Pain Management Meds Flashcards

Question

Gabapentin & Pregabalin | ADRs

Answer 1

Gabapentin: The most common side effects are dizziness, somnolence, ataxia, peripheral edema, and confusion. Among other, more serious adverse effects are anaphylaxis, suicidality, depression, fever, infection, steven-Johnson syndrome, angioedema, erythema multiforme, and rhabdomyolysis. Pregabalin: Dizziness, somnolence, headache, peripheral edema, nausea, weight gain, disorientation, blurred vision, increased risk of suicidal thoughts

Answer 2

Hypersensitivity dose adjustment for pts with compromised RENAL FUNCTION Evaluate baseline creatinine levels before and during the treatment for patients under treatment for either gabapentin or pregabalin. Screen for depression, behavioral changes, and suicidality Gabapentin: Gabapentin does not carry the risk of overdose or addiction as other pain management medications (eg., opioids). However, gabapentin may increase a euphoric state caused by opioids. Pregabalin: The highest documented accidental overdose occurred during clinical research and was 8000 mg. No specific antidote.

Answer 3

* Effectively reduce or eliminate sensation * Can be administered topically, by local injection, or intrathecal infusion (e.g. epidural) * effective in treating acute pain(e.g., labor pain, post-surgical pain, trauma) * can be used to manage chronic pain(most often in combination with an opioid or NSAID) * intraoperative anesthesia (topical or epidural) (dental, ophthalmic, podiatry, abdominal, etc) * aid in minor procedures (topical) (blood draws, etc)

Answer 4

Esters & Amides

Answer 5

(ONE i) -degraded by plasma esterases * benzocaine * procaine * tetracaine * novacaine * cocaine

Answer 6

(TWO i's) - degraded by hepatic enzymes * Lidocaine, procaine * bupivacaine * mepivacaine * ropivacaine * dibucaine, lidocaine

Answer 7

* Lidocaine is among the most commonly used* FDA approved for postherpetic neuralgia and recommended for peripheral neuropathic pain * MOA : Lidocaine stabilizes the neuronal membrane by inhibiting sodium ion channels on the internal surface of nerve cell membranes. * Thus, pain conduction through nerve impulses becomes impaired at the site of action, which contributes to the absence of systemic effects * Presentations include skin patches, topical solutions, creams, gels, ointment, and lotions. * Adverse effects: Application-site pain, pruritus, erythema, and skin irritation * Contraindications: History of sensitivity. Application of lidocaine patches should only be to intact skin

Answer 8

Narrow therapeutic index Patients with severe hepatic impairment, under prolonged infusions, or with broken or inflamed skin should be monitored for increased plasma levels. Lidocaine toxicity usually presents at lidocaine blood concentrations above 5 mcg/mL. * Symptoms progress from slurred speech, tinnitus, paresthesias, and dizziness to loss of consciousness, seizures, cardiac arrhythmias, and cardiorespiratory arrest. * Management is supportive (oxygen, IV fluids, and inotropes) * If with refractory cardiovascular collapse, intravenous lipid emulsion is indicated

Answer 9

Most effective and widely used drugs in **treating severe pain. ** Have potential for **addiction, tolerance, and side effects. ** CDC guidelines recommends that only if the expected benefits for both pain and function outweigh the risks Clinicians should prescribe opioids at the **lowest effective dose and for the shortest expected duration **to treat the pain severe enough to require opioids Dosage forms to use for several routes of administration: oral, transdermal, intramuscular, intravenous, subcutaneous infusion, rectal, epidural, intrathecal, intranasal, and transmucosa

Answer 10

act on G protein-coupled receptors (3): kappa, delta, & sigma Mojority act primarly at "mu receptors" & are considered **"mu agonist" ** depending on receptor activated different physiologic effects occur exert effects on both presynaptic & postsynaptic neurons

Answer 11

block calcium channels on nociceptive afferent nerves, thus inhibiting the release of neurotransmitters such as substance P and glutamate.

Answer 12

enhance the activity of potassium channels, thus hyperpolarizing cell membranes and increasing the required action potential to generate nociceptive neurotransmission.

Answer 13

1. sedation – drowsiness, and impaired cognitive function 2. constipation – activation of mu-opioid receptors in gut; basis 3. respiratory suppression – primary cause of death 4. - results from a desensitization of medullary respiratory center to CO2 (i.e., a larger rise in CO2 is needed to stimulate respiration); truncal rigidity (increased tone of core muscles) also contributes to reductions in respiration 5. euphoria – mu-opioid effect; contributes to abuse-liability 6. dysphoria – k-opioid effect 7. nausea / vomiting – activation of chemoreceptor trigger zone 8. physical dependence – develops with chronic use; contributes 9. to continued use/abuse