Pain-Anesthesia Flashcards
Where did the first information on opioids come from?
Ancient Mesopotamia
Where is opium extracted from?
Resin of the poppy bud
Who first noticed that opium could put people to sleep?
Paracelsus, 1493-1541
What did Paracelsus observe?
By combining alcohol and opium, the painkilling effect increases
Who first isolated morphine from opium?
1806, Friedrich Wilhelm Serturner
What was significant about Friedrich Serturner’s discovery of morphine?
He isolated morphine into a pure white powder, which allowed for determining accurate dosage
How did Friedrich Serturner name morphine?
After the Greek god of dreams “Morpheus”
What is the therapeutic window of morphine?
It is very narrow, meaning the difference between a dose that relieves pain and one that causes death is small.
When did the British introduce opium to China?
In the 1800s, during British rule over India.
What was China’s initial response to British opium exports?
China resisted due to the addictive nature of opium and did not want to open opium dens.
What wars were caused by China’s resistance to the British opium exports?
The First Opium War (1839-1842) and the Second Opium War (1856-1860).
What was the result of the Opium Wars for China?
China lost, leading to widespread opium addiction in the country.
What was another issue during the time after the Opium Wars?
Patent medicines: they contained active ingredients but the dosage was unknown to consumers, leading to addiction
When was the issue of patent drugs addressed?
In 1906, when the US introduced the first ever Food and Drug Act. (It concerned labeling but was not super strict yet)
What are endorphins? What do they do?
Endorphins are proteins that relieve pain and create feelings of pleasure, such as those during laughter, orgasms, and the high after exercising.
How does morphine relieve pain?
Morphine resembles endorphins, the body’s natural pain relievers, and fits into the same receptors that endorphins do, blocking pain signals.
What neurotransmitter causes pain, and how does morphine affect it?
Substance P causes pain, and morphine blocks Substance P to reduce pain.
What type of addiction does morphine cause?
It causes physical addiction because the body needs more and more of it over time, and withdrawal symptoms occur when it’s not in the body’s system
What is the double-edged sword of opioids?
It is used in medicine for good, like pain relief, but can also cause some bad, like addiction
Who synthesized heroin (diacetyl morphine) from morphine?
In 1874, Charles Romley Wright
What was the initial view on heroin?
Thought to be a better painkiller and less addictive, and was compared to aspirin, but they are very different
How addictive is heroin?
One single injection can lead to addiction. It takes less less heroin to get someone addicted than morphine
Where is heroin used?
It is not used in any medicines or hospitals
How is morphine converted to heroin?
It is very easy: a slight change in molecular structure, just attach two acetyl groups to morphine.
Who is credited with the development of aspirin?
Felix Hoffmann
What substance is found in the bark of the willow tree?
Salicin
What happens to salicin when you swallow it?
It gets converted into salicylic acid
How was aspirin first made?
Salicylic acid + acetic acid = acetyl salicylic acid or ASA (aspirin)
Aspirin is made from something found in the bark of the willow tree
Who won the Nobel Prize for discovering how aspirin works?
In 1982, Sir John Vane
How does aspirin work?
Aspirin blocks the enzyme, cyclooxyrgenase, stopping the formation of prostaglandins that cause inflammation, swelling, pain, and fever.
How does aspirin cause negative effects?
It interferes with the production of prostaglandins, which protect the stomach lining, decreasing stomach acid production and help the gut release more protective mucus.
Who found oxycodone? And how?
Martin Freund and Edmund Speyer found it from thebaine, a compound in opium, when they played around with the structure of morphine
How is oxycodone created from morphine?
By treating morphine with an oxidizing agent.
How and when was dilaudid or hydromorphone made?
In 1962, when a little change was done to morphine
What is dilaudid like?
It is less addictive, but also a less effective painkiller. It is still used as a common painkiller in hospitals
When and how was demerol made?
In 1932. A significant change in the molecular structure of morphine.
How does demerol work as a painkiller (as is other painkillers)?
Its molecular structure twists and folds in such a way that it fits into a morphine receptor to block the pain. In this way, a painkiller doesn’t have to be similar to the molecular structure of morphine in order to work as a painkiller.
What connection does Hitler have with oxycodone?
Hitler was prescribed oxycodone and became addicted to it.
What two common pain relievers were developed in 1953?
Acetaminophen (Tylenol)
What are some characteristics about Acetaminophen (Tylenol)?
- It doesn’t have blood clouting effect.
- It relieves pain and reduces fever.
- But the studies on its pain relieving effect are inconsistent.
- May be a cyclooxyrgenase inhibitor, like aspirin
Can certain pain-relieving drugs be taken together for enhanced effect?
Yes, some drugs like Vicodin can be combined to enhance pain relief.
What is an opioid?
Any substance that behaves like morphine, whether it comes from opium or not, is called an opioid.
Who founded Purdue Pharma, and what was their first product?
Drs. Raymond, Arthur, and Mortimer Sackler founded Purdue Pharma, and their first product was morphine.
What was MS Contin, and how did it work?
MS Contin was a continuous-release form of morphine sulfate, designed to slowly release morphine for prolonged pain relief.
What was OxyContin, and how was it marketed? Was it accurate?
OxyContin was oxycodone with a continuous-release mechanism. It was marketed as a 12-hour, less addictive painkiller with the low risk of 1% of people getting addicted. Purdue’s claims were all false.
What was Purdue’s response to their marketing mistake of OxyContin?
Purdue introduced OxyNeo, a gel formulation of oxycodone, to prevent misuse, but it was enough to fix their mistake.
What is the main criticism of Purdue Pharma’s actions?
The shame lies not in creating OxyContin but in promoting it with false claims, leading to widespread addiction.
Is OxyContin a bad drug?
No, OxyContin is not a bad drug when used properly for legitimate medical reasons. However, most addicts had not been prescribed it for medical reasons.
How does fentanyl work as a painkiller?
It has the shape that fits into a receptor despite not resembling morphine
What are the natures of fentanyl?
It is highly addictive and strictly regulated because of this
How do underground chemists bypass fentanyl regulations?
They alter its molecular structure to create variants like alphamethyl-fentanyl or 3-methyl-fentanyl, which aren’t illegal since they are not yet a known drug yet
What is the opioid antagonist that reverses the effects of opioids by displacing them from their receptor sites?
In 1961, Naloxone
What makes naloxone?
A slight change in the molecular structure of morphine
What is Advil, and what are its side effects?
Advil is a pain reliever that inhibits prostaglandins, but it can cause stomach issues, including gastrointestinal bleeding.
What year was Advil introduced?
1969
Who discovered Stadol, and what is it used for?
Bernard Belleau at McGill University discovered Stadol, which is used for migraines and is available as a nasal spray.
Is Stadol highly effective?
No, Stadol is not highly effective but is still used today.
Tramadol
Tramadol was introduced in 1977 as a synthetic opiate.
What are side effects all opioids have?
All opioids can cause constipation and slow breathing, among other side effects.
Who discovered nitrous oxide?
In 1777, Joseph Priestley
How was nitrous oxide discovered?
By heating ammonium nitrate, which produced nitrous oxide gas
Who described the effects of nitrous oxide?
In the 1800s, Humphry Davy, noting that it caused people to laugh - “laughing gas”
How was nitrous oxide popularized?
Nitrous oxide was used at performances and parties where people inhaled it, becoming giddy and laughing, which made it widely known to the public.
Who was the dentist who observed something about nitrous oxide? What did he observe?
Horace Wells. A man fall off a stage and had a gash on his leg while under the influence of nitrous oxide, yet felt no pain and continued to dance
How did Horace Wells test nitrous oxide for dental use?
Wells tested nitrous oxide on his assistant and then on himself, successfully pulling out his own teeth without feeling pain.
Where did Horace Wells demonstrate the effects of nitrous oxide?
Massachusetts General Hospital
What happened with Horace Wells demonstration?
Wells’ demonstration failed because he didn’t allow enough time for the nitrous oxide to take full effect in the patient before performing the procedure.
What happened to Horace Wells?
He committed suicide
Who continued the study on nitrous oxide after Horace Wells?
Wells’ fellow dentist, William Mortan
What did William Morton?
He continued experimenting and consulted chemist Charles Jackson, who suggested using ether. Morton tested ether, which successfully put patients to sleep.
What device William Morton make with ether?
He made an inhaler with sponges soaked with ether in them
When and where did the first successful anesthesia demonstration using ether occur?
The first successful demonstration using ether occurred on October 16, 1846, at Massachusetts General Hospital in a room later called the “ether dome.”
How did the world first hear of anesthesia?
Magician Robert Houdin heard about anesthesia in Boston and incorporated ether into his magic act, joking that it could defy gravity, making people think they might float.
Who was the guy who never came out to report on his findings of ether before William Horton?
In 1842, Crawford Long, a Georgia physician
Who are considered the possible “fathers of anesthesia”?
The battle over the title of “father of anesthesia” includes William Morton, Charles Jackson, and Horace Wells, and maybe even Paracelsus.
Who discovered chloroform as an anesthetic and what was his significant contribution?
In 1847, James Simpson. Introduced its use for childbirth.
What was the opposition to the use of chloroform for childbirth?
The Church opposed chloroform for childbirth, citing the Bible’s command that women should experience pain in childbirth.
How was the use of chloroform defended against Church opposition?
James Simpson argued that God was the first anesthetist, as He put Adam to sleep before creating Eve.
How many major surgeries are performed under anesthesia worldwide today?
An estimated 230 million major surgical procedures are carried out under anesthesia worldwide each year.
What is waste anesthetic gases?
Anesthetic gases that are leaked or exhaled from a patient after inhaling during surgery
What are the three problems with waste anesthetic gases?
Ozone destruction, greenhouse effect, and occupational hazard
