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Pharm II Exam 3 (Cholley) > Pain Management (KEY POINTS) > Flashcards

Pain Management (KEY POINTS) Flashcards

1
Q

Describe somatic pain

A

Arises from skin, bone, joint, muscle, or CT

Throbbing, well localized

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2
Q

Describe visceral pain

A

Arises from internal organs s/a intestine or pancreas

Localized or referred pain

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3
Q

What are the free nerve endings (nociceptors) stimulated by?

A

Mechanical, thermal, & chemical impulses

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4
Q

What fibers = large diameter? What do they evoke?

A

Myelinated Aδ fibers

Sharp, well-localized pain

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5
Q

What fibers = small diameter? What do they evoke?

A

Unmyelinated C fibers

Dull, aching, poorly localized pain

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6
Q

How is pain modulated by the body?

A

Endogenous opiate system

Blockage of N-methyl-D-aspartate (NMDA) receptors

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7
Q

The endogenous opiate system contains what receptors?

A

μ, δ, and κ

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8
Q

The CNS also contains a highly organized…

A

descending system for control of pain transmission.

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9
Q

What NTs in the CNS are involved in pain control?

A

Endogenous opioids
Serotonin
NE
GABA

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10
Q

What functions can modify pain?

A

Cognitive & behavioral

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11
Q

What type of changes in our neurobiochemical makeup can worsen pain?

A

Depression & anxiety

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12
Q

What is inflammatory pain?

A

The body shifting from: preventing tissue damage –> promotion of healing

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13
Q

What does the inflammatory process lead to?

A

Reduced pain threshold

Injured area becomes more sensitive to pain

Decreased movement

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14
Q

What is inflammatory pain associated with?

A

Increase in excitability or responsiveness of neurons within the CNS (central sensitization)

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15
Q

What are major causes of hypersensitivity to pain after injury?

A

Peripheral & central sensitization

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16
Q

Neuropathic pain is a result of…

A

nerve damage

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17
Q

What can be thought of as an abnormal operation of the nervous system?

A

Functional pain

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18
Q

How is neuropathic & functional pain described?

A

Burning, tingling, shock-like, shooting

Hyperalgesia (painful response to noxious stimuli)

Allodynia (painful response to normally nonnoxious stimuli)

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19
Q

Which type of pain often manifests long after the actual nerve-related injury or when no actual injury is identified?

A

Neuropathic & functional pain

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20
Q

What are non-pharm therapies in acute & chronic pain?

A 
Physical manipulation
Heat or cold
Massage 
Exercise 
TENS
Cognitive, behavioral, social
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21
Q

What is the tx goal in acute vs chronic pain?

A

Acute = pain reduction

Chronic = functionality

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22
Q

What are sx of acute pain?

A

Sharp, dull, shock-like, tingling, shooting, radiating

Flunctuates in intensity, varies in location

Occurs in a timely relationship w/ a noxious stimuli

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23
Q

Describe chronic pain

A

Can appear to have no noticeable suffering

Attention to mental/emotional factors that alter the pain threshold

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24
Q

What are sx of chronic pain?

A

Sharp, dull, shock-like, tingling, shooting, radiating

Flunctuates in intensity, varies in location

Occurs w/out a temporal relationship w/ a noxious stimuli

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25
Q

What are non-opioid analgesics?

A

Salicylates: ASA,
Choline & Mg trisalicylate

Acetaminophen

Ibuprofen

Ketorolac (Pyrrolacetic acid)

Celecoxib (Cox2 selective)

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26
Q

What is the max daily dose of ibuprofen?

A

3200mg - inflammatory

1200mg - analgesic/fever/dysmenorrhea

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27
Q

How is ketorolac administered?

A

Parenterally

28
Q

In cardiac pts where low dose ASA is indicated, when should celecoxib be given?

A

After the ASA dose

29
Q

What are 2 ADEs of NSAIDs?

A

Upper GI bleed

Acute renal failure

30
Q

What should you monitor in pts taking NSAIDs?

A

CBC
Guaiac (if black tarry stools)

Serum creatinine

31
Q

What is an ADE of acetaminophen?

A

Hepatotoxicity

32
Q

What should you monitor in pts taking acetaminophen?

A

Transaminases (ALT/AST)

Liver tests (PT/INR, albumin)

Acetaminophen [ ]

33
Q

When are NSAIDs/acetaminophen/ASA used?

A

Mild-Mod pain

34
Q

What drugs are phenanthrenes?

A

Morphine
Hydro-morphone/codone
Oxy-morphone/codone
Codeine

35
Q

What are characteristics of both morphine and codeine?

A

Naturally occurring

Histamine release

36
Q

What is the drug of choice for severe pain?

A

Morphine

37
Q

When do you use codeine?

A

In mild-mod pain & cough suppression

38
Q

What does codeine depend on for metabolism to morphine?

A

CYP450 2D6

39
Q

When do you use hydrocodone & oxycodone?

A

Mod/severe pain

40
Q

What drugs are phenylpiperidines? (used in severe pain)

A

Meperidine (Demerol)

Fentanyl (Sublimaze, Duragesic, Actiq)

41
Q

What is a contraindication of meperidine?

A

Renal failure

42
Q

What are ADEs of meperidine?

A

Tremors, myoclonus, seizures

Mydriasis

43
Q

What is meperidine’s active metabolite?

A

Normeperidine

44
Q

When should you NOT use fentanyl transdermal?

A

Acute pain

45
Q

What drug is a diphenylheptane?

A

Methadone

46
Q

What drug causes QT prolongation?

A

Methadone

47
Q

Titrations of methadone should be avoided more frequently than…

A

every 2 wks

48
Q

What drugs are agonist-antagonist or partial agonists?

A

Pentazocine
Butorphanol
Nalbuphine
Buprenorphine (Butrans, Subutex)

49
Q

What are characteristics of buprenonorphine?

A

2nd line for mod-severe pain

Detailed dosing conversion

Must complete training to Rx

50
Q

Buprenorphine may precipitate…

A

withdrawal in opiate-dependent pts

51
Q

Is naloxone effective in reversing resp. depression?

A

May not be

52
Q

What are central analgesic?

A

Tramadol*

Tapentadol

53
Q

What are ADEs of opioids?

A

Resp. depression

Constipation

Sedation (decreases over time)

N/V (decreases over time)

54
Q

Who is at higher risk of developing resp. depression when taking opioids?

A

OSA

COPD

55
Q

What is an opioid antagonist?

A

Naloxone (Narcan)

56
Q

What is important to know about pregabalin (Lyrica) ?

A

Exerts antinociceptive & anticonvulsant activity

57
Q

What adjunctive therapies are available for chronic pain?

A

TCAs, SSRIs, SNRIs (topical)

Duloxetine (Cymbalta)

58
Q

What is the MOA of duloxetine?

A

Potent inhibitor of serotonin & norepinephrine reuptake

59
Q

What are NSAIDs & skeletal muscle relaxants recommended for?

A

Acute low back pain

60
Q

What are 1st line & 2nd line agents for chronic low back pain?

A 
1st = NSAIDs
2nd = Duloxetine & tramadol
61
Q

What is NOT recommended for tx of fibromyalgia?

A

Opioids!

62
Q

What drugs are rarely effective for neuropathic pain?

A

Acetaminophen & NSAIDs

63
Q

What is a true allergy? Give an examples.

A

IgE-mediated or T-cell mediated

Ex. bronchospasm

64
Q

Is angioedema a true allergy?

A

Usually, but pseudoallergy is also possible

65
Q

What is pseudoallergy? What causes it?

A

Common rxn to opioids

Histamine release, a nonimmunologic effect

66
Q

What are sx of pseudoallergy?

A

Itching, flushing, sweating

Pharm II Exam 3 (Cholley) (6 decks)

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