Pain and Analgesic (opioids), NSAIDs, and Steroidal Anti-Inflams Flashcards
Define nociception
neural process of encoding noxious stimuli
Define neuralgia
nerve pain
Define allodynia
pain from a stimulus that doesn’t usually cause pain
Define neuropathic pain
damage to the neurons and somatosensory NS due to disease, condition, or lesion
Define hyperalgesia
abnormal increased amount of pain from stimulus
Acute vs chronic pain disorders
acute: pain lasting < 3 months
chronic: pain lasting > 3 months
Treatments for mild, mod, and severe pain as per WHO analgesic ladder
Mild: PT, OT, NSAID, non-opioid analgesics
Moderate: PT, OT, weak opioids
Severe: PT, OT, strong opioids
Classify analgesics and anti-inflam agents
Analgesics: opioid (narcotics), non-opioid (NSAID, acetaminophen)
Anti-inflams: NSAID, glucocorticosteroids
List the endogenous opioid peptides
Endorphins
Enkephalins
Dynorphins
List the opioid receptors
Mu, kappa, delta
Purpose of strong agonists. Examples?
used to treat severe pain; interact primarily with μ opioid receptors
Morphine (MS contin)
Methadone (dolophine)
Oxycodone (oxycontin)
Hydromorphone (dilaudid)
Purpose of mild-mod agonists. Examples?
used to treat mild-mod pain
Hydrocodone (hycodan)
Purpose of mixed agonists-antagonists. Examples?
have the ability to act differently at specific classes of opioid receptors; activate 𝛋 receptors → kappa receptor agonists, partially activate μ receptors → μ receptor antagonists or partial agonists
Buprenorphine (buprenex)
Purpose of antagonists. Examples?
block all opioid receptors with particular affinity for mu variety; used to treat opioid OD and addiction
Naloxone (narcan)
Naltrexone (ReVia, vivitrol)
Mechanism of pre synaptic effects of opioids
Opioids close voltage-gated Ca2+ channels on presynaptic nerve terminals → reduce transmitter release (glutamate and substance P)
Mechanism of post synaptic effects of opioids
Opioids open K+ channels on postsynaptic neurons and hyperpolarize them → inhibit postsynaptic neurons
Major CNS pharmacological effects of opioids (10)
Analgesia
Euphoria
Sedation
Respiratory depression
Cough suppression
Miosis (pupil constriction)
Truncal rigidity (trunk)
Nausea and vomiting
Body temp
Sleep disturbances
Major PNS pharmacological effects of opioids (6 systems w/ S/S)
-CV system: bradycardia, hypotension, increase cerebral BF, increase intracranial pressure
-GI system: constipation (opioids don’t develop tolerance to constipating factors)
-Biliary (bile) tract: biliary colic (stone in cystic duct, GB to small intestine)
-Renal: decrease renal fxn, antidiuretic effect, urinary retention
-Endocrine: decrease testosterone w/ chronic use, decrease libido, energy and mood
-Pruritus (“itching” of skin): flushing and warming skin, sweating, urticaria (hives), itching, increase peripheral histamine release
Major cause of opioid OD-induced death?
Opiate toxicity triad: CNS depression (coma), respiratory depression (cyanosis), pupillary miosis
Common and serious AE of opioids (not sure if this is the right answer)
tolerance, dependence, withdrawal, addiction
What pharmacological effects of opioid develop tolerance (6)
Tolerance: analgesic, sedating, respiratory depressant, antidiuretic, emetic, hypotensive
What pharmacological effects does not develop tolerance
Doesn’t develop tolerance: miotic, convulsant, constipating actions
List out treatment options for opioid overdose and toxicity
Naloxone (narcan) = antidote for OD
Ventilation and oxygenation
Purpose of COX-1
produces prostaglandins that mediate homeostatic fxns
homeostatic: protect gastric mucosa, platelet activation, renal fxns, macrophage differentiation
