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Block 3: Pathophysiology and pharmacology > Pain + Analgesics > Flashcards

Pain + Analgesics Flashcards

1
Q

What are the main categories of pain?

A

Nociceptive (tissue damage, acute)

Neuropathic (neuronal damage, chronic)

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2
Q

What is hyperalgesia

A

Hypersensitivity to pain

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3
Q

What is allodynia?

A

Triggering of a pain response from stimuli which do not normally provoke pain

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4
Q

What is nociceptive pain?

A

Caused by physical damage resulting in activation of free nerve endings

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5
Q

What is neuropathic pain?

A

Results from neuronal damage and includes symptoms such as shooting/ burning pain and paraesthesias (e.g. tingling, numbness, pins and needles)

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6
Q

Give examples of neuropathic pain

A 
Phantom limb 
Trigeminal neuralgia 
Malignant pain 
Post-stroke (thalamic) pain 
Post-herpetic pain 
Complex regional pain syndrome (CRPS)
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7
Q

Give examples of nociceptive pain

A

Lower back pain
Myofascial (muscle) pain
Arthritis
Visceral pain (e.g. cystitis, pancreatitis)

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8
Q

What are the 5 types of headache?

A 
Tension 
Sinus 
Migraine
Cluster
Medication overuse headache
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9
Q

What type of headache is a clinical emergency?

A

‘Worst ever headache’

Subarachnoid haemorrhage

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10
Q

What is the standard treatment for tension headaches?

A

NSAIDs

Determining triggers

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11
Q

What is the standard treatment for sinus headaches?

A

Decongestant
Antihistamines
Steroids

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12
Q

What is the standard treatment for migraine headaches?

A

3 step approach:
1. NSAIDs +/- antiemetics
2. Rectal NSAIDs +/- antiemetics
3, Anti-migraine drugs (triptans)

[Avoid opioids!]

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13
Q

Why does chronic pain develop?

A 
Badly managed acute pain 
Emotional sensitivity/ poor coping skills
Previous experience
Surgical complications 
Genetic predisposition
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14
Q

What are the non-pharmacological options for pain management?

A

Exercise/ physiotherapy
Acupuncture
Transcutaneous Electrical Nerve Stimulation (TENS)

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15
Q

What invasive procedures are used to manage pain?

A

Nerve blocks/ injections (e.g. steroids)
Ablation (removal of neurones from region of pain)
Implants (e.g. pumps, neuromodulators)

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16
Q

What pharmacological options are available for managing nociceptive pain?

A

NSAIDs

Opioids

17
Q

What pharmacological options are available for managing neuropathic pain?

A

Tricyclic antidepressants (amitriptyline, nortriptyline)
Antiepileptics (gabapentin, pregabalin)
Can be used in combination with carbamezapine

18
Q

What is the WHO ladder for cancer pain control?

A

Pain free
Low level pain - treated by non-opioid analgesic
Mid level pain - treated by weak opioids
High level pain - treated by strong opioids

19
Q

What is the MoA for NSAIDs?

A

Blocks production of prostaglandins by inhibiting COX enzymes (1+2)

20
Q

Which COX enzyme is involved in the inflammatory response?

A

COX enzyme 2

21
Q

What NSAIDs are specific COX-2 inhibitors?

A

Celecoxib

Etoricoxib

22
Q

How do NSAIDs affect cells at a neuronal level?

A

Removal of prostaglandins

23
Q

What is salicylism?

A

Salicylate toxicity due to ingestion of NSAIDs

24
Q

How can NSAID intoxication be treated?

A

Fluid replacement
Haemodialysis
Activated charcoal
IV Lorazepam/ Diazepam (for seizures)

25
Q

What are the key symptoms of NSAID intoxication?

A 
Tinnitus 
Pulmonary and cardiovascular symptoms 
CNS symptoms 
Renal failure
Coma
26
Q

What are the 3 groups of opioids?

A

Agonists
Partial agonists (or mixed agonists-anatgonists)
Antagonists

27
Q

What drugs are opioid agonists?

A 
Strong = morphine, diamorphine, tramadol 
Weak = codeine, dihydrocodeine
28
Q

What drugs are opioid partial agonists/ mixed agonist-antagonist?

A

Buprenorphine

29
Q

What drugs are opioid antagonists?

A

Naloxone

Naltrexone

30
Q

Where in the CNS do opioids act?

A

Mu, kappa, delta opioid receptors (OP1-4)

ORL1

31
Q

What are the key side effects of opioids?

A

Respiratory depression
Conscious depression/ mood alterations
Miosis

32
Q

What are the key indicators of opioid overdose?

A

Pupillary constriction
Respiratory depression
Coma (GCS <7)

33
Q

What treatment is used for opioid overdose?

A

Opioid antagonists (e.g. naloxone, naltrexone)
Oxygen
Glucose
Thiamine

34
Q

What drugs can be used as migraine prophylaxis?

A

Beta-blockers

Amitriptyline (tricyclic antidepressant)

35
Q

What is the MoA of opioids?

A

Mimic endogenous opioids acting on opioid receptors to modulate pain at all CNS levels.
Hyperpolarises neuron so it is less likely to fire when a stimulus comes through

Block 3: Pathophysiology and pharmacology (16 decks)

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