Pain Deck 2 Flashcards
Peripheral
Sensitization
Drugs
Local Anesthetics Topical Analgesics Anticonvulsants Tricyclic Antidepressants Opioids
Descending Modulation
Drugs
Anticonvulsants
Opioids
Tricyclic/SNRI Antidepressants
Central Sensitization
Drugs
Anticonvulsants
Opioids
NMDA-Receptor Antagonists
Tricyclic/SNRI Antidepressants
NSAID examples
Aspirin Nonselective Cox 1and 2 inhibitors (ibuprofen, naproxyn) Selective cox-2 inhibitors (celebrex) Ketorolac (Toradol)
NSAID MOA
Block prostaglandin synthesis
Analgesia, antipyretic, anti-inflammatory actions
Toradol is used on an outpatient bases for
migraine
prostaglandins do what
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
ASA is an
antiplatelet
IBU can be taken every __ versus naproxin which is ___
6 to 8
12
NSAID pharmacokinetics
Biotransformed in the liver
Small amount excreted renally
NSAID side effects
Side effects: GI, renal, CV ( BP or HF)
Risk factors for NSAID ADR
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
NSAIDs Contraindications
PUD, GI or other bleeding disorders, Hyperuricemia,
Impaired renal or hepatic function, Vitamin D
deficiency, Cancer, Pregnancy and lactation
Asthma-ASA-Nasal polyps triad
NSAID Lab considerations
LFTs, salicylate level, hct, PT and INR
False – urine glucose tests (Clinitest, Tes-Tape)
HF and Hypertension can be worsened by
NSAID
Acetaminophen MOA
Prostaglandin and Cox inhibition in CNS, no peripheral
action
Mild Analgesia, antipyretic, no anti-inflammatory
Acetaminophen PHarmacokinetics
Metabolized liver
Acetaminophen SE
Nephropathy , liver injury
Limit 3-4G per day*
The following opioids are available as combination
products with acetaminophen, aspirin, or ibuprofen
Codeine; hydrocodone; oxycodone; propoxyphene
acetaminophen has a direct
effect on hypothalmus
opioid combination are typically used for
Moderate episodic (PRN) pain
Breakthrough pain in addition to a long-acting opioid
opioids never use more than
one combination product at any one time