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Pharmacology > Pain Management > Flashcards

Pain Management Flashcards

1
Q

What are the types of pain

A

Nociceptive pain
Inflammatory pain
Neuropathic pain
Functional pain

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2
Q

What is Nociceptive pain

A

Pain in response to noxious stimulus

- can be somatic or visceral

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3
Q

What is Inflammatory pain

A

when tissue damage occurs despite the nociceptive defense system..inflammatory pain ensues.

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4
Q

What is Neuropathic pain

A

Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system rather than stimulation of pain receptors.

  • TRAMADOL
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5
Q

What is Functional Pain

A

Pain due to abnormal processing or function of the central nervous system in response to normal stimuli

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6
Q

which types of pain can be involved in Acute pain

A

Acute pain is usually nociceptive but can also be neuropathic.

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7
Q

which types of pain can be involved in Chronic Pain

A 
may be:
nociceptive 
inflammatory
neuropathic  
or functional
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8
Q

Chronic malignant pain is associated with kind of diseases?

A

Associated with progressive disease like cancer of AIDs

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9
Q

Chronic Non-malignant pain is not associated with?

A

Pain not associated with a life threatening disease and lasting longer than 6 months beyond the healing period.

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10
Q

What medication should be given for mild to moderate pain

A

Acetamiophen and NSAIDs are effective for mild to moderate pain.
- Non-opioids do not cause physical dependence or tolerance.

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11
Q

What is the first line choice for lower back pain and osteoarthritis and is often selected as intial therapy for mild to moderate pain?

A

Acetaminophen

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12
Q

opioids for mild-moderate pain:

A 
codeine
hydrocodone
oxycodon
Meperidin 
Tramadol (neuropathic pain)
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13
Q

Opioids for mild to severe pain:

A 
Morphine
Hydromorphone
Oxymorphone
Levorphanol
Fentanyl
Sufentanil
Methadone
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14
Q

Breakthrough pain
how is it alleviated?
what are the formulation for the analgesic?

A

Transitory severe acute pain that occura on a background of chronic pain that is adequately controlled by an opioid regimen
- targeted with a transmucosal Fentanyl formulation

6 formulation are available in the US:

  • Oral transumucosal lozenge
  • Immediate-release transmucosal tablet
  • Effervescent buccal tablet
  • Bucaal solubke film
  • Nasal spray
  • sublingual spray
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15
Q

Mixed agonist-antagonists all have what kind of effect?

are they a good for patients with severe pain?

A 
Mixed agonist-antagonist:
- Pentazocine
- butorphanol
- Nalbuphine
and buprenorphine

all have Ceiling effect
Bad choice

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16
Q

Normeperidine (metabolite) AE:

A 
t1/2=15-20hrs 
"No MSD"
Dysphoria
Myoclonus 
Seizures
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17
Q

Mixed agonist-antagonists adverse effects:
Pentazocine
nalbuphine
butorphanol

A

psychotomimetic adverse effects ( k agonists)

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18
Q

Most common opioid adverse effects:

A

Pruritis
Constipation
Nausea/Vomiting
Sedation

19
Q

opioid induced Pruritis managed by

A

hydroxyzine or

diphenhydramine

20
Q

opioid inuduced nausea and vomiting managed by

A

hydroxyzine
metoclopramide
prochlorperazine

21
Q

Persisitent opioid SEDATION that limits activity should be managed by?

A

Methylphenidate

modafinil

22
Q

if opioid use compromises respiration use:

A

Naloxone

23
Q

Analgesic adjunctive agents (Coanalgesics)

A

Antidepressants
Anticonvulsants
Glucocorticoids

24
Q

Tricyclic Antidepressants

A

tertiary amines: (TAI is a Turd)
Amitriptyline
Imipramine

Secondary amines: fewer side effects. Desired in elderly.
Desipramine
Nortriptyline

25
Q

Tricyclic antidepressants: AE

A 
constipation
dry mouth
blurred vision
cognitive changes
tachycardia
urinary hesitation
rare AE:
Sexual dysfunction
orthostatic hypotension
weight gain
sedation
26
Q

Tricyclic antidepressants should be administered cautiously in patients with:

A

Angle-closure glaucoma (due to blurry vision)
BPH
Urinary retention (because of urinary hesitation)
Constipation
CV disease (due to tachycardia)
impaired Liver function

27
Q

TCA: Amitriptyline, Imipramine, Desipramine, Nortriptyline

should be avoided in patients with:

A 
Second or third degree heart block
Arrhythmias
Prolonged QT Interval
Severe Liver disease
Recent acute MI
28
Q

Serotonin and Norepinephrine Reuptake inhibitors (SNRIs)

A

Venflaxaxine and Duleoxetine:

  • SNRIs selectively inhibit reuptake of serotonin and norepinephrine.
  • SNRIs lack the antihistamine; a-adrenergic blocking and anticholinergic effects of TCAs (Amitriptyline, Imipramine, Desipramine, Nortriptyline).
29
Q

What kind of pain are Venflafaxine and Duloxetine effective for:

A

Neuropathic pain

30
Q

SNRIs AE:
which are better tolerated between SNRIs (Venlfafaxine and Duloxetine) and TCAs (Amitriptyline, Imipramine, Desipramine, Nortriptyline)?

A

Nausea
sexualdysfunction
somnolence
SNRIs are better tolerated than TCAs.

31
Q

Anticonvulsants

A

Gabepentin and Pregabalin

Carbamazepine

32
Q

Gabepentin and Pregabalin
MOA?
AE?

A

Block voltage gated calcium channels leading to reduction of the influx of calcium into neurons decreasing release of glutamate norepinephrine and substance P.

AE:
dizziness
solmnolence
peripheral edema

33
Q

DOC for trigeminal Neuralgia

MOA?

A

Carbamazepine

  • Voltage-gated sodium channels in sensory neurons play a crucial role in neuropathic pain
  • Carbamazepine blocks voltage gated sodium channels.
34
Q

Carbamazapine AE:

A 
Drowsiness 
dizziness
nausea
vomiting
Carbamazepine-induced leukopenia is not uncommon
Aplastic anemia is a rare side effet
35
Q

Glucocorticoids

DOC

A

commonly used in advanced illness

  • useful for acute nerve compression; increased intracranial pressure; Bone pain; viseral pain; anorexia; nausea and depressed mood
  • Dexamethasone is the DOC
  • Prednisone and methylprednisolone can also be used.
36
Q

Glucocorticoids indications

A

Improve appetite; nausea; malaise and overal quality of life.

37
Q

Hydroxyzine adds to what kind of effect?

A

May add to the analgesic effect of opioids

38
Q

Clonidine can be administered in what forms?

A

Available as oral or transdermal patch formulations. May improve pain and hyperalgesia in sympathetically maintained pain.

39
Q

Lidocaine Patch or capsaicin patch

A

are approved for postherpetic neuralgia

40
Q

Caffeine can enhance analgesic effect of

A

Acetaminophen and NSAIDs.

41
Q

OPOID management of adverse effects:
Pruritus
Due to histamine release from mast cells Can be managed

A

with hydroxyzine or diphenhydramine.

42
Q

OPOID management of adverse effects:

Nausea/vomiting managed by?

A

It can be treated with hydroxyzine, metoclopramide or prochlorperazine.

43
Q

ANTIDEPRESSANTS AND ANTICONVULSANTS

A

Mainstay of treatment for several neuropathic pain syndromes

44
Q

ANTIDEPRESSANTS MOA of serotonin and norepinephrine?

A
  • Serotonin and norepinephrine mediate descending inhibition of ascending pain pathways in the brain and spinal cord
  • Antidepressants that enhance both serotonergic and noradrenergic transmission display significant analgesic effects
    • Tricyclic antidepressants (TCAs)
    •Serotonin and norepinephrine reuptake inhibitors (SNRIs).

Pharmacology (27 decks)

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