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Internal Medicine Test 3 > pain management > Flashcards

pain management Flashcards

1
Q

what are the 3 distinct families of endogenous opioid peptides

A

endorphins
enkephalins
dynorphins

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2
Q

what are common side effects of Mu receptor activation

A

sedation and respiratory depression

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3
Q

antagonists don’t produce ____

A

analgesia

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4
Q

antagonists are primarily used to treat….

A

opioid overdoses
addiction

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5
Q

what is the primary agent used to treat opioid overdose

A

naloxone

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6
Q

strong agonists are used to treat…

A

severe pain

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7
Q

morphine is an example of

A

strong agonist

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8
Q

mild-to-moderate agonists are used to treat….

A

moderate pain

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9
Q

codeine, hydrocodone and oxycodone are what type of agonsit

A

mild-to-moderate

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10
Q

mixed agonist-antagonists strength

A

less risk of side effects with Mu receptors

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11
Q

mixed agonist-antagonist weaknesses

A

may produce psychotropic effects
maximal analgesic effect may not be as strong

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12
Q

spinal effects/mechanism of opioids

A

inhibits both presynaptic and postsynaptic membranes of pain-mediating synapses by “trapping” neurotransmitters

(basically is able to stop neurons from communicating to each other that there is pain)

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13
Q

opioid receptors are linked via _________ to signaling pathways

A

G proteins

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14
Q

supraspinal effects/mechanism of opioids

A

opioids bind to the midbrain’s gray matter (PAG) and sends signals down a pathway to the pain sight to slow the pain signals

(basically decreases pain by stopping the pain signals to the brain)

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15
Q

increased activity of descending pathways travel through the ventromedial medulla (VMM) to reach the ______

A

dorsal horn of the spinal cord

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16
Q

neurons in descending pathways release _____ and _____ onto _______ to inhibit pain impulses to the brain

A

serotonin
norepinephrine
dorsal horn synapses

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17
Q

orthostatic hypotension

A

when you get up too fast and get dizzy

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18
Q

2 mechanisms of opioid tolerance

A
  1. receptor down-regulation
  2. loss of communication between opioid receptors and G proteins
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19
Q

when do withdrawal symptoms become evident, when is the peak, and how long do they last for?

A

evident: 6-10 hours
peak: day 2-3
last for: 5 days

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20
Q

some symptoms of physical dependence to pain medicine include

A

body aches
diarrhea
fever
insomnia
irritability
stomach cramps
vomiting/nausea

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21
Q

opioid-induced hyperalgesia

A

failure to respond to opioids
could increase pain sensitivity

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22
Q

methadone function

A

offers milder withdrawal symptoms

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23
Q

peripheral effects/mechanism of opioids

A

the exogenous opioids assist the endogenous peptides in stopping the transmission of pain

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24
Q

2 types of corticosteroids

A
  1. glucocorticoids (cortisol)
  2. mineralocorticoids (aldosterone)
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25
Q

what corticosteroid affects carbohydrate and protein metabolism

A

glucocorticoids (cortisol)

26
Q

what corticosteroid regulates electrolyte and water metabolism

A

mineralocorticoids (aldosterone)

27
Q

glucocorticoids __(increase/decrease)___ blood glucose and liver glycogen

A

increase

28
Q

glucocorticoids act on macrophages, lymphocytes, and endothelial cells to inhibit the expression of __________

A

inflammatory proteins (cytokines)

29
Q

how do glucocorticoids reduce inflammation

A
  1. inhibits inflammatory proteins (cytokines)
  2. reduces lymphocytes and eosinophils
  3. inhibits adhesion molecules so leukocytes can’t promote inflammation
  4. reduces vascular permeability by suppressing histamine and kinins
30
Q

in order to reduce vascular permeability, ____ and ___ must be produced (think endogenous)

A

histamine and kinins

31
Q

what are the main functions of glucocorticoid medications

A

decrease inflammation
immunosuppression
replacement for adrenal insufficiency

32
Q

the main adverse symptom of prolonged corticosteroids in the ENDOCRINE system

A

hyperglycemia

33
Q

the main adverse symptom of prolonged corticosteroids in the CARDIOVASCULAR system

A

fluid retention/edema

34
Q

the main adverse symptoms of prolonged corticosteroids in the IMMUNE system

A

increase risk of infections
activates latent viruses
masks infection

35
Q

the main adverse symptoms of prolonged corticosteroids in the MUSCULOSKELETAL system

A

osteoporosis
bone fractures

36
Q

the main adverse symptoms of prolonged corticosteroids in the GASTROINTESTINAL system

A

peptic ulcers
GI bleeding
gastritis
nausea

37
Q

the main adverse symptoms of prolonged corticosteroids in the NERVOUS system

A

insomnia
mood changes

38
Q

-prazole

A

proton pump inhibitor

helps with gastric ulcers

39
Q

-idine

A

histamine H2-receptor blockers

helps with gastric ulcers

40
Q

-amide

A

oral antidiabetics (sulfonylurea group)

helps with type 2 diabetes (antidiabetics)

41
Q

-dronate

A

bisphosphonates

helps with osteoporosis

42
Q

what is the first step of the eicosanoid biosynthesis and then what are the 2 pathway options

A

arachidonic acid is released then either goes the LOX or COX pathway

43
Q

prostaglandin

A

a group of lipid-like compounds that are produced by all living cells (except RBCs)

44
Q

leukotriene

A

pro-inflammatory and mediates airway inflammation

45
Q

increased PGE2 causes

A

inflammation

46
Q

how do eicosanoids promote fever

A

altering thermo-regulatory set-point

47
Q

dysmenorrhea

A

painful cramps that accompany menstruation

48
Q

eicosanoids cause

A

pain
fever
dysmenorrhea
thrombus formation
inflammation

49
Q

how do eicosanoids cause thrombus formation

A

TXA2 causes platelet aggregations that result in the blood clot formations

50
Q

what do aspirin and other NSAIDs inhibit

A

Cyclooxygenase (COX)

51
Q

what does it mean to say that aspirin is a nonselective inhibitor? Why is this a bad thing?

A

it means that aspirin inhibits COX1 and COX2

This is bad because COX1 helps platelet function and gastric protection

52
Q

COX1 function

A

gastric protection
platelet function

53
Q

COX2 function

A

pain
fever
bone formation

54
Q

what is aspirin good at preventing

A

pain/inflammation
fever
vascular disorders
cancer prevention

55
Q

what is the primary NSAID used in treating fever in adults

A

aspirin

56
Q

2 main adverse effects of aspirin-like drugs

A
  1. gastrointestinal problems
  2. cardiovascular problems
57
Q

aspirin is linked to causing _______ in children

A

reye syndrome

58
Q

benefit of COX-2 selective drugs

A

because COX1 is untouched, the chance of gastric irritation is much lower

59
Q

what does NSAID stand for

A

Nonsteroidal anti-inflammatory drugs

60
Q

which COX drug (1 or 2) may increase the risk of serious cardiovascular events like heart attack/stroke

A

COX-2

61
Q

is acetaminophen an NSAID drug? why or why not?

A

no because it lacks anti-inflammatory and anti-coagulant properties

62
Q

what is the main contraindication to taking acetaminophen

A

people who have pre-existing liver disease (or are alcohol abusers)

acetaminophen is filtered through the liver and can be especially toxic in these individuals

Internal Medicine Test 3 (5 decks)

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