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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
Glucocorticoids Side Effects:
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
Acetaminophen Administration = Solubility = Absorption = Distribution = Storage sites =
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
Acetaminophen Excretion/Elimination: MOA: Clinical Application: Therapeutic Peak/Timing:
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
Acetaminophen Half-life: Side effects: Receptor type: Metabolism:
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
Acetaminophen Generic Name:   Brand Name: Adverse effects:
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
Acetaminophen PT Implications:
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
Opioid Analgesics =
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
Opioid Analgesics Past vs present terminology:
Past Terminology: Narcotics > Due to sedative effect = described effect rather than drug Current Terminology: Opioid > Represents all morphine-like medication
33
Opioid Medication Side Effects:
Mental slowing and drowsiness Euphoric Cardiovascular problems = orthostatic hypotension GI distress = nausea and vomiting Anti-peristaltic action = constipation Pupil Changes
34
Opioid Medication Adverse Effects:
Respiratory depression Drug tolerance changes leading to increased dosage and addiction
35
Opioid: Side Effects Can Be Fatal
Sedative properties = mental slowing and drowsiness Euphoric state = varies amongst individuals
36
Opioid: Serious side effects
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
Opioid: Addiction
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
Opioid: Tolerance
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
Opioid: Physical Dependence
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
Opioid Withdrawal Symptoms
Body aches Runny nose Diarrhea Shivering Fever Sneezing Stomach cramps Insomnia Sweating Irritability Tachycardia Loss of appetite Nausea/vomiting Weakness/fatigue
41
Fentanyl:
purpose = narcotic analgesic watch for = weak or shallow breathing, fast or slow HR, stiff muscles, severe weakness, light-headed
42
Codeine:
purpose = narcotic analgesic watch for = difficulty breathing, sedation, light-headed, bradycardia
43
Methadone:
purpose = narcotic analgesic watch for = slow or shallow breathing, fatigue, light-headed
44
Endogenous Opioid Peptides & Opioid Receptors
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
Three distinct families of ‘endogenous morphine’ :
Endorphins Enkephalins Dynorphins
46
Endorphins =
produced by hypothalamus and pituitary relieve pain general feeling of well being
47
Enkephalins =
involved in regulating nociception processing of painful stimuli
48
Dynorphins =
functions related to learning, emotional control, stress response and pain
49
Opioids: Strong Agonists
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
Opioids: Mixed Agonist-Antagonists
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
Opioids: Antagonists
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
Opioid Pharmacokinetics Routes of administration =
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
Opioid Distribution and Metabolism
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
Opioid Analgesics: Clinical Application
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
Non-Opioid drugs =
should be attempted first for pain control Acetaminophen, ibuprofen, aspirin, steroids
56
Opioid analgesics used when:
quality of life improvements outweighs the potential risks associated with these drugs
57
Unique form of analgesia:
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
Orally administered opioids and non-opioids are more effective when:
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
Tolerance and Dependence During Therapeutic Opioid Use
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
When the opioid dose exactly matches the patient’s need for pain control =
there is no excess drug to stimulate the drug-seeking behavior commonly associated with opioid addiction
61
Role of PT in ending the opioid epidemic
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
Which of the following is not treated with Benzodiazapines and Nonbenzodiazapines? A) Seizures B) Hypotension C) Insomnia D) Anxiety
B. Hypotension respiratory depression, hypotension are contraindicated with non-benzodiazapines and benzodiazapines

Pharmacology and Nutrition (5 decks)

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