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Anesthesia Pharm Study Guide > Pain and Opioids > Flashcards

Pain and Opioids Flashcards

1
Q

Fast pain fibers are:

a) Unmyelinated A-delta fibers
b) Myelinated A-delta fibers
c) Unmyelinated C-fibers
d) Myelinated C-fibers

A

b)Myelinated A-delta fibers

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2
Q

Slow pain fibers are:

a) Unmyelinated A-delta fibers
b) Myelinated A-delta fibers
c) Unmyelinated C-fibers
d) Myelinated C-fibers

A

c) Unmyelinated C-fibers

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3
Q

Define Eudynia.

A

Symptomatic/”Normal” pain

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4
Q

Define Maldynia.

A

“Abnormal” pain-pathophysiologic disease of the nervous system

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5
Q

True/False

Chronic pain is protective and usually adequately treated by pharmacological methods.

A

FALSE

Chronic pain is non-protective (has NO biological use) and is difficult to treat. Chronic pain is a disease.

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6
Q

Define Allodynia.

A

Pain to non-painful stimuli.

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7
Q

Define Hyperalgesia.

A

Heightened pain response to painful stimuli.

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8
Q

What 2 substances are released to allow transmission of pain?

A

Glutamate

Substance P

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9
Q

What are the 3 Main Opioid Receptors?

A

Mu, Delta, and Kappa

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10
Q

Name four Endogenous Opioids.

A

Endomorphins, Endorphins, Enkephalins, Dynorphins

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11
Q

True/False

Opioids can cause the release of histamine.

A

TRUE

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12
Q

Morphine

1) Mechanism of Action
2) Onset of Action

A

1) Classic Mu Opioid receptor Agonist-binds to G-protein coupled opioid receptor to block pain transmission
2) Slow Onset of Action (Low lipid solubility)

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13
Q

Does Morphine cross the BBB?

A

Yes, b/c Morphine is Non-Ionized

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14
Q

Does Morphine have an Active Metabolite?

A

Yes, M-6-Glucuronide (M6G) which is 10x more potent

*Must be careful in Kidney disease d/t kidney excretion

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15
Q

Codeine

1)Mechanism of Action

A

Morphine Derivative
ProDrug that’s converted to Morphine via CYP2D6
*Commonly combined w/Acetaminophen

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16
Q

Hydrocodone

1)Mechanism of Action

A

Morphine Derivative
ProDrug that’s converted to Hydromorphone via CYP2D6
*Commonly combined w/Acetaminophen

17
Q

Hydromorphone

1)Mechanism of Action

A

Morphine Derivative
5x More potent than Morphine
More lipid soluble=Faster Onset of Action than Morphine

18
Q

Oxycodone

1)Mechanism of Action

A

Morphine Derivative
ProDrug that’s converted to Oxymorphone via CYP2D6
*Commonly combined w/Acetaminophen
**Oxycontin=Sustained Release formula

19
Q

Methadone

1)Use

A

Morphine Derivative
Use: Addictive patient’s maintenance and Chronic pain
*ULTRA-LONG half-life

20
Q

Meperidine

1) Mechanism of Action
2) Onset of Action
3) Use
4) Adverse Effects

A

1) Synthetic Opioid: mu and kappa Opioid Receptor Agonist *1/10th potency of Morphine
2) More lipid Soluble than Morphine=Faster Onset
3) Post-operative Shivering, Pain
4) Psychomimetic effects (d/t kappa action), Histamine release (more than morphine)

21
Q

Why is Meperidine contraindicated to use w/MAOIs and SSRIs?

A

Serotonin Syndrome: Meperidine inhibits serotonin re-uptake

Symptoms: Delirium, Fever, Convulsions

22
Q

Does Meperidine have an active metabolite?

A

YES, Normeperidine

23
Q

Fentanyl

1) Mechanism of Action
2) Onset of Action
3) Adverse Effects

A

1) Synthetic Opioid: Mu receptor agonist
* 50-100x MORE potent than Morphine
2) Short Onset of Action
3) Metabolized by CYPs

24
Q

Alfentanil

1) Mechanism of Action
2) Onset of Action

A

1) Synthetic Opioid: Mu receptor agonist
* 10x MORE potent than Morphine
2) Extremely Rapid Onset of Action

25
Q

Remifentanil

1) Mechanism of Action
2) Onset of Action
3) Adverse Effects

A

1) Synthetic Opioid: Mu receptor agonist
* Equipotent to Fentanyl
2) Extremely Rapid Onset of Action AND Clearance (3min)
* Metabolized by Non-specific Plasma Esterases
3) Little Post-op Pain Relief

26
Q

What does Context Sensitive Half-life mean?

A

Half-life of the Drug depends on Administration Length of Time (Longer infusion time=Longer Half-life)
“Context” is the duration of infusion.

27
Q 
From the Drugs listed below, which have Context Sensitive Half-lives?
Morphine
Alfentanil
Remifentanil
Fentanyl
A

Alfentanil and Fentanyl

28
Q

What is Opioid Synergism?

A

Opioid + Benzo OR Opioid + Propofol
–> causes significantly greater respiratory depression, obtundation, and respiratory arrest at much lower doses of these agents when used together

29
Q

True/False

Spinal Opioids with preservatives are safe to use.

A

FALSE, Spinal Opioids MUST be Preservative FREE!

30
Q

Tramadol

1) Mechanism of Action
2) Use
3) Adverse Effects

A

1) Opioid Partial Agonist: binds to mu receptor partially and inhibits re-uptake of monoamines (NE and Serotonin)
2) Mild/Moderate Acute and Chronic Pain
3) Metabolized by CYPs-can cause drug-drug interactions

31
Q

Tapentadol

1) Mechanism of Action
2) Use
3) Adverse Effects

A

1) Opioid Partial Agonist: binds to mu receptor partially and inhibits re-uptake of monoamines (NE and Serotonin)
* Greater mu receptor efficacy than Tramadol
2) Mild/Moderate Acute and Chronic Pain
3) Metabolized by CYPs-can cause drug-drug interactions

32
Q

Nalbuphine

1) Mechanism of Action
2) Use

A

1) Kappa Opioid receptor agonist AND Partial mu Opioid receptor antagonist
* Positive Opioid Benefits w/Fewer side effects
2) Short term, Acute, Moderate/Severe Pain
* Does NOT work for Chronic Pain

33
Q

Pentazocine

1)Mechanism of Action

A

1) Has 2 Isomers–> One has affinity for kappa Opioid receptor, other does NOT
* Has a “ceiling effect”- once max dose reached, NO additional agonists effects occur

34
Q

Buprenorphine

1) Mechanism of Action
2) Use

A

1) Partial mu Opioid receptor agonist and kappa Opioid receptor antagonist
* High affinity for mu receptor=difficult for other Opioids to bind
2) Opioid Addiction (must use high doses)

35
Q

Nalozone

1) Mechanism of Action
2) Use

A

1) Opioid Antagonism: competitive antagonist at mu, kappa, and delta receptors
* Causes REVERSAL of ALL Opioid effects
2) Acute Opioid Overdose
* May require multiple dosing d/t half-life of OD drug vs. reversal agent

36
Q

Naltrexone

1) Mechanism of Action
2) Use

A

1) Opioid Antagonism: competitive antagonist at mu, kappa, and delta receptors
* ORAL agent=slower acting
2) Maintenance treatment for Opioid dependence

37
Q 
Which Opioids below have Active Metabolites?
Morphine.                      Codeine
Hydrocodone.               Fentanyl
Meperidine.                   Methadone
Oxycodone.                   Oxymorphone
Tapentadol.                   Tramadol
A 
Morphine
Hydrocodone
Meperidine
Oxycodone
Codeine
Tramadol

Anesthesia Pharm Study Guide (13 decks)

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