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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
Which meds should be avoided in opioid consitpation?
Avoid the bulking agents or fiber laxatives because these will worsen the constipation if the motility issue is not addressed with sennosides.
26
Myoclonus d/t opioid tx?
lorazepam and fluids
27
Morphine and codeine often cause this SE?
Pruritus can be encountered with all opiates, but especially morphine and codeine - NOT an allergic response
28
Which meds are used to tx opioid associated nausea?
promethazine, prochlorperazine, metoclopramide, or even low-dose haloperidol are the drugs of choice
29
Which opioid should be avoided d/t a high incidence of neurotoxicity/seizures, premature death?
Avoid meperidine
30
In which cases can meperidine be used?
Shivering/ rigors
31
Full Agonist Opiate Analgesics examples
Morphine and its derivatives
32
Full Agonist Opiate Analgesics MOA
Have activity at pre- and postsynaptic mu receptors
33
Full Agonist Opiate Analgesics MOA
Have activity at pre- and postsynaptic mu receptors
34
Which opiate is NOT absorbed orally?
fentanyl is not usually given orally
35
Opiate Equianalgesic Tables
Used to convert one opioid to another
36
Full Agonist Opiate Analgesics
hydromorphone morphine meperidine methadone codeine hydrocodone oxycodone fentanyl oxymorphone
37
Opioid naiive pts who take fentanyl at an increased risk of what?
Resp. depression
38
Full Agonist Opiate Analgesics SE
Decreased BP, pruritus Constipation, Urine retention Sedation, facial flushing, somnolence, dizziness respiratory depression
39
Full Agonist Opiate Analgesics can cause further resp. depression when combined with this med?
Benzos
40
When using methadone or buprenorphine which meds should be avoided d/t interaction?
Meds causing QT prolongation
41
If at increased risk of OD w/ opiates, what should pts be offered?
A Naloxone kit
42
Mixed/Partial Agonist Analgesics examples
buprenorphine nalbuphine butorphanol
43
Buprenorphine MOA
Partial mu agonist and weak kappa antagonist activity
44
Nalbuphine MOA
Agonist of kappa opiate receptors and partial antagonist of mu opiate receptors in the CNS
45
Nalbuphine common SE
Higher rate of hallucinations, nightmares, and anxiety compared to other opioids
46
Why is Buprenorphine used as an alternative to methadone?
Hard to abuse because of its agonist and antagonist action
47
Butorphanol MOA
Agonist of kappa opiate receptors and partial agonist of mu opiate receptors in the CNS
48
What must be monitored in pts who are given a opiate antagonist?
Patients must have respiratory rate, rhythm, and depth; pulse and ECG blood pressure; and level of consciousness monitored after initiation of antagonist
49
Signs of opioid withdrawal
vomiting, restlessness, abdominal cramps, increased BP, increased temperature
50
Opioid antagonist examples
Naloxone (Narcan) Methylnaltrexone (Relistor) Nalmefene (Revex) and naltrexone (ReVia, Trexan)
51
Naloxone use
To rapidly reverse effects of opiates, especially respiratory depression
52
Naloxone dosing
The typical dose is 0.4 mg IV/IM, or 4mg intranasally
53
Naloxone MOA
Pure opioid antagonist that competes and displaces opioids at opioid receptor sites
54
Why is Naloxone not given PO?
Very poor absorption from the GI tract.
55
Naloxone SE
Severe opiate withdrawal
56
In which pts would you use Naloxone with caution?
Use cautiously in female patients who are pregnant because it may cause withdrawal symptoms in both mother and fetus
57
Methylnaltrexone use
Treatment of opioid- induced constipation that is not responsive to normal tx
58
Methylnaltrexone MOA
Peripherally acting mu-opioid receptor antagonist without affecting opioid effects and analgesia in the brain
59
Methylnaltrexone SE
Abdominal pain, flatulence, nausea hyperhidrosis
60
Methylnaltrexone contraindicated use
In patients with known or suspected mechanical GI obstruction.
61
Why is Methylnaltrexone used as a last resort for constipation?
Expensive
62
Naltrexone use
Used for alcohol and opioid use disorder
63
Naltrexone compared to naloxone
3-5 times as potent as naloxone (Narcan) with excellent oral bioavailability
64
Nalmefene use
Used in the treatment of alcohol dependence
65
Tramadol MOA
Binds to mu-opioid receptors in the CNS causing inhibition of ascending pain pathways and inhibits the reuptake of serotonin
66
What schedule is Tramadol?
4
67
Tramadol SE
Flushing, pruritis constipation, xerostomia Dizziness (usually transient), headache
68
Tramadol use
Analgesia of moderate to moderately severe pain It may have a particular niche in treating neuropathic pain
69
Tramadol interactions
SSRIs can lead to serotonin syndrome Antagonized by ondansetron
70
Why is tramadol contraindicated in pts w/ sz?
Lowers threshold
71
Ziconotide MOA
Selective N-type voltage-gated calcium channel blocker used to inhibit the release of pro-nociceptive neurochemicals
72
How is Ziconotide given?
intrathecally
73
Ziconotide use
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
What schedule is Ziconotide?
None - not a controlled substance
74
What schedule is Ziconotide?
None - not a controlled substance
75
Ziconotide SE
Peripheral edema Abnormal vision Nausea, constipation Dizziness, memory problems
76
Ziconotide contraindications
In people with a history of psychosis, schizophrenia, clinical depression, bipolar disorder, and seizures
77
What should be monitored in pts who are on a pump w/ Ziconotide?
Watch for signs of meningitis
78
Tapentadol MOA
Centrally-acting synthetic analgesic believed to exert its analgesic activity by binding to mu-opioid receptors
79
Tapentadol schedule
2

Pharm 2 Exam 2 (8 decks)

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