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HLSC 220 Pharmacotherapeutics for Health Professionals πŸ’Š > Pain and Analgesic Drugs > Flashcards

Pain and Analgesic Drugs Flashcards

1
Q

What is Nociception?

A

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

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2
Q

What is pain?

A

Unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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3
Q

What are the four processes of pain?

A

Transduction
Transmission
Perception
Modulation

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4
Q

What is acute pain?

A

Sudden onset
Usually subsides once treated

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5
Q

What is an example of a nociceptive stiumulus?

A

Stepping on a nail
Causes acute pain via activation of nociceptive pathways

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6
Q

What is chronic pain?

A

Persistent or recurring pain
-More than 6 weeks
Difficult to treat

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7
Q

Examples of chronic pain?

A

Mild, musculoskeletal pain
Deep pain
Neuropathic pain
Chronic pain of indeterminate cause

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8
Q

What is neuropathic pain?

A

Pain induced by injury or disease of the somatosensory system

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9
Q

What causes neuropathic pain?

A

nerve injury
Infections of the NS
e.g, phantom limb pain, trigeminal neuralgia, shingles (postherpetic neuralgia), diabetic neuropathy

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10
Q

How does neuropathic pain develop?

A

Slowly
outlasts healing of original injury

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11
Q

Examples of neuropathic pain?

A

Allodynia
Hyperalgesia
Causalgia (burning)

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12
Q

What are some sources of pain?

A

Somatic (superficial)
Visceral (vascular, respiratory)
Referred
Cancer (breakthrough)
Phantom
Neuropathic
Psychogenic
Central

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13
Q

What are the two groups of pain medications?

A

Analgesic
Anesthetic

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14
Q

What do analgesic pain medications do?

A

Selectively blocks the sensation of pain without
blocking other symptoms or loss of consciousness

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15
Q

What do local anesthetic pain medications do?

A

Blocks nerve conduction and all local sensations (including pain)

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16
Q

What do general anesthetic pain medications do?

A

Cause loss of sensations and unconsciousness

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17
Q

Where is the site of action of opioids?

A

Higher centres
Spinal cord

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18
Q

What do opioids alter in higher centres in the brain?

A

Psychological response to pain
-Pain can still be felt but produces less suffering
-Changes perception

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19
Q

What do opioids do in the spinal cord?

A

Reduce neurotransmitter release from terminals pain fibres in dorsal horn of spinal cord
-Modulation

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20
Q

How do opioids work?

A

The drugs bind to opioid receptors

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21
Q

What is an opiate?

A

Any drug derived from opium
e.g, Morphine, codeine

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22
Q

What is opium?

A

β€œjuice” of the poppy (Papaver somniferum)

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23
Q

Why do different opioids have different properties?

A

They have various affinity and activation for different opioid receptor subtypes
and pharmacokinetic differences

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24
Q

All opioid analgesics are what?

A

Full agonists of partial agonists at Β΅ and/or ΞΊ receptors

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25
Q

What are the kinds of opioid receptors?

A

Β΅ (mu) receptors
ΞΊ (kappa) receptors
Ξ΄ (delta) receptors

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26
Q

Β΅ (mu) receptors

A

Analgesia
Brain and spinal cord

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27
Q

Which parts of the brain have Β΅ (mu) receptors?

A

Cortex, medulla, thalamus, limbic system, amygdala

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28
Q

ΞΊ (kappa) receptors

A

Analgesia
Brain and spinal cord
-Dysphoria and hallucinations

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29
Q

What are the pharmacological properties of opioids?

A

Analgesia
Sedation and mental clouding
Euphoria and tranquility
Antitussive -no cough reflex
Depression of respiratory centre
Nausea, vomiting
Miosis (pin point pupil)
Tolerance, serious dependence
Constipation
Postural hypotension
Dilation of cutaneous blood vessels, warm skin
Urinary urgency but difficult urination
Biliary colic and epigastric distress

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30
Q

Which pharmacological properties of opioids are associated with Β΅ (mu) receptors?

A

Analgesia (and kappa)
Euphoria and tranquility (and delta)
Depression of respiratory centre
Miosis (pin point pupil) (and kappa)
Tolerance, serious dependence
Constipation (and delta)

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31
Q

Examples of opioid analgesics?

A

Morphine
Methadone (longer action than morphine)
Fentanyl
Diamorphine (Heroin)
Levorphanol
Hydromorphone
Oxycodone
Codeine

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32
Q

What are opioids used for?

A

Alleviate mild, moderate to severe pain (depends on opioid or given with adjuvant agent to relieve pain)
Cough centre suppression
Treatment of diarrhea
Balanced anaesthesia

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33
Q

What opioid suppresses cough centre?

A

Codiene

34
Q

What opioid is used for the treatment of diarrhea?

A

Loperamide

35
Q

What opioid is used to balance anasthesia?

A

Fentanyl

36
Q

What is morphine used for?

A

Acute and chronic pain

37
Q

What drug are other analgesics often compared to?

A

Morphine
it is the standard
Equianalgesic doses

38
Q

Which receptors does morphine mostly bind to?

A

mu-opioid receptors in the brain and spinal cord

39
Q

How is morphine administered?

A

IV, IM, SC, PO, intrathecal

40
Q

What is half-life (T 1/2) of morphine?

A

2-4 hours

41
Q

Where is morphine metabolized?

A

Extensive liver metabolism
-First-pass metabolism
-Inactivation
-Liver disease

42
Q

What happens if morphine is used during pregnancy?

A

Dependance, crosses placenta

43
Q

What happens if morphine is used while breastfeeding?

A

Enters breast milk

44
Q

What is breakthrough pain?

A

Transient episodes of pain, while chronic pain is controlled
Requires access to rescue medication

45
Q

How is cancer pain treated?

A

Sustained release morphine (MS Contin) Around The Clock (ATC)
NSAIDs
Adjuvants
Other analgesics when needed

46
Q

How is MS Contin administered?

A

PO

47
Q

What is MS Contin?

A

MS = morphine sulfate
Contin = continuous/sustained release

48
Q

What is the most common non-narcotic analgesic?

A

NSAIDs

49
Q

What are some examples of adjuvants?

A

Antidepressants eg amitriptyline (Elavil)
Antiseizure drugs eg carbamazepine
Glucocorticoids

50
Q

When is morphine use contraindicated or should be used very cautiously?

A

Severe asthma or other respiratory insufficiency
- causes RESPIRATORY depression
Hepatic dysfunction
Elevated intracranial pressure (ICP) – exacerbates it
Pregnancy

51
Q

What is the #1 serious adverse effect associated with opioids?

A

Respiratory depression

52
Q

What other adverse effects are associated with opioid analgesics?

A

CNS depression (could lead to coma)
Nausea and vomiting
Constipation
Hypotension
Histamine release
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)

53
Q

When is nausea and vomiting caused by opioids greatest?

A

On 1st dose then decreases

54
Q

Why do opioids cause hypotension?

A

Cause dilation of peripheral arteries and veins (histamine release)

55
Q

What happens because of histamine release associated with opioid use?

A

Itchiness
Rash
Dilation of peripheral arteries and veins

56
Q

What other drugs do opioids have cumulative effects with?

A

CNS depressents
e.g, antipsychotics, antihistamines, sedatives (benzodiazepines, barbiturates)
Ethanol (alcohol)

57
Q

What are some moderate opioids?

A

Codeine (3-methylmorphine)
Oxycodone
Buprenorphine
Codiene

58
Q

What are properties of codiene?

A

Less analgesia and respiratory depression
Antitussive
Liver metabolism (~10% of oral dose) = unpredictable
Often combined

59
Q

What is Codiene often combined with?

A

Acetaminophen in Tylenol 1, 2 and #
Acetylsalicylic acid in 222’s or 292

60
Q

What is required for the activation of Oxycodone?

A

Metabolism

61
Q

What is there potential for with oxycodone use?

A

Abuse (addiction)

62
Q

What is oxycodone also kown as?

A

Oxycontin or Percodan

63
Q

What is oxycodone widely used in combination with?

A

Acetaminophen ( aka percocet)

64
Q

What are some opioid antagonists?

A

Naloxone (Narcan)
Naltrexone

65
Q

What are opioid antagonists used for?

A

Complete or partial reversal of opioid induced respiratory depression

66
Q

What is the half-life of Naloxone?

A

~2 hours
-Shoter half-life than morphine and other ropioids

67
Q

How is Naloxone administered?

A

IV, IM, SC and nasal

68
Q

What way is naloxone administered in rescue kits?

A

IV or nasal

69
Q

How is opioid addiction treated?

A

Methadone program
Buprenorphine + nalosone (suboxone)

70
Q

What is Buprenorphine + naloxone (suboxone)?

A

SL tablet
Alternative to methadone
-help you use other opioids less

71
Q

What is a common physiological result of chronic opioid treatment?

A

Tolerance

72
Q

What is opioid physical dependance?

A

State that develops in which an abstinence syndrome will occur if a drug is abruptly withdrawn
Drug must be administered to maintain normal function
Occurs with other unrelated drugs classes
On abrupt discontinuation or when an opioid
antagonist is administered

73
Q

What is narcotic withdrawal?

A

Opioid abstinence syndrome
Unpleasant but not dangerous

74
Q

What are withdrawal symptoms?

A

Anxiety
Irritability
Chills and hot flashes
Joint pain
Lacrimation
Sneezing
Rhinorrhea
Diaphoresis
Nausea
Vomiting
Abdominal cramps
Diarrhea

75
Q

Physical dependence is NOT the same as what?

A

Addiction

76
Q

What is addiction?

A

Substance dependence syndrome

77
Q

What are both parts of the body’s response to the presence of opioid drugs?

A

Tolerance
Physical dependence

78
Q

Oral opioids should be taken with what

A

Food
-minimize gastric upset

79
Q

When should opioid dose be withheld, and physician should be contacted?

A

If there is a decline in the client’s condition or is VS are abnormal
-Especially if respiratory rate is less than 12

80
Q

How can respiratory depression caused by opioids manifest?

A

Less than 12 breaths per minute
Dyspnea
Diminished breath sounds
Shallow breathing

81
Q

How can constipation caused by opioids be managed?

A

Take with adequate fluid and fibre intake
stool softener (docusate) and or stimulant (senna) daily

82
Q

How can ortjostatic hypotension caused by opioids be managed?

A

Instruct to change positions slowly

HLSC 220 Pharmacotherapeutics for Health Professionals πŸ’Š (15 decks)

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