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Pharmacology and Nutrition > Pain & Anti-Inflammatory Meds > Flashcards

Pain & Anti-Inflammatory Meds Flashcards

1
Q

Pain Medications:

A

Analgesics are among the drugs most frequently taken by patients who are treated in a rehabilitation setting

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2
Q

The vast array of drugs that are used to treat pain can be roughly divided into two categories:

A

Narcotics: Opioid -> Morphine, Codeine

Anti-Inflammatory Meds: Non-opioid -> Ibuprofen, Naproxen, Aspirin, Acetaminophen, Panadol

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3
Q

Analgesics

A

Rehabilitation Setting: most common drug
> Purpose: pain relief

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4
Q

Common Non-Opioid Analgesics:

A

Acetaminophen
Aspirin
Ibuprofen
Glucocorticoids

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5
Q

Acetaminophen:

A

pain, anti-inflammatory

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6
Q

Aspirin:

A

pain, anti-coagulant, antipyretic

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7
Q

Ibuprofen:

A

pain, anti-inflammation

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8
Q

Glucocorticoids:

A

pain, strong anti-inflammatory

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9
Q

Common Opioid Analgesics:

A

Morphine
Codeine
Fentanyl
Methadone

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10
Q

Morphine:

A

pain

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11
Q

Codeine:

A

pain, cough

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12
Q

Fentanyl:

A

severe pain

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13
Q

Methadone:

A

pain, Opioid Use Disorder (OUD)

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14
Q

Aspirin:

Administration =
Solubility =
Metabolism =
Distribution =

A

Non-Steroidal Anti-inflammatory

Administration: oral & rectal

Solubility: Slightly water soluble, weak acid

Metabolism: Liver, GI and plasma

Distribution: absorbed rapidly from the stomach and intestine by passive diffusion

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15
Q

Aspirin:

Receptor Type/Location =
MOA =
Excretion/elimination =
Half-life =

A

Receptor Type/Location: Inhibitor of the Beta 2 adrenergic receptor  G-Protein coupled

Mechanism of Action: Aspirin blocks pain causing prostaglandin synthesis = prostaglandins are mediators of inflammatory process Aspirin also blocks the production of platelet aggregation which can treat a thrombus

Excretion/Elimination: Metabolized in the liver and excreted via urine

Half life: 2-6 hours

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16
Q

Aspirin

Clinical Application =
Side Effects =
Adverse Effects =
Drug Interactions =

A

Clinical Application:Antipyretic, analgesic, anti-inflammatory, Antiplatelet = thrombus and MI prevention

Side Effects: GI upset, nausea, gastritis, GI ulceration, abdominal pain, bleeding, headache

Adverse Effects: Prolonged bleeding times = aspirin stopped 1-2 weeks before surgery; GI ulceration, allergic reactions

Drug Interactions: aspirin competes with warfarin (anticoagulant); in combination with alcohol increase risk of GI bleeding

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17
Q

Aspirin

Clinical application =
Special Considerations =

A

Clinical application: good for conditions such as arthritis, and general pain, can help before therapy, don’t over prescribe

Special Considerations: Aspirin in Children, may result in Reye’s Syndrome= swelling in liver and brain

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18
Q

Aspirin

Dose for Pain:
Therapeutic Peak/Timing:
Generic Name:
Chemical Name:
Brand Name:

A

Dose for Pain: 325-650 mg every 4-6 hours

Therapeutic Peak/Timing: 2-3 hours

Generic Name: Aspirin

Chemical Name: acetylsalicylic acid

Brand Name: Ascriptin, Aspergum, Aspirtab, Bayer, Easprin, Ecotrin, Ecpirin, Entercote, Genacote, Halfprin, Ninoprin, Norwich Aspirin

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19
Q

Aspirin Patient education

A

Gastric irritation

Report signs of liver dysfunction = jaundice

Aspirin and other NSAIDs may impair bone and cartilage healing

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20
Q

Ibuprofen

Administration:
Metabolism:
Solubility:
Distribution:

A

Ibuprofen: Non-Steroidal Anti-Inflammatory

Administration: oralmost common, IV, Topical

Metabolism: liver

Solubility: lipid soluble, weak acid

Distribution: general circulation to CNS and PNS for analgesic and anti-inflammatory effects

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21
Q

Ibuprofen

Excretion/elimination:
Storage Sites:
Side Effects:
Drug Interactions:
Adverse Effects:

A

Excretion/elimination: urine

Storage Sites: kidneys

Side Effects: GI irritation and abdominal pain (dyspepsia), nausea, constipation, headache, dizziness, drowsiness, rash, ALT and AST elevated, fluid retention and decreased urine output, delayed ovulation, ulceration, allergic reactions

Drug Interactions: diuretics and anti-hypertensives, anticoagulants

Adverse Effects: GI bleed, MI, stroke, thromboembolism, hypertension, anaphylaxis, bronchospasm, anemia

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22
Q

Ibuprofen

Half-life:
MOA:
Generic Name:
Brand Name:
Therapeutic Peak/Timing:

A

Half-life: 1.8-2 hours

Mechanism of Action: Selectively inhibit COX-2 receptors = Inhibits cyclooxygenase which reduces prostaglandin (control inflammation) and thromboxane synthesis (platelet synthesis)

Generic Name: Ibuprofen

Brand Name: Advil, Motrin

Therapeutic Peak/Timing: 1-2 hrs after administration, 200-400 mg every 4-6

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23
Q

Ibuprofen PT implications:

A

Antipyretic, analgesic, anti-inflammatory

pt may not be presenting the Sx if this was taken before the time of the visit

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24
Q

Glucocorticoids

Synthetic Corticosteroids:
Administration:
Clinical Implication:

A

Anti-Inflammatory Med

Synthetic Corticosteroids: Prednisone & Dexamethasone are potent anti-inflammatories

Administration: Intra-articular injections = increased risk of joint destruction & tendon atrophy

RA & DJD

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25
Q

Glucocorticoids

Side Effects:

A

Renal Insufficiency: Rapid withdrawal of exogenous corticosteroids = adrenal gland may not be able to reinstitute endogenous cortisol efficiently

Immunosuppression = increased risk of infection

Depression
Cataracts
Fluid Retention
Hyperglycemia
Osteoporosis
GI Disturbances

26
Q

Acetaminophen

Administration =
Solubility =
Absorption =
Distribution =
Storage sites =

A

Nonopioid Narcotic

Administration: Oral

Solubility: water soluble, weak base

Absorption: Small Intestine, passive diffusion

Distribution: widely distributed throughout most body tissues

Storage Sites: Liver

27
Q

Acetaminophen

Excretion/Elimination:
MOA:
Clinical Application:
Therapeutic Peak/Timing:

A

Excretion/Elimination: urine

Mechanism of Action: Analgesic = Unknown; Antipyretic = direct action on the hypothalamic heat-regulating center

Clinical Application: Mild to moderate pain relief (analgesic), fever reducer (antipyretic)

Therapeutic Peak/Timing: 30-60 minutes; food may delay time and peak concentration

28
Q

Acetaminophen

Half-life:
Side effects:
Receptor type:
Metabolism:

A

Half-life: 2-3 hours, can be increased to 4 hours in pts with hepatic issues

Side effects: nausea, vomiting, stomach pain, appetite loss, trouble urinating, light-headedness/ fainting/ weakness, unusual bruising or bleeding

Receptor Type: Agonist

Metabolism: 85-90% metabolized in the liver via conjugation
10-15% undergoes oxidative metabolism toxic metabolite

29
Q

Acetaminophen

Generic Name:
Brand Name:
Adverse effects:

A

Generic Name: Acetaminophen

Brand Name: Tylenol

Adverse Effects: Liver toxicity at doses higher than 10 mg or chronic use due to metabolite formed that is toxic to the liver.

30
Q

Acetaminophen
PT Implications:

A

use for minor aches/pains for pts, be alert for signs of hepatotoxicity and liver failure

Be alert for signs of hepatotoxicity and liver failure, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising

Implement appropriate manual therapy techniques, physical agents, relaxation techniques and therapeutic exercises to reduce pain and decrease the need for acetaminophen and other analgesics

31
Q

Opioid Analgesics =

A

Naturally occurring, semisynthetic, and synthetic agent

Used to treat moderate to severe pain

Act on neuronal receptors located primarily in the Central Nervous System = secondarily the peripheral nervous system

Ability to produce physical dependence
Classified as controlled substance: schedule II

32
Q

Opioid Analgesics
Past vs present terminology:

A

Past Terminology: Narcotics
> Due to sedative effect = described effect rather than drug

Current Terminology: Opioid
> Represents all morphine-like medication

33
Q

Opioid Medication
Side Effects:

A

Mental slowing and drowsiness

Euphoric

Cardiovascular problems = orthostatic hypotension

GI distress = nausea and vomiting

Anti-peristaltic action = constipation

Pupil Changes

34
Q

Opioid Medication
Adverse Effects:

A

Respiratory depression

Drug tolerance changes leading to increased dosage and addiction

35
Q

Opioid: Side Effects Can Be Fatal

A

Sedative properties = mental slowing and drowsiness

Euphoric state = varies amongst individuals

36
Q

Opioid: Serious side effects

A

Respiratory Depression = slow breathing rate which can last for minutes to hours

Not typically an issue with therapeutic doses

Can be severe or fatal in medically complex patients, patients with preexisting respiratory condition, and overdose

GI distress also very common = nausea and vomiting, constipation

37
Q

Opioid: Addiction

A

repeated ingestion of a substance for mood alteration and pleasurable experiences

primary, chronic, neurological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations

characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving

38
Q

Opioid: Tolerance

A

the need to progressively increase the dosage of a drug to achieve a therapeutic effect when the drug is used for prolonged periods

Chronic pain = increase in dosage over time

Prolonged exposure causes decrease in sensitivity of opioid receptors = receptor downregulation

Enzyme upregulation = metabolism

state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the opioid effects over time

39
Q

Opioid: Physical Dependence

A

onset of withdrawal symptoms when the drug is abruptly removed

In severe dependence unpleasant symptoms become evident 6 – 10 hours after the last dose

Symptoms typically peak 2-3 days after the last dose

Physical symptoms last approximately 5 days

Psychological ‘craving’ may last years

40
Q

Opioid Withdrawal Symptoms

A

Body aches
Runny nose
Diarrhea
Shivering
Fever
Sneezing
Stomach cramps
Insomnia
Sweating
Irritability
Tachycardia
Loss of appetite
Nausea/vomiting
Weakness/fatigue

41
Q

Fentanyl:

A

purpose = narcotic analgesic

watch for = weak or shallow breathing, fast or slow HR, stiff muscles, severe weakness, light-headed

42
Q

Codeine:

A

purpose = narcotic analgesic

watch for = difficulty breathing, sedation, light-headed, bradycardia

43
Q

Methadone:

A

purpose = narcotic analgesic

watch for = slow or shallow breathing, fatigue, light-headed

44
Q

Endogenous Opioid Peptides & Opioid Receptors

A

Exogenous opioids react with endogenous receptors

Internal control of pain and inflammation

Response to physical and psychological stress, eating and drinking behaviors, and physiological addiction to exogenous opioids/other drugs

Exercise upregulates internal morphine substances

45
Q

Three distinct families of ‘endogenous morphine’ :

A

Endorphins
Enkephalins
Dynorphins

46
Q

Endorphins =

A

produced by hypothalamus and pituitary

relieve pain

general feeling of well being

47
Q

Enkephalins =

A

involved in regulating nociception

processing of painful stimuli

48
Q

Dynorphins =

A

functions related to learning, emotional control, stress response and pain

49
Q

Opioids: Strong Agonists

A

Used to treat severe pain

High affinity for specific receptors in CNS
> Example: Morphine, Oxycodone, Fentanyl, Heroin

High efficacy

Risks associated with respiratory depression

50
Q

Opioids: Mixed Agonist-Antagonists

A

Agonist and antagonist activity due to ability to act differently at specific classes of opioid receptors

Less risk of side effects associated with respiratory depression

Efficacy may not be as great as agonists = alternative to treat moderate to severe pain

Examples: Butorphanol, Buprenorphine, Nalbuphine

51
Q

Opioids: Antagonists

A

Block all opioid receptors = no analgesic effect

Used to treat opioid overdoses and addiction

Example: Naloxone and Naltrexone
> Rapidly reverses respiratory depression = 1-2 minutes

> Respiratory depression is the usual cause of death in opioid overdose

> Competitive antagonists

52
Q

Opioid Pharmacokinetics
Routes of administration =

A

Preferred Administration: Oral

Other routes of administration
> Rectal: nausea or vomiting an issue

> Subcutaneous: poor intestinal absorption or significant first-pass inactivation

> IV, epidural, intrathecal: slow controlled

> Transdermal: convenient steady, prolonged administration

53
Q

Opioid Distribution and Metabolism

A

Regardless of administration route: systemic circulation is the goal
> Ultimately reach receptors in the CNS – some effect on peripheral nervous system receptors

Metabolism: primarily in the liver, secondarily in the kidneys and lungs

54
Q

Opioid Analgesics:
Clinical Application

A

most effective in treating constant moderate-to-severe pain

Not as effective in treating sharp, intermittent pain

Uses: surgery, trauma, myocardial infarction, chronic pain, cancer pain

Side effect risks are significant: dose should be well monitored

Antitussive: codeine in cough syrup

55
Q

Non-Opioid drugs =

A

should be attempted first for pain control

Acetaminophen, ibuprofen, aspirin, steroids

56
Q

Opioid analgesics used when:

A

quality of life improvements outweighs the potential risks associated with these drugs

57
Q

Unique form of analgesia:

A

alter the patient’s perception of pain rather than eliminating pain entirely

Pain is no longer the primary focus = referred to as euphoria and a sensation of floating

58
Q

Orally administered opioids and non-opioids are more effective when:

A

given at regularly schedule intervals vs. ‘as needed’

Plasma concentrations maintained within a therapeutic range

Easier to control pain in its earlier stages = mitigate full pain intensity

59
Q

Tolerance and Dependence During Therapeutic Opioid Use

A

Debate as to whether tolerance and dependence accompanies the therapeutic use of opioid drugs for treatment of chronic pain

Some experts feel that tolerance and physical dependence will not occur in most patients if the dosage is carefully adjusted to meet the patient’s needs

60
Q

When the opioid dose exactly matches the patient’s need for pain control =

A

there is no excess drug to stimulate the drug-seeking behavior commonly associated with opioid addiction

61
Q

Role of PT in ending the opioid epidemic

A

Interdisciplinary team approach (pts, families, providers, payers, and professionals across the continuum of health care settings)

Focus not only on the S/Sx of pain but also the movement patterns that may be contributing to pain

Intervention strategies: exercise, manual therapy, stress management, sleep hygiene, pain neuroscience education

62
Q

Which of the following is not treated with Benzodiazapines and Nonbenzodiazapines?
A) Seizures
B) Hypotension
C) Insomnia
D) Anxiety

A

B. Hypotension

respiratory depression, hypotension are contraindicated with non-benzodiazapines and benzodiazapines

Pharmacology and Nutrition (5 decks)

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