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Pharm 2 Exam 2 > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Nociception

A

the process of pain perception and transmission

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2
Q

What kind of pain is acute pain?

A

nociceptive pain -> pain that follows the usual pain sensory pathways

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3
Q

Acute pain is caused by?

A

result of actual or pending tissue damage

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4
Q

How long does chronic pain last?

A

lasts for at least 3-6 months

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5
Q

Adjuvant Medications

A

Medications that may be used in the management of pain but whose primary indication is not for analgesia

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6
Q

Examples of Adjuvant Medications

A

tricyclic antidepressants, anticonvulsants, corticosteroids, anesthetics (ketamine), bisphosphonates, muscle relaxants, antiarrhythmics (lidocaine)

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7
Q

When are Adjuvant Medications typically used?

A

Tx chronic pain

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8
Q

Opiates

A

Natural drugs derived from alkaloids of opium or are synthetic derivatives of these alkaloids

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9
Q

Non-opiates

A

Synthetic drugs that alleviate pain / inflammation (NSAIDs)

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10
Q

Opiate receptors?

A

Mu (most targeted in the CNS), Delta, Kappa

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11
Q

Mu receptors can affect pain and?

A

respiratory depression, decreased HR, euphoria, and physical dependence

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12
Q

Naturally occurring opium alkaloids

A

morphine
codeine
oxycodone
hydromorphone
hydrocodone

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13
Q

Synthetic agents

A

meperidine
fentanyl
methadone

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14
Q

Mu agonist-antagonist/ mixed

A

butorphanol
nalbuphine
buprenorphine
methylnaltrexone
naltrexone
nalmefene

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15
Q

Opioid naïve

A

Patients not chronically receiving opioids on a daily basis

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16
Q

Opioid tolerant

A

Patients who have been taking, for a week or longer, at least 60mg of morphine equivalents daily

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17
Q

Which opioid should NOT be prescribed in pts who are opioid naiive pts?

A

Due to its potency, fentanyl should not be prescribed to opioid naïve patients.

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18
Q

What is a major safety hazard in opioid dosing?

A

no ceiling dose

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19
Q

Best way to schedule opioids in chronic pain?

A

Schedule medications around the clock

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20
Q

Breakthrough pain

A

pain that comes on suddenly, lasts for 3-30 minutes, and can occur at any time

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21
Q

How is breakthrough pain tx?

A

Supplemental opioid medication (10-15% of the daily dose) is warranted; may be added to the original regimen and given every 2 hours as needed.

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22
Q

How is incidental pain tx?

A

calculation is the same as for breakthrough pain (10-15% of daily dosage), but is administered 1 hour before the regular dose is scheduled if it is by mouth or 10-15 minutes before the regular IV dose

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23
Q

Main SE of opiates?

A

Constipation is the main side effect

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24
Q

Opioid constipation tx?

A

daily stimulants such as sennosides + prunes
Avoid chronic bisacodyl because it can damage myenteric plexus

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25
Q

Which meds should be avoided in opioid consitpation?

A

Avoid the bulking agents or fiber laxatives because these will worsen the constipation if the motility issue is not addressed with sennosides.

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26
Q

Myoclonus d/t opioid tx?

A

lorazepam and fluids

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27
Q

Morphine and codeine often cause this SE?

A

Pruritus can be encountered with all opiates, but especially morphine and codeine - NOT an allergic response

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28
Q

Which meds are used to tx opioid associated nausea?

A

promethazine, prochlorperazine, metoclopramide, or even low-dose haloperidol are the drugs of choice

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29
Q

Which opioid should be avoided d/t a high incidence of neurotoxicity/seizures, premature death?

A

Avoid meperidine

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30
Q

In which cases can meperidine be used?

A

Shivering/ rigors

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31
Q

Full Agonist Opiate Analgesics examples

A

Morphine and its derivatives

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32
Q

Full Agonist Opiate Analgesics MOA

A

Have activity at pre- and postsynaptic mu receptors

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33
Q

Full Agonist Opiate Analgesics MOA

A

Have activity at pre- and postsynaptic mu receptors

34
Q

Which opiate is NOT absorbed orally?

A

fentanyl is not usually given orally

35
Q

Opiate Equianalgesic Tables

A

Used to convert one opioid to another

36
Q

Full Agonist Opiate Analgesics

A

hydromorphone
morphine
meperidine
methadone
codeine
hydrocodone
oxycodone
fentanyl
oxymorphone

37
Q

Opioid naiive pts who take fentanyl at an increased risk of what?

A

Resp. depression

38
Q

Full Agonist Opiate Analgesics SE

A

Decreased BP, pruritus
Constipation, Urine retention
Sedation, facial flushing, somnolence, dizziness
respiratory depression

39
Q

Full Agonist Opiate Analgesics can cause further resp. depression when combined with this med?

A

Benzos

40
Q

When using methadone or buprenorphine which meds should be avoided d/t interaction?

A

Meds causing QT prolongation

41
Q

If at increased risk of OD w/ opiates, what should pts be offered?

A

A Naloxone kit

42
Q

Mixed/Partial Agonist Analgesics examples

A

buprenorphine
nalbuphine
butorphanol

43
Q

Buprenorphine MOA

A

Partial mu agonist and weak kappa antagonist activity

44
Q

Nalbuphine MOA

A

Agonist of kappa opiate receptors and partial antagonist of mu opiate receptors in the CNS

45
Q

Nalbuphine common SE

A

Higher rate of hallucinations, nightmares, and anxiety compared to other opioids

46
Q

Why is Buprenorphine used as an alternative to methadone?

A

Hard to abuse because of its agonist and antagonist action

47
Q

Butorphanol MOA

A

Agonist of kappa opiate receptors and partial agonist of mu opiate receptors in the CNS

48
Q

What must be monitored in pts who are given a opiate antagonist?

A

Patients must have respiratory rate, rhythm, and depth; pulse and ECG blood pressure; and level of consciousness monitored after initiation of antagonist

49
Q

Signs of opioid withdrawal

A

vomiting, restlessness, abdominal cramps, increased BP, increased temperature

50
Q

Opioid antagonist examples

A

Naloxone (Narcan)
Methylnaltrexone (Relistor)
Nalmefene (Revex) and naltrexone (ReVia, Trexan)

51
Q

Naloxone use

A

To rapidly reverse effects of opiates, especially respiratory depression

52
Q

Naloxone dosing

A

The typical dose is 0.4 mg IV/IM, or 4mg intranasally

53
Q

Naloxone MOA

A

Pure opioid antagonist that competes and displaces opioids at opioid receptor sites

54
Q

Why is Naloxone not given PO?

A

Very poor absorption from the GI tract.

55
Q

Naloxone SE

A

Severe opiate withdrawal

56
Q

In which pts would you use Naloxone with caution?

A

Use cautiously in female patients who are pregnant because it may cause withdrawal symptoms in both mother and fetus

57
Q

Methylnaltrexone use

A

Treatment of opioid- induced constipation that is not responsive to normal tx

58
Q

Methylnaltrexone MOA

A

Peripherally acting mu-opioid receptor antagonist without affecting opioid effects and analgesia in the brain

59
Q

Methylnaltrexone SE

A

Abdominal pain, flatulence, nausea
hyperhidrosis

60
Q

Methylnaltrexone contraindicated use

A

In patients with known or suspected mechanical GI obstruction.

61
Q

Why is Methylnaltrexone used as a last resort for constipation?

A

Expensive

62
Q

Naltrexone use

A

Used for alcohol and opioid use disorder

63
Q

Naltrexone compared to naloxone

A

3-5 times as potent as naloxone (Narcan) with excellent oral bioavailability

64
Q

Nalmefene use

A

Used in the treatment of alcohol dependence

65
Q

Tramadol MOA

A

Binds to mu-opioid receptors in the CNS causing inhibition of ascending pain pathways and inhibits the reuptake of serotonin

66
Q

What schedule is Tramadol?

A

4

67
Q

Tramadol SE

A

Flushing, pruritis
constipation, xerostomia
Dizziness (usually transient), headache

68
Q

Tramadol use

A

Analgesia of moderate to moderately severe pain
It may have a particular niche in treating neuropathic pain

69
Q

Tramadol interactions

A

SSRIs can lead to serotonin syndrome
Antagonized by ondansetron

70
Q

Why is tramadol contraindicated in pts w/ sz?

A

Lowers threshold

71
Q

Ziconotide MOA

A

Selective N-type voltage-gated calcium channel blocker used to inhibit the release of pro-nociceptive neurochemicals

72
Q

How is Ziconotide given?

A

intrathecally

73
Q

Ziconotide use

A

Appropriate only for management of severe chronic pain in patients for whom IT therapy is warranted and who are intolerant of or refractory to other treatment

74
Q

What schedule is Ziconotide?

A

None - not a controlled substance

74
Q

What schedule is Ziconotide?

A

None - not a controlled substance

75
Q

Ziconotide SE

A

Peripheral edema
Abnormal vision
Nausea, constipation
Dizziness, memory problems

76
Q

Ziconotide contraindications

A

In people with a history of psychosis, schizophrenia, clinical depression, bipolar disorder, and seizures

77
Q

What should be monitored in pts who are on a pump w/ Ziconotide?

A

Watch for signs of meningitis

78
Q

Tapentadol MOA

A

Centrally-acting synthetic analgesic believed to exert its analgesic activity by binding to mu-opioid receptors

79
Q

Tapentadol schedule

A

2

Pharm 2 Exam 2 (8 decks)

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