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pharm > pain & analgesic drugs > Flashcards

pain & analgesic drugs Flashcards

1
Q

what is pain

A

a subjective unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

what is nociception

A

detection of noxious stimuli or stimuli that are capable of damaging tissue

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3
Q

4 processes in pain perception

A

1) transduction
2) transmission
3) perception
4) modulation

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4
Q

what is transduction

A

detection of physical stimuli into nerve input
- pain nerve endings

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5
Q

what is transmission

A

action potential travels along nerves to CNS

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6
Q

what is perception

A

the feeling/awareness of sensations in periphery
- happens in the cortex

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7
Q

what is modulation

A

CNS release inhibitors which decrease info going to brain
- less perception of pain

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8
Q

what is acute pain

A
  • sudden onset
  • subsides with treatment
  • nociceptive stimulus causes
  • sharp or dull (different receptors)
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9
Q

what is chronic pain

A
  • long lasting (>6 weeks)
  • persistent or recurring
  • difficult to treat
  • many different causes (not always from stimulus)
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10
Q

what is allodynia

A

pain from stimuli that’s not normally painful

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11
Q

what is hyperalgesia

A

heightened pain detection

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12
Q

what is causalgia

A

burning sensations

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13
Q

what is neuropathic pain

A

from damaged nerve fibers

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14
Q

somatic pain

A

superficial (skin, mucosal membranes, joints, bones)

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15
Q

visceral pain

A

vascular, organ, deep, respiratory

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16
Q

referred pain

A

occurs away from area of real cause
- heart attack felt in left arm

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17
Q

cancer pain

A

chronic, breakthrough

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18
Q

phantom pain

A

pain felt after amputation

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19
Q

success of analgesic drugs depends on type of pain

A

acute > chronic

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20
Q

two types of medication for pain

A

1) analgesic
2) anesthetic

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21
Q

analgesic medication

A

selectively blocks sensation of pain without blocking other symptoms or loss of consciousness
- not treating cause of pain

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22
Q

anesthetic medication

A

local anesthetic blocks all nerve conduction and all local sensations (pain, temperature, touch, etc)

general anesthetics cause loss of sensations and unconsciousness

23
Q

type of analgesic drugs

A

opioids

24
Q

opioid sites of action

A

1) higher centers (brain/cortex) to alter psychological response to pain
- brain detects pain, and regulates intensity and emotion around response

2) reduce neurotransmitter release from terminal pain fibers in dorsal horn of spinal cord
- modulation (dampen response and nociception sent to brain)

25
Q

opioids general info

A
  • drugs that bind to opioid receptors
  • natural or synthetic
  • agonists (bind to receptors and cause same effect of what normally binds to it
26
Q

what is an opiate

A

any drug derived from opium (natural source - resin from poppy seeds)
- codeine, morphine

morphine is better at binding to receptor sites bc of slight difference in structure making it more effective

27
Q

opioid receptor sites

A

all opioid analgesics are full agonists or partial agonists at mu or kappa receptors (for algesia)

there are mu, kappa, and delta opioid receptors

28
Q

agonist receptors

A

drugs that bind to these receptors produce a cell response
- full agonist: good at binding and easily produce maximal response
- partial agonist: not as good at producing response

29
Q

mu receptors

A
  • very strong and present
  • for algesia
  • found in brain (cortex for feeling and perception of pain, and the thalamus, medulla, limbic system and amygdala for emotional response)
  • spinal cord
30
Q

kappa receptors

A
  • less amount
  • for algesia
  • brain and spinal cord
  • may cause dysphoria (unpleasant response and sensation) and hallucinations
31
Q

pharmacological properties of opioids (important ones)

A
  • analgesia: mu & kappa receptors, good for dull and persistent pain
  • sedation and mental clouding: calmness and can’t think clearly
  • euphoria and tranquility: dopaminergic pathways (drug abuse)
  • antitussive: cough reflex depressed
  • depression of resp center: less breaths/min, shallow breathing, drive for breathing decreases, potential for coma and stopping breathing
  • constipation: increase GI muscle tone
32
Q

other pharmacological properties of opioids

A
  • nausea and vomiting
  • miosis (pinpoint pupil): parasympathetic nerve
  • tolerance and serious dependence (more drug needed for same pain relief effect)
  • postural hypotension
  • dilation of cutaneous blood vessels (warm skin)
  • urinary urgency, difficulty urinating
  • biliary colic and epigastric distress
33
Q

opioid analgesic examples

A
  • morphine (golden standard)
  • methadone (longer action)
  • fentanyl (non-naive pt)
  • diamorphine (heroin)
  • levorphanol
  • hydromorphone
  • oxycodone (not as strong, less risk for longer use)
  • codeine (not as strong, less risk for longer use)
34
Q

opioid indications

A
  • alleviate mild-moderate-severe pain (often given with adjuvant analgesic agents to assist with pain relief - work at different areas along pain pathway)
  • cough center suppression (codeine)
  • treatment of diarrhea (loperamide)
  • balanced anesthesia (fentanyl)
35
Q

morphine general info

A
  • acute and chronic pain
  • the standard (other analgesics compared to it for dosing )
  • 10 mg IM standard (equals to 0.1 mg fentanyl, 200mg codeine)
  • IV, IM, SC, PO, intrathecal (CSF)
36
Q

morphine metabolism

A

t1/2 = 2-4 hours
- extensive liver metabolism (first pass)
- inactivation
- PO dose is 30-40 mg
- liver disease: not as much metabolism = potential overdose if a higher PO dose taken to counteract first pass metabolism

37
Q

morphine and pregnancy/breastfeeding

A

risk exists for physical dependance (of baby)
- can lead to physical reactions
- crosses placenta or enters breastmilk
short half life allows for timing with breastfeeding

38
Q

analgesics and cancer pain

A

chronic pain requires ATC treatment (often combination of opioids, NSAIDs, and adjuvants)
- MS contin ATC (sustained release morphine around the clock)

breakthrough pain are transient episodes of pain while chronic pain is controlled (rescue medication)

39
Q

WHO pain management ladder

A

1) pain: nonopioid and adjuvant if needed
2) increase in pain: opioid for mild to moderate pain and non opioid + adjuvant if needed
3) persisting/increasing pain: opioid for moderate to severe pain and non opioid + adjuvant if needed

40
Q

NSAIDs

A

non steroidal anti inflammatory drugs
- most common non narcotic analgesic

41
Q

adjuvants

A
  • antidepressants (amitriptyline - elavil)
  • antiseizure drugs (carbamazepine)
  • glucocorticoids
42
Q

morphine contraindications and cautions

A
  • asthma or respiratory insufficiency (resp depression)
  • hepatic dysfunction (caution for dosage - PO)
  • elevated ICP (exacerbates condition)
  • pregnancy
43
Q

opioid adverse effects

A
  • respiratory depression (hold next dose if <12 breath/min)
  • CNS depression (sedation, dampen brain activity - possible coma)
  • N & V (greatest on first dose)
  • constipation (no tolerance development)
  • hypotension (dilation of peripheral vessels - histamine release)
  • itchiness (histamine release)
  • urinary retention
  • diaphoresis and flushing
  • pupil constriction (miosis)
44
Q

opioid interactions

A

CNS depressants
- cumulative effects
- antipsychotics, antihistamines, sedatives (benzodiazepines, barbiturates)
- ethanol/alcohol

45
Q

moderate opioid analgesics

A
  • codeine (3-methylmorphine)
  • oxycodone
  • buprenorphine

safer because the lower the effect on pain relief the lower the adverse effects

46
Q

codeine

A
  • agonist
  • less algesia and resp depression
  • liver metabolizes into morphine which gives more relief (~10% PO dose)
  • unpredictable effect: don’t know how much will convert to morphine
  • antitussive
  • often combined: acetaminophen in tylenol, acetylsalicyclic acid in 222s or 292
47
Q

oxycodone (oxycontin or percodan)

A
  • agonist
  • metabolism required for activation
  • abuse potential
  • common use with acetaminophen
  • was overprescribed
48
Q

naloxone (narcan, naltrexone)

A
  • antagonist
  • used for complete or partial reversal of respiratory depression from overdose
  • opioid cannot bind to receptor bc naloxone is there
  • short half life: level of naloxone may drop faster than opioid so may need to give another dose if s&s of overdose come back
  • IM/SC/nasal spray
49
Q

methylnaltrexone

A
  • antagonist
  • treat opioid induced constipation
  • stop increase in muscle tone and decrease in peristalsis by attaching to receptor
  • last resort after diet and laxatives
50
Q

treating opioid addiction

A

1) methadone program (doesn’t give the same high but still satisfies craving, slowly lower the dose)

2) buprenorphine and naloxone (suboxone) SL
- b: can act as a partial agonist and give some degree of pain relief
- b: agonist-antagonist if morphine in system at the same time buprenorphine more likely to bind over morphine and give partial analgesic effect
- n: added to get around misuse, naloxone poorly absorbed and has high first pass metabolism but if someone tried to crush it and inject it then naloxone would take effect

51
Q

opioid tolerance

A

common physiological result of chronic opioid treatment
- need more drug for same amount of relief

52
Q

physical dependence of opioids

A
  • abstinence syndrome will occur if drug is abruptly withdrawn
  • drug must be administered to maintain normal function
  • withdrawal symptoms not dangerous but unpleasant
  • symptoms may take 2 weeks to get under control (anxiety, chills, hot flash, joint pain, lacrimation, cramping, vomiting, diarrhea, etc)
53
Q

opioid nursing implications

A
  • take oral form with food to minimize GI upset
  • withhold if vital signs abnormal (esp respiratory rate)
  • take with adequate fluid and fiber and stool softeners to minimize constipation
  • change positions slowly (orthostatic hypotension)

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