

Topical analgesic

ADRs: CNS excitement, convulsions, resp. depression, cardiac arrest

Question 22

Analgesics for sever pain

Answer 22

morphine

Question 23

Analgesics for moderate pain

Answer 23

oxycodone (Oxycontin)

oxy w/ acetaminophen (Percocet)

Question 24

Tramodol

Answer 24

Opiate agonist

Centrally acting opiate receptor agonists taht inhibits uptake of NE & serotonin - opioid & non-opioid mechanisms

Less resp depression than morphine

Indicated for mod - moderately severe pain

Question 25

What drugs are used for cancer pain

Answer 25

Long-acting morphine