Pain Management Flashcards
what are the non opioid analgesics and its use
Acetaminophen
NSAIDs
mild to moderate pain
adverse effect of acetaminophen and what increases this adverse effect
hepatotoxicity
increased by hepatitis or chronic alcohol use, binge drink, fasting state
opioids for mild to moderate pain
HOT MC
Hydrocodone
Oxycodone
Tramadol
Meperidine
Codeine
opioids for moderate to severe pain
Morphine, Hydromophone, Oxymorphone Levorphanol Fentanyl Sufentanil Methadone
what are the opioid analgesics that do not have a ceiling effect (dose beyond which there is no more analgesic effect)
Morphine
Fentanyl
Hydromorphone
what opioids are not used for routine dosing
- Meperidine - its metabolite normerpidine has longer half life and when it accumulates –> tremulousness, dysphoria, myoclonus, seizures
- Mixed agonist-antagonists: Pentazocine, Nalbuphne, Butorphanol –> ceiling effect and can lead to psychotomimetic effects
When do you not give a mixed agonist-antagonist and why
when patients is on a pure opioid agonist because it reduces its effect
most common side effects seen in usage of opioid analgesic
nausea vomiting sedation itching constipation
what drugs can be used to treat rash and pruritus seen as adverse effects of opioids
hydroxyzine
diphenhydramine
what drugs can be used to treat constipation seen in opioids
- stimulants like senna or bisacodyl
- osmotic agents like magnesium hydroxide and lactulose
- softeners like docusate are not useful on their own but can be if used with a stimulant
drugs that can be used to treat nausea and vomiting seen as adverse effects of opioids
Prochlorperazine
Hydroxyzine
Metoclopromaide
drugs used to treat sedation seen as adverse effect of opioids
amphetamine
methylphenidate
modanifil
if respiratory depression occurs due to opioid use, what drug can be used
naloxone
big class names for co-analgesics aka analgesic adjuvant that are not necessarily classified as analgesics
Antidepressives
Anticonvulsants
Glucocorticoids
Other drugs
why are antidepressants used as analgesics
they increase circulating serotonin and norepinephrine (via SNRI and TCAs) which mediate descending inhibition of ascending pain pathways in brain and spinal cord
what are the TCA antidepressants
DANI
Desipramine
Amitriptyline
Nortriptyline
Imipramine
how do TCAs cause analgesia
they inhibit the reuptake of serotonin and norepinephrine thus enhancing the actions of these neurotransmitters
adverse effects of TCA
-associated with anticholinergic effects: constipation, dry mouth, blurred vision, cognitive changes, tachycardia, urinary retention
which TCAs are better used for the elderly
the secondary amines Desipramine and Nortriptyline because they exhibit fewer sedative and anticholinergic effects in comparison to tertiary amines Amitriptyline and Imipramine
also cause sexual dysfunction, orthostatic hypotension, weight gain
contraindications for TCAs
angle closure glaucoma, BPH, constipation, CVD, heart conditions like arrhythmias, Impaired liver function
what are the SNRIs and how do they differ from TCAs
Venlafaxine and Duloxetine
lack the anticholinergic, antihistamine, alpha adrenergic blocking effects of TCA
what are the adverse effects of SNRIs
better tolerated than TCAs
somnolence, nausea, sexual dysfunction
what are the anticonvulsants
CPG
Carbamazepine
Pregabalin
Gabapentin
mechanism of Pregabalin and Gabapentin
block voltage gated calcium channels –> reduces influx of calcium into neurons –> decrease release of glutamate, NE, and substance P
adverse effects of Pregabalin and Gabapentin
dizziness
somnolence
peripheral edema
what is pregabalin and gabapentin used to treat
postherpetic neuralgia
drug of choice for trigeminal neuralgia
carbamazepine
mechanism of carbamazepine
blockage of voltage gated sodium channels
adverse effects of carbamazepine
drowsiness, nausea, vomiting, dizziness
carbamazepine induced leukopenia
Aplastic Anemia
Glucocorticoids used as co-analgesic
Dexamethasone***
Prednisone and Methylprednisolone
why is dexamethasone usually the drug of choice for use of glucocorticoids as an analgesic
it has long half life with minimal mineralcorticoid effect
drug that enhances the analgesic effect of acetaminophen and NSAIDs
caffeine
drug approved for postherpetic neuralgia
Lidocaine
Capsaicin
anticonvulsants: Pregabalin and Gabapentin
improves pain and hyperalgesia in sympathetically maintained pain
clonidine
