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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
how can Fibromyalgia be treated
Antidepressants seem to have greatest efficacy | •SNRI (serotonin norepinephrine reuptake inhibitors)
26
what are some Nonpharmacologic options?
TENS units Massage Acupuncture Biofeedback Cognitive therapy Heat/ice Psychotherapy
27
What is the gold standard for RA rx
DMARDs
28
How can RA be treated pharmacologicly
* NSAIDs * Corticosteroids * DMARDs: * Biological Agents- Anti-TNF-αAgents (risk for infection)
29
which drugs are opiods and what are the general side effects
- 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
what is an benefit of Tramadol?
•Reduction in pain without GI or renal toxicities. •Lower addiction potential than opioids. * Now a Schedule IV controlled agent in several states
31
``` Define tolerance physical dependence WITHDRAWAL ADDICTION and PSEUDOADDICTION ```
* 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
what is an expectation for pain you can use to inform patients
some pain is okay. Acceptable vs addressed
33
what does dopamine control ?
* Movement (too little dopamine in Parkinson’s Disease) * Emotion * Motivation * Pleasure
34
what does Glutamate control ?
``` Found in MSG –makes food taste good -Stimulates reward system -Changes in the brain over time can impact cognitive function •Memory •Clear thinking ```
35
what are the drug effects of Heroin and Marijuana?
neurotransmitters similar to natural ones | •Trick the brain to believe real neurotransmitters (especially dopamine)
36
what are the drug effects of Cocaine and Methamphetamine ?
dump large amount of neurotransmitters, especially dopamine
37
what is the brains response to drugs
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
what can you use for a Opioid overdose?
-•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
Suboxone - what is it ?
•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
what are Morphine Milligram Equivalents (MME’s) used for?
Compared osesof Opiods
41
What are the recommendations for acute pain?
* 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
What med should be avoided with opiods ?
•Avoid benzodiazepines

Pharmacology (5 decks)

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