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Nurs 5229 Clinical Pharmacotherapeutics > Pain Deck 2 > Flashcards

Pain Deck 2 Flashcards

1
Q

Peripheral
Sensitization
Drugs

A 
Local Anesthetics
Topical Analgesics
Anticonvulsants
Tricyclic Antidepressants
Opioids
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2
Q

Descending Modulation

Drugs

A

Anticonvulsants
Opioids
Tricyclic/SNRI Antidepressants

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3
Q

Central Sensitization

Drugs

A

Anticonvulsants
Opioids
NMDA-Receptor Antagonists
Tricyclic/SNRI Antidepressants

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4
Q

NSAID examples

A 
† Aspirin
† Nonselective Cox 1and 2 inhibitors (ibuprofen,
naproxyn)
† Selective cox-2 inhibitors (celebrex)
† Ketorolac (Toradol)
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5
Q

NSAID MOA

A

Block prostaglandin synthesis

† Analgesia, antipyretic, anti-inflammatory actions

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6
Q

Toradol is used on an outpatient bases for

A

migraine

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7
Q

prostaglandins do what

A

reduce pain and fever
reduce inflmation

they also protect the stomach and promting clotting. So anything that works against these will cause GI upset and bleedign

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8
Q

ASA is an

A

antiplatelet

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9
Q

IBU can be taken every __ versus naproxin which is ___

A

6 to 8

12

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10
Q

NSAID pharmacokinetics

A

† Biotransformed in the liver

† Small amount excreted renally

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11
Q

NSAID side effects

A

… Side effects: GI, renal, CV ( BP or HF)

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12
Q

Risk factors for NSAID ADR

A 
… Alcohol intake
… Age > 60 years
… Female gender
… Duration of treatment
… Type of NSAID use
… Multiple NSAID use
… Corticosteroid use
… Duration of treatment … History of PUD
… Increased dosage
… History of PUD
… Comorbid CV
condition
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13
Q

NSAIDs Contraindications

A

† PUD, GI or other bleeding disorders, Hyperuricemia,
Impaired renal or hepatic function, Vitamin D
deficiency, Cancer, Pregnancy and lactation

† Asthma-ASA-Nasal polyps triad

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14
Q

NSAID Lab considerations

A

† LFTs, salicylate level, hct, PT and INR

† False – urine glucose tests (Clinitest, Tes-Tape)

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15
Q

HF and Hypertension can be worsened by

A

NSAID

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16
Q

Acetaminophen MOA

A

† Prostaglandin and Cox inhibition in CNS, no peripheral
action
† Mild Analgesia, antipyretic, no anti-inflammatory

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17
Q

Acetaminophen PHarmacokinetics

A

† Metabolized liver

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18
Q

Acetaminophen SE

A

† Nephropathy , liver injury

† Limit 3-4G per day*

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19
Q

The following opioids are available as combination

A

products with acetaminophen, aspirin, or ibuprofen

† Codeine; hydrocodone; oxycodone; propoxyphene

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20
Q

acetaminophen has a direct

A

effect on hypothalmus

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21
Q

opioid combination are typically used for

A

† Moderate episodic (PRN) pain

† Breakthrough pain in addition to a long-acting opioid

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22
Q

opioids never use more than

A

one combination product at any one time

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23
Q

hydrocodone and oxycodone are more potent
than ____ , which is more potent than
_____, which some studies suggest is
equipotent to aspirin

A

codeine

propoxphene

24
Q

there is little difference between hydrocodone

products and

A

oxycodone products in terms of

potency

25
Q

Adjuvants

A 
… Non-pharmacologic
… Topicals
… Tylenol
… NSAIDS, Celecoxib, steroids
… Anticonvulsants
… Antidepressants
… Antiarrhythmics
26
Q

Tramadol - Indications

A

mild to moderate pain

27
Q

Tramadol MOA

A

entrally acting synthetic pain reliever
† Action similar to morphine
† Max dose 300mg/d
† Not recommended for acute use for >5d

28
Q

Tramadol SE

A

Side Effects
† Increased falls in the elderly?
† May be habit forming

29
Q

Tramadol dont

A

Don’t stop abruptly, taper off

30
Q

Agents to treat acute pain - Adjuncts

A 
† Preemptive analgesia
† NMDA receptor agonists
† Alpha-2 adrenerg g ic a onists
† Local anesthetics
† Anticonvulsants
31
Q

Agents to treat chronic pain - Adjuncts

A

† Anticonvulsants

† Antidepressants

32
Q

Preemptive Analgesia

A

After tissue injury or surgery:
† Damage causes peripheral sensitization and central
sensitization
… Treatment started before and is operational during a
surgical procedure
… Antinociceptive treatment that reduces altered
sensory input

Research
† preemptive analgesia decreases peripheral sensitization
† Decrease in central sensitization controversial

33
Q

… Agents Shown to be of Pre-Emptive Benefit

A

†Ketamine 0.25-1 mg/kg
†Cox-2 I hibi * 2 Inhibitors*
†Neurontin 300 mg
†Local Anesthetics

34
Q

Ketamine MOA

A

binds to phencyclidine site on the NMDA

receptor

35
Q

Ketamine Use at

A

subanesthetic dose

36
Q

Ketamine Current literature

A

† Administer pre-incision and throughout the

perioperative period

37
Q

Ketamine Other effects

A

† Less PONV than control, no adverse psychic effects or

sedation

38
Q

Local Anesthetics MOA

A

reversibly block impulse conduction along
nerve axons and other excitable membranes that
utilize sodium channels as the primary means of
action potential generation

39
Q

Local Anestheits causes

A

reversible local anesthesia and a loss of

nociception

40
Q

Esters

A

… Tetracaine (Pontocaine)
… Benzocaine
… Cocaine
… Procaine (Novacaine)

41
Q

Amides

A 
… Lidocaine
… Mepivicaine
… Bupivicaine (Marcaine)
… Etidocaine(Duranest)
… Prilocaine
42
Q

classification of local anesthetics

A

Esthers

Amides

43
Q

Topical types

A

Topical
† Emla
† Tracheal lidocaine

44
Q

Topicsal MOA

A

… Peripheral nerve endings and major nerve trunks

† Axillary, ankle blocks etc.

45
Q

Topical administration

A

Epidural or subarachnoid

46
Q

Alpha-2 Adrenergic Agonists examples

A

clonidine

dextemetomidine

47
Q

Alpha 2 can be gven as an

A

infusion

48
Q

Clinidine

A

† Antihyptensive amd analgesic adjunct

† No respiratory depression

49
Q

Dextemetomidine (Precedex)

A 
† Central and peripheral effects
„ More alpha-2 selective
„ No respiratory depression
„ May reduce HR and BP
„ Potentiates effects of opioids, sedatives, anesthetics
50
Q

Gabapentin (Neurontin) - in animal studies it

A

In animal studies it helps to prevent allodynia

51
Q

Gabapentin (Neurontin) 0 used

A

Used preemptively, reduces anxiety in

52
Q

Gabapentin (Neurontin) MOA

A

… U k MOA Unknown MOA
† Studies have suggested that it helps preemptively by
reducing wind up pain

53
Q

Gabapentin (Neurontin) Dosine condierations

A

Dosing considerations: Renal dosing

54
Q

Gabapentin (Neurontin) SE

A

dizziness, somnolence, edema

55
Q

Pregabalin (Lyrica) is like

A 
“Neurontin on steroids”
† Has greater analgesic effect on neuropathic pain in animal
models
† Titrate up, taper down
† Reduces Opioid induced hyperalgesia
56
Q

Pregabalin SE

A

† Be careful with elderly
„ Can cause ataxia, drowsiness, depression, suicidal
† Weight gain, peripheral edema,

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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