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Pharmacy312 > Pain > Flashcards

Pain Flashcards

1
Q

What is pain?

A

An unpleasant sensory or emotional experience associated with actual or potential tissue damage.

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2
Q

What is nociceptive pain?

A

Pain that arises from actual or threatened damage to non-neural tissue due to the activation of nociceptors.

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3
Q

What are examples of nociceptive pain?

A 
Muscle sprain, strain
Dental pain
Cuts, burns
Inset stings
Post-operative
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4
Q

What is neuropathic pain?

A

Pain caused by a lesion or disease of the somatosensory nervous system.

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5
Q

What are conditions associated with neuropathic pain?

A 
Multiple sclerosis
Stroke
Traumatic brain injury
Cancer
Surgery
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6
Q

What is acute pain and what causes it?

A

Pain that lasts up to 12 weeks, usually due to tissue injury thus patients typically recover.

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7
Q

What is chronic pain and what causes it?

A

Pain that exceeds 12 weeks, usually due to changes in neural connections and sensitivity.

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8
Q

Paracetamol MOA?

A

Unknown, potential inhibition of COX

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9
Q

Paracetamol ADR?

A

Few at therapeutic doses, overdose may cause fatal liver toxicity

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10
Q

NSAIDs MOA?

A

Reduce prostaglandin synthesis by inhibiting COX, resulting in analgesic, anti-inflammatory and anti-pyretic effects.

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11
Q

What is the difference between COX1 and COX2 selectivity?

A

COX-2 inhibition results in reduction of inflammation, pain and fever.

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12
Q

What are some COX2 selective NSAIDs?

A

Diclofenac, Celecoxib

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13
Q

NSAIDs ADR?

A
  1. GI: Potential GI upset (take with food)
  2. CV: May increase risk of heart failure hospitalization
  3. Renal: renal failure due to decreasing renal blood flow
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14
Q

What are the benefits vs risks of COX2 NSAIDs?

A

These have greater specificity for inflammation, pain and fever, less GI upset but may increase risk of CV events.

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15
Q

What are weak opioids?

A

Codeine
Tramadol
Dihydrocodeine

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16
Q

What are strong opioids?

A 
Morphine
Oxycodone
Methadone
Fentanyl
Pethidine
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17
Q

Opioids MOA?

A

Binds to opiate receptors (delta kappa mu) in the CNS, inhibiting ascending pain pathways.

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18
Q

What are opioids indicated for?

A

Short-term acute nociceptive pain.

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19
Q

Opioids ADR?

A 
Sedation, dizziness
Respiratory depression
Nausea
Constipation
Addiction
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20
Q

What is tolerance?

A

The need for increasing doses to achieve the same effect

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21
Q

What is physical dependence?

A

Physical symptoms of withdrawal if the next dose is not received

22
Q

What is addiction?

A

Chronic relapsing disorder characterised by compulsive drug seeking and continued use despite harmful consequences.

23
Q

What is hyperalgesia?

A

Increased sensitivity to pain with prolonged use.

24
Q

What drugs are recommended for nociceptive pain?

A

Paracetamol
NSAIDs
Opioids

25
Q

What drugs are recommended for neuropathic pain?

A

Tricyclic antidepressants
Gabapentinoids
Anticonvulsants

26
Q

What questions should be asked for a patient with acute pain when taking history?

A 
Severity of pain 0-10?
Where is the pain, is it radiating?
When did the pain start?
What makes the pain stop?
What makes the pain worse?
27
Q

What is the WHO analgesic ladder?

A
  1. Paracetamol/NSAID
  2. Weak opioid
  3. Strong opioid

Start at a higher step and then work down, continuing adjunct treatments.

28
Q

What are types of chronic pain?

A

Chronic neuropathic pain (diabetic neuropathy)
Arthritic pain
Chronic intermittent pain (recurrent headaches)

29
Q

What are the goals of chronic pain treatment?

A
  1. Empower patient to lead role in pain management
  2. Focus on improving function and disability
  3. Encourage patient to remain active and stay positive
30
Q

What are the types of neuropathic pain?

A

Sensory
Motor
Autonomic

31
Q

What are types of sensory pain?

A
  1. Allodynia: pain experienced from stimulus that does not usually cause pain
  2. Hyperalgesia: exaggerated pain response to normal stimulus
  3. Dysaesthesia: unpleasant sensation
  4. Hypesthesia: decreased sensitivity to stimulation
  5. Loss of proprioception: inability to control movement
32
Q

What is motor and autonomic pain?

A

Weakness, absent reflexes

Changes in skin colour due to vasodilation

33
Q

What is the S-LANSS pain score?

A

A way to measure a patient’s pain. Score >12 suggests predominantly neuropathic pain.

34
Q

What is the first line choice for neuropathic pain?

A

Tricyclic antidepressants (amitriptyline, nortriptyline)

35
Q

TCAs MOA?

A

Increases synaptic concentration of serotonin by inhibition of their reuptake by the presynaptic neuronal membrane pump.

36
Q

How should TCAs be dose?

A

Start low, go slow to avoid ADR

Reduce dose gradually before stopping to prevent antidepressant discontinuation syndrome.

37
Q

Gabapentinoids MOA?

A

While gabapentinoids are structurally similar to GABA, they do not act on GABA receptors, and instead act on a variety of receptors through the brain to bring about pain relief effects.

38
Q

Pharmacokinetic considerations of gabapentinoids?

A

Pregabalin has more predictable pharmacokinetics

39
Q

Gabapentin ADR?

A

Sedation
Mood disorders
Respiratory depression
Potential for abuse

40
Q

What is central sensitisation?

A

Persistent state of high reactivity to pain and touch.

41
Q

What are the three types of opioid receptors?

A

Mu
Kappa
Delta

42
Q

What is the structure of an opioid receptors?

A

G-protein coupled receptor
7 transmembrane domains
Variation is in extracellular loops

43
Q

What do mu receptor agonists do?

A

Produce analgesic effects, respiratory depression, euphoria, release of hormones

44
Q

What is a mu receptor agonist?

A

MORphine

45
Q

What is the structure of morphine?

A 
5-ring system
2 hydroxyl groups
Ether linkage between C4 and C5
Basic and tertiary amine
5 chiral centres.
46
Q

How is codeine different from morphine?

A

Methylated at the 3-position

  • increases ability of drug to cross BBB
  • lower analgesic potency
  • lower addiction potential
47
Q

How is oxycodone different from morphine?

A

Methylated at the 3-position

Hydroxylated at the 14-position
- increases affinity for MOR receptor

Reduced double bond at C7/8 and oxidation at 6
- increases flexibility

48
Q

What is the structure of tramadol?

A

Codeine but with B,D,E rings removed
Two chiral centers in cyclohexane ring therefore 4 possible stereoisomers
- R enantiomer responsible for serotonin uptake
- S enantiomer responsible for norepinephrine uptake

49
Q

What is the structure of fentanyl?

A

Alkyl chains which provide high lipophilicity.

High potency, rapid onset, short duration of action.

50
Q

What is the structure of methadone?

A

Racemate of R and S enantiomers
Long acting mu-receptor agonist
Metabolites are responsible for long duration of action

51
Q

What is nalaxone?

A

Opioid receptor blocker, used for opioid overdose (Narcan)

Pharmacy312 (5 decks)

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