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DPT > Pain Lecture 3 and 4 > Flashcards

Pain Lecture 3 and 4 Flashcards

1
Q

What is pain?

A

An experience based on complex interactions of physical and psychological processes.

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2
Q

3 goals of pain control

A

1st- relieving the pain source

2nd- modify patients perception of discomfort

3rd- maximize function within the limitations of the pain perception

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3
Q

What are the three types of pain?

A

Nocioceptive
Neuropathic
Psychogenic

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4
Q

Where does pain enter and leave?

A

Enters through dorsal horn and exits through spinothalamic tract

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5
Q

What is an opioid?

A

any substance, whether endogenous or synthetic, that produces morphine-like effects that are blocked by the morphine antagonist naloxone

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6
Q

List the 9 opioids

A
  • Codeine
  • Hydrocodone
  • Hydrocodone with acetaminophen (Vicodin)
  • Morphine (MS Contin)
  • Oxycodone (Oxycontin)
  • Oxycodone with acetaminophen (Percocet)
  • Fentanyl (Duragesic)
  • Hydromorphone (Dilaudid)
  • Meperidine (Demerol)
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7
Q

What are the indications for opioids?

A

analgesia, antitussive (codeine)

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8
Q

Opioid MOA

A

bind opioid receptors in the CNS to inhibit ascending pain pathways

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9
Q

Opioid routes

A

PO, rectal, IM, IV, topical, subcut infusion, epidural, intrathecal, intranasal, transmucosal
(everything)

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10
Q

Opioids most common AE

A

CNS- sedation, nausea

Peripheral- constipation

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11
Q

Which opioid side effect do you not gain a tolerance to?

A

Constipation, miosis

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12
Q

PT specific considerations regarding opioids

A

Respiratory depression even at usual doses-contributes to accidental OD

Cognitive Impairement

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13
Q

What is oxycodone often combined with for additive effects

A

acetaminophen or aspirin

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14
Q

Only mild-moderate opioid

A

codeine

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15
Q

What is special about codeine

A

It is a prodrug meaning that it is inactive until it is converted into morphine via metabolization

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16
Q

What does Tramadol increase the risk of?

A

Seizures

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17
Q

What schedule drug is tramadol?

A

IV

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18
Q

Difference between induction therapy and maintanence therapy?

A

Induction- inpatient to titrate drug out

Maintanence- outpatient for observation

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19
Q

Naloxone routes

A

IV, IM, subcut, intranasal

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20
Q

Opioid therapeutic concerns

A
  • Drowsiness and decreased cognition
  • Pateints pain perception is altered
  • Avoid heat on patches
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21
Q

List the 8 NSAIDs

A
  • Ibuprofen (Mortin, Advil)
  • Naproxen (Aleve)
  • Indomethacin
  • Aspirin
  • Celecoxib (Celebrex)
  • Meloxicam
  • Diclofenac (Voltaren gel, Flector patch)
  • Trolamine salicylate (Aspercreme)
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22
Q

Aspirin AE

A

GI
Rare skin rash
Rayes Syndrome

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23
Q

Why would you need to increase your aspirin dose?

A

In order to be selective for cox-2 as well as cox 1.

Cox-2 for analgesia and anti inflammatory effects

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24
Q

NSAID general risks

A

Renal
GI
Cardiovascular

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25
Q

Which drug should be avoided if you have a CV risk?

A

Celecoxib

Take naproxen

26
Q

If you have a GI risk you should take which NSAIDs?

A

Ibuprofen or Celecoxib

27
Q

Acetaminophen route

A

PO, IV, rectal

28
Q

Acetaminophen indication

A

Analgesia and Anti-pyretic

Combo with NSAIDs to reduce risk

29
Q

Acetaminophen AE

A

Hepatotoxicity

Metabolized in 3 ways (3rd is hepatotoxic)

30
Q

Acetaminophen MOA

A

inhibits prostoglandin synthesis in CNS

31
Q

What population is this the safest?

A

Elderly

32
Q

What are the two types of neuropathic pain?

A

Stimulus independent and stimulus dependent (If I don’t know the meaning, its stimulus-dependent)

33
Q

What is the first line of treatment for neuropathic pain

A

Gabapentin

34
Q

What are the AE of gabapentin

A

dizziness and drowsiness

35
Q

What is intraarticular hyaluronate

A

Injection used to provide joint lubrication

36
Q

What is RA

A

Chronic, progressive, systemic inflammatory disease

autoimmune disease

37
Q

What are the 2 main drug groups to treat RA

A

Non-biologic and biologic (TNF inhibitor and non-TNF inhibitor) DMARD

38
Q

Drugs in each of these groups:

  1. Non biologic DMARD
  2. Biologic TNF inhibitor DMARD
  3. Biologic non-TNF inhibitor DMARD
A 
1.
Hydroxychloroquine 
Sulfasalazine
Methotrexate (MTX)
2.
Adalimumab
Etanercept
3.
Rituximab
39
Q

What is the gold standard for RA?

A

Methotrexate

40
Q

Combo of MTX+ another DMARD

A

Can improve efficacy but also toxicity

41
Q

What is the purpose of corticosteroids?

A

Short term treatment of RA

42
Q

Routes for corticosteroids?

A

PO and intraarticular

43
Q

Corticosteroid MOA?

A

decrease inflammation and suppresses immune system

44
Q

Corticosteroid long term vs short term AE

A

short term:
increase blood glucose, mood changes, fluid retention

long term:
osteoporosis/↑fracture risk, thin skin, muscle wasting, poor wound healing, adrenal suppression, Cushing’s disease, ↑ risk of infection due to immunosuppression

45
Q

MTX MOA

A

unknown in RA, possibly by impacting IL-1 (interleukin), TNF-alpha and leukotriene levels

46
Q

MTX route

A

PO once weekly

47
Q

MTX common AE

A

N/V/D, alopecia, malaise

48
Q

MTX less common AE

A

↑ liver function tests (LFTs), hepatotoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression

49
Q

Hydroxychloroquine MOA

A

impacts mediators of inflammatory response

50
Q

Hydroxychloroquine route

A

PO

51
Q

Hydroxychloroquine common AE

A

GI and skin reactions

52
Q

Hydroxychloroquine rare AE

A

retinal toxicity

53
Q

Hydroxychloroquine indication

A

RA, Lupus, Malaria

54
Q

non-TNF and TNF inhibitor route

A

IV or subcut

serious infection risk

55
Q

What do both non-TNF and TNF inhibitor’s MOA act on

A

inflammation process

56
Q

Rehab concerns with DMARDS

A

Awareness of drug toxicity

  • Skin rashes: inspect skin
  • Renal effects: toxic metabolites  keep patient hydrated!
  • Liver effects

Other concerns

  • Immunosuppression
  • Bone marrow suppression
  • Easily bruised
  • Anemia
  • Fatigue
57
Q

What is SLE

A

Systemic Lupus Erythematosus

Auto-antibody production (i.e. body produces antibodies against its own cells and causes tissue damage)

58
Q

SLE has what type of cell activity

A

A lot of B cell activity

59
Q

SLE treatment

A

mild-moderate (no major organ manifestations):

  • NSAIDs (arthritis, arthralgia, fever)
  • Steroids (inflammation)
  • Antimalarials
  • Hydroxychloroquine (Plaquenil)
  • Immunosuppressants

severe (major organ manifestations):

  • High-dose steroids
  • Immunosuppressants
60
Q

Rehab concerns for SLE drugs

A

Immunosuppression
Infection control!!
Photosensitivity
Bacterial infections

DPT (8 decks)

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