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NURS216A > Pain and Inflammation Drugs > Flashcards

Pain and Inflammation Drugs Flashcards

1
Q

OPQRRRST

A 
Onset
Provocation
Quality
Region
Radiation
Relief
Severity
Time (of pain)
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2
Q

Pain Rating /10 and Reasonable Treatment

A

<4/10:
non-opioids, NSAIDS, tylonel

4-6/10:
Opioids, PO (codeine/morphine)

<6/10:
Higher potency opioids, IV

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3
Q

What kind of meds stop pain at the peripheral level? CNS level?

A

Peripheral:

  • non-opioids
  • NSAIDS

CNS:

  • non-opioid centrally acting (acetaminophen)
  • Opioids
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4
Q

Acetaminophen

A 
Centrally acting analgesic
Not a NSAID
Not antinflammatory
Anti-pyretic, q4h PO
Toxic Metabolite (N-acetyl benzo) then glutathione (phase 2)
Cmax: 30-60m
low PPB (20%)
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5
Q

What is an Agonist?

A

Initiates a physiologic response when combined with a receptor

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6
Q

Mu1 Receptor

A

Effect: Analgesic (supraspinal,spinal), low abuse potential. Bradycardia, Hypothermia, Urinary Retention
Agonists: Endorphins, morphine, synthetic opioids

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7
Q

Mu2 Receptor

A 
Analgesic (spinal)
Depression of ventilation
Physical dependence
CONSTIPATION
Agonists: Endorphins, morphine, synthetic opioids
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8
Q

Kappa Receptor

A

Analgesic (supraspinal,spinal)
Dysphoria,sedation
Low abuse potentional

Diuresis
Agonists: Dynorphins

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9
Q

Delta

A

Analgesic: Supraspinal,spinal
Depression of ventilation
physical dependence

CONSTIPATION
Urinary retention
Agonists: enkephalins

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10
Q

High Efficacy Opioids:

A 
Fentanyl
Hydromorphone (dilaudid)
Oxymorphone (numorphan)
Meperidine (Demerol)
Morphine
Methadone (metadol)
Tramadol (Ultram)
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11
Q

Moderate Efficacy Opioids:

A 
Hydrocodone
Oxycodone (OxyNeo and oxycotin)
Percocet
Percodan
Vicodin
Tramacet
Buprenorphine
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12
Q

Low Efficacy Opioids

A

Codeine

Tylonel #1-4

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13
Q

Combination Drugs

A 
Percocet (oxycodone and acetaminophen)
Percodan (oxycodone and ASA)
Vicodin (hydrocodone and acetaminophen)
Tramacet (tramadol and acetaminophen)
Tylonel #1-4 (acetaminophen and caffiene and codeine)
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14
Q

Med for GI Pain

A

Dicyclomine (Bentyl)

Muscarinic Antagonist, GI smooth muscle relaxant

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15
Q

Myocardial Pain Med

A

Morphine

Opioid, decreased vasoconstriction (decreased BP and CO)

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16
Q

Adverse Effects of Opioids:

A 
CNS depression (sedation)
N and V
Itching
Constipation
Urinary Retention
Euphoria

ANTAGONIST is Naloxone

17
Q

NSAIDs

A

Useful if pain is associated with inflammation caused by cellular injury not allergy
-Prostaglandin target

18
Q

Prostaglandins

A

Lipids, COX1 and 2

19
Q

COX1

A

-Present in all tissues
-Protects gastric mucosa, supports kidney fx, promotes platelet aggregation
When inhibited: gastric bleeding and kidney failure

20
Q

COX2

A

Present at site of tissue injury
-Mediates inflammation, sensitizes pain receptors, mediates fever in the brain
When inhibited: suppression of inflammation (this is the ideal treatment)

21
Q

Selective Cox2 inhibitor?

A

Celecoxib (Celebrex)

-black box warning, can cause death.

22
Q

Non Selective Cox inhibition?

A 
NSAIDS
-ASA, Ibuprofen (and others like it)
\: Diclofenac (Voltaren0
Naproxen (Aleve, Naprosyn)
Ketorolac (Toradol)
Indomethacin (20x ASA POTENCY)
23
Q

Chose ASA When…

A

Low dose antithrombotic

Low-moderate joint pain

24
Q

Chose Ibuprofen When…

A

headache/1st migraine

soft tissue swelling (treatment of sprains)

25
Q

Chose Indomethacin When..

A

Moderate-severe joint pain

arthritis and gout

26
Q

ASA in Kids Causes..

A

Reye’s Syndrome: swelling of the brain and liver.

27
Q

Glucocorticoids

A

Endogenous hormone:
-adrenal cortex secretion
-Lipophilic
-nuclear receptor binding
-for survival during fasting (stimulates gluconeogenesis, protein degradation and lipolysis)
High efficacy as an antiinflammatory. Histamine release suppression, COX2 inhibition and suppression of phagocytes and lymphocytes

28
Q

Glucocorticoid Meds (end in ONE)

Are easily excreted when metabolized. High PPB

A 
Short acting: 
Hydrocortisone
cortisone
Prednisone (prodrug)
Prednisolone
Methylprenisolone

Long Acting:
Dexamethasone

29
Q

Glucocorticoids are used for..

A

Inflammation (IBD, Lupus):
dexamethasone

Joint Pain: cortisone injection

Anaphylaxis: stabilization of pt post anaphylactic shock. Prednisolone IV followed by PO Prednisone for 3 days

Allergic Rhinitis (intranasally)
Inhalation (asthma)

NURS216A (15 decks)

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