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Pathophysiology/Pharmacology Across the Lifespan I (NURS-351) > Pain and Inflammation Medications > Flashcards

Pain and Inflammation Medications Flashcards

1
Q

Which receptors do opioids bind to?

A

MU receptors
Kappa Receptors
Delta Receptors

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2
Q

Examples of Opioid Strong Agonists

A
  • Morphine Sulfate
    Fentanyl
    Merperidine (Demerol)
    Hydromorphone (Dilaudid)
    Methadone
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3
Q

Opioid Moderate to Strong Agonist Examples

A
  • Codeine
    Oxycodone
    Tramadol (Ultram)
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4
Q

Opioid Agonist-Antagonist Examples

A
  • Butorphanol
    Nalbuphine (Nubain)
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5
Q

What do MU Receptors cause?

A

Analgesia
Respiratory Depression
Euphoria
Miosis
Reduced GI motility

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6
Q

What do Kappa Receptors cause?

A

Analgesia
Sedation
Respiratory Depression
Dysphoria
Miosis

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7
Q

What do Delta receptors cause?

A

Analgesia

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8
Q

Which neuropeptides are part of the endogenous analgesia system?

A

Endorphins
Enkephalins
Dynorphins

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9
Q

Endorphins

A

Inhibit Pain Signal Transmission
Induce Euphoria

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10
Q

Enkephalins

A

Inhibit substance P release
Modulate Pain Perception

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11
Q

Dynorphins

A

Produce analgesia

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12
Q

Morphine Sulfate

A

They bind to opioid receptors in brain, spinal cord, and peripheral tissues and activate endogenous analgesia system.

Moderate to servere pain

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13
Q

Adverse Effects of Morphine Sulfate

A

Respiratory depression
CNS depression
Nausea and Vomiting
Orthostatic hypotension
Sedation
Urinary Retention
Pupil Constriction
Itching

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14
Q

Black Box Warning for Morphine Sulfate

A

Regarding combined use of morphine and other opioid analgesics with benzodiazepines and other CNS depressants. All opioid analgesics – respiratory depression, coma, death, drug abuse and dependence.

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15
Q

CNS Depressants

A

Alcohol, antidepressants, antipsychotic, barbiturates, benzodiazepines, and sedatives

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16
Q

Meperidine (Demerol)

A
  • Produces neurotoxic metabolite (normeperidine) which accumulates with chronic use, large doses or renal failure.
  • CNS Stimulation – Agitation, hallucinations, seizures
  • Normeperidine not reversible with sopioid antagonist drugs

Not frequently used

17
Q

Methadone

A
  • Longer Duration of action
  • Therapueutic uses: Servere pain and detoxification and maintenance treatment of opioid use disorder
  • Adverse Effects: Lead to fatal dysrhythmias (Torsades de pointes)
18
Q

Examples of Potent Opioids

A

Fentanyl and hydromorphone (Dilaudid)

19
Q

Examples of milder opioids

A

Oxycodone and Codeine

Black Box Warning: Children who are ultra rapid metabolizers of codeine

20
Q

Signs of Opioid Toxicity

A

Classic Triad: Coma, Respiratory Depression, Pinpoint Pupils

21
Q

Equianalgesic Dosing

A

An equianalgesic dosing chart is a conversion chart that lists equivalent doses of analgesics

22
Q

Patient-controlled Analgesia (PCA)

A
  • Patient self-administers
  • Preset bolus
  • Basal amount
  • Lockout period
  • Education
23
Q

Tramadol (Ultram)

A

MOA: Binds to mu opioid receptors and inhibits norepinephrine and serotonin reuptake
Therapeutic uses:
* Moderate to severe pain
* Older adults
* Fibromyalgia, neuropathic pain
* Chronic pain

24
Q

Tramadol (Ultram) adverse effects

A
  • Serotonin syndrome
  • Respiratory depression
  • GI effects
  • Hypotension
  • Seizures
  • Suicidal ideation

Drug interactions: CNS depressants and SSRIs

25
Q

Opioid Nursing Considerations

A
  • Opioid tolerant vs. Opioid naive
  • Pain Assessment
  • Sedation Assessment
  • Respiratory Assessment
  • Orders
  • Treatment goals
26
Q

Opioid Agonist/Antagonist Examples

A
  • Butorphanol
  • Nalbuphine (Nubain)
  • Buprenorphine
27
Q

Butorphanol

A
  • Similar to morphine in analgesic effects and respiratory depression risk
  • Can induce withdrawal in opioid dependence
  • MOA: Act on same pain receptors as other opioid
    agonists. Agonists at some receptors and produce
    antagonist activity at others.

For moderate to severe pain

28
Q

Adverse Effects of Butorphanol

A

Black Box Warning: Potentially fatal respiratory depression, coma, death, drug dependence and abuse potential
Vertigo
Nausea and Vomiting
Possible withdrawal in opioid-tolerant

29
Q

Signs and Symptoms of Opioid Withdrawal

A
  • Perspiration
  • Chills
  • N/V/D
  • Anxiety, restlessness, insomnia
  • Pupil dilation
  • Anorexia
  • Increased body temperature, RR, BP
  • Dehydration
  • Muscle cramps
30
Q

Opioid Antagonist Example

A

Naloxone (Narcan)

31
Q

Naloxone (Narcan)

A
  • Antidote for CNS and respiratory depression caused by opioids. Also reverses analgesia
  • MOA: Competes with opioids at receptor sites and prevents binding or displaces bound opioids.
  • Therapeutic use: Reverse respiratory and CNS depression caused by opioid
    overdose

Adverse Effect: Withdrawal
Shorter duration of action than opioids.

32
Q

Nonnarcotic Analgesic Antipyretic Example

A

Acetaminophen (Tylenol)

33
Q

Acetaminophen (Tylenol)

A

MOA: Mechanism of action for pain response is largely unknown.
Acts on hypothalamus to reduce fever. Does not block prostaglandin synthesis in the periphery, pain relief action
suspected to be via CNS.
Therapeutic uses: Analgesic, antipyretic

Does not have anti-inflammatory properties

34
Q

Adverse effects of Acetaminophen (Tylenol)

A

Hepatotoxicity
- Max dose 4 grams/24 hours
- Use in caution with liver or renal impairment
Nephrotoxic in overdose
Overdose
- In multiple combination drugs
- Acetylcysteine (Mucomyst)

35
Q

Antiprostaglandins/
Cyclooxygenase Inhibitors Examples

A

Salicylate
NSAIDS (1st and 2nd Generations)

36
Q

What are the roles of prostaglandins?

A
  • Participate in Inflammatory response
  • Formed in response to cellular injury
  • Sensitize pain along with other chemical mediators
  • Protect GI tract adn kidneys
  • Regulate platelet function
  • Regulate vascular tone
37
Q

Aspirin (Acetylsalicylic acid)

A

MOA: Nonselective inhibitor of cyclooxygenase, suppresses platelet aggregation. Acts centrally and peripherally. Blocks pain response.

38
Q
A

Pathophysiology/Pharmacology Across the Lifespan I (NURS-351) (13 decks)

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