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Pharmacology > Pain & Inflammation Meds: opioids and non opioids > Flashcards

Pain & Inflammation Meds: opioids and non opioids Flashcards

1
Q

what are pain medication considerations?

A
  • Severity
  • Location (role of oral and/or topical)
  • Careful patient selection
  • Nonpharmacologic options
  • Tolerance, dependence, withdrawal
  • Concomitant disease states
  • Age
  • Cost
  • Conventional treatment for the pain syndrome
  • Risk-benefit ratio of all potential interventions
  • Impact of potential adverse consequences
  • Risk of nonmedical use
  • Use of combination products
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2
Q

what drug is considered the gold standard in OA therapy ?

A

Acetaminophen - max of 4 grams a day
most effective when taken daily
- APAP

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3
Q

do obesity and malnutrition increase toxicity risk

A

yes

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4
Q

the more cox 2 selective a drug is the ..

A

less the effect of platelet aggregation
less effects on renal fxn
less GI irratation

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5
Q

what are the risks of NSAIDS

A 
(GI,CV,Renal)
•GI toxicity risk
•Cardiovascular effects
•Blood pressure
•Edema
•Renal effects
-non selective NSAIDS have 2 components, cox1 / 2. the cox 1 pathways is responsible for GI, renal and CV effects. Therefor having a cox2 selective nsaid decreases risks
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6
Q

can NSAIDS help with heart conditions like aspirin?

A

No, only for the time the NSAID is taken will platlet aggregation decr. Asprin manages platelets better for longer periods
- NSAIDS can increase edema and send pts with preexisting HTN, BP, or HF issues over the edge

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7
Q

should a patient over 75 be taking oral nsaids?

A

no, topical instead such as DiclofenacGel

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8
Q

What should a patient do with a hx of GI bleeds?

A
  • use NSAID with PPI or COX-2 inhibitor
  • within year: ombine NSAID or COX-2 inhibitor with PPI, if use at all
  • if on asprin , DONT use ibuprofen of cox-2 inhibitor
  • No nsaid if chronic kidney disease stage IV or V (carefully weight risks and benefits if stage III
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9
Q

What are common non selective nsaids ?

A
  • Ibuprofen(Advil®, Motrin®)
  • Naproxen(Aleve®, Naprosyn®)
  • have Cv and renal risks
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10
Q

What are more cox-2 selective nsaids ?

A

-Meloxicam

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11
Q

what is Celebrex (celecoxib)

A

COX-2 Inhibitors

  • similar to nsaid
  • Fewer GI side effects
  • use in pts with GI bleed hx
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12
Q

What are other , no opioid pain options

A

SNRI (serotonin norepinephrine reuptake inhibitor) - cymbalta
SE - suicidal thoughts and behavior
- SNRI

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13
Q

what is the MOA of a SNRI

A

inhibits reuptake of serotonin and norepinephrine

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14
Q

what is a pregablin ?

A

used for fibromyalgia, neuropathic pain, adjunct for partial-onset seizures, postherpeticneuralgia
- not active at opiate receptors

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15
Q

what is gabapentin?

A
  • opioid type high at high dose

- Schd 5 drug

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16
Q

What is lidocaine

A

Patch

-moa : blocks initiation and conduction of nerve impulses, decreases membrane permeability to Na ions

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17
Q

spasticity can arise from …

A

CNS injury
•Multiple sclerosis
•Spinal cord transection
•Brain injury (CVA, stroke TBI)

18
Q

what is a type of Antispasm Pharmacologic Options?

A
  • Diazepam (Valium®)
  • cyclobenzaprine
  • Baclofen
  • gabapentin
  • botox
19
Q

Diazepam MOA?

A

Potentiates inhibitory effect of GABA on alpha motor neuron activity in the spinal cord

20
Q

what are natural remedies for arthrtiis

A

Glucosamine & Chondroitin
-2012 ACR guidelines conditionally recommend that patient should not use chondroitinsulfate or glucosamine, but could change in 2019

21
Q

Nsaids are used for ___ acteminophin is used for___

A

Nsaids are used for RA -

-acteminophin is used for OA

22
Q

when should Hyaluronic Acid be used?

A

As a last line of defense for OA

  • injected into knee and can perhaps delay sugery
  • not much support for long term use
  • Intra-articular hyaluronic acid can be used for non sx candidates
23
Q

whata are Intra-articular Glucocorticoids use for?

A
  • Relieve pain for short term acute pain like knee effusion/ inflammation
  • can have Decreased systemic effects (vs. oral)
  • not rec’d for long term use 2/2 joint detruction
24
Q

what are topical agents that can be used for OA

A

Capsaicin, Methylsalicylate, topical nsaids for hand OA

25
Q

how can Fibromyalgia be treated

A

Antidepressants seem to have greatest efficacy

•SNRI (serotonin norepinephrine reuptake inhibitors)

26
Q

what are some Nonpharmacologic options?

A

TENS units Massage Acupuncture Biofeedback Cognitive therapy Heat/ice Psychotherapy

27
Q

What is the gold standard for RA rx

A

DMARDs

28
Q

How can RA be treated pharmacologicly

A
  • NSAIDs
  • Corticosteroids
  • DMARDs:
  • Biological Agents- Anti-TNF-αAgents (risk for infection)
29
Q

which drugs are opiods and what are the general side effects

A
  • morphine
  • oxycodone
  • tramadol (now is considered a opiod)
  • fentanyl (risk with heat)
  • interaction with alcohol (EtOH); addiction, abuse, misuse; life-threatening respiratory depression; neonatal opioid withdrawal syndrome; accidental ingestion, GI effects
30
Q

what is an benefit of Tramadol?

A

•Reduction in pain without GI or renal toxicities.
•Lower addiction potential than opioids.
* Now a Schedule IV controlled agent in several states

31
Q 
Define tolerance 
physical dependence 
WITHDRAWAL 
ADDICTION and 
PSEUDOADDICTION
A
  • TOLERANCE –adaptation of nerve transmitters during chronic use; each dose last shorter, less effective over time
  • PHYSICAL DEPENDENCE –natural physiologic process –the body lets the med treat the pain
  • WITHDRAWAL –body aches, insomnia, irritability, tachycardia, weakness, yawning, shivering, GI symptoms
  • ADDICTION –dysfunctional use for other than alleviating pain; use for a high or low
  • PSEUDOADDICTION –in patients with severe, unrelieved pain; looks like addiction because so afraid to experience withdrawal or breakthrough pain
32
Q

what is an expectation for pain you can use to inform patients

A

some pain is okay. Acceptable vs addressed

33
Q

what does dopamine control ?

A
  • Movement (too little dopamine in Parkinson’s Disease)
  • Emotion
  • Motivation
  • Pleasure
34
Q

what does Glutamate control ?

A 
Found in MSG –makes food taste good
-Stimulates reward system
-Changes in the brain over time can impact cognitive function 
•Memory
•Clear thinking
35
Q

what are the drug effects of Heroin and Marijuana?

A

neurotransmitters similar to natural ones

•Trick the brain to believe real neurotransmitters (especially dopamine)

36
Q

what are the drug effects of Cocaine and Methamphetamine ?

A

dump large amount of neurotransmitters, especially dopamine

37
Q

what is the brains response to drugs

A

the brain interprets an overload of neurotransmitters and enables a protective mechanism that releases Less dopamine, with Fewer receptors available - Control the dopamine by letting less be available

  • you will never hit that level of high again
  • when you feel down, there are less NT available and you feel tired, groggy, unmotivated ect
  • seeking behavior begins
38
Q

what can you use for a Opioid overdose?

A

-•Naloxone (Narcan) –takes over the opioid receptor and removes the opioid
•SUDDEN withdrawal, short term only
-Pure opioid antagonist

  • Naltrexone (Vivitrol) –blocks the opiate receptor so taking opiates (narcotics, heroin) won’t work
  • Opioid antagonist
  • Suboxone - combo for longterm use
  • Methadone - detox
39
Q

Suboxone - what is it ?

A

•Buprenorphine and naloxone (Suboxone) –provide a steady amount of long-term stimulation to the opioid (mu) receptor•Gives the brain that steady dose of dopamine•Gradually decrease it as the brain gradually takes over making its own dopamine

40
Q

what are Morphine Milligram Equivalents (MME’s) used for?

A

Compared osesof Opiods

41
Q

What are the recommendations for acute pain?

A
  • Alwaysoffer a Bowel Regimen
  • Avoid opioids if possible
  • Offer other modalities (TENS, PT, Massage, acupuncture)
  • If opiate -minimal amounts-<50 MME/day
  • Recommend no more than a seven (7) day supply and continue for no more than a 3 month term.
42
Q

What med should be avoided with opiods ?

A

•Avoid benzodiazepines

Pharmacology (5 decks)

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