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BBDA Spring (Exam 6) > Pain Management: Pharmacotherapy > Flashcards

Pain Management: Pharmacotherapy Flashcards

1
Q

Nociception

A

the process by which information about tissue damage in conveyed to the CNS

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2
Q

Four Processes of Pain

A

Transduction
Transmission
Perception
Modulation

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3
Q

Trandsduction

A

energy from a noxious external stimulus is turned into a nerve impulse at a specialized type of neuron called a nociceptor, release of prostaglandins and other chemicals.

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4
Q

Transmission

A

impulses travel along nociceptor to spinal cord and are then propagated or transmitted to the brain via NT’s.

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5
Q

Perception

A

impulses in brain stimulate the thalamus, contralateral somatosensory cortex and the limbic system

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6
Q

Modulation

A

another phase in impulse propagation, the attenuation of pain via Endorphins, NE, and GABA

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7
Q

To treat transduction

A

NSAIDs and local anesthetics

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8
Q

To treat transmission

A

opioids, GABA analogs (baclofen and gabapentin)

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9
Q

To treat perception

A

general anesthetics

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10
Q

To treat pain modulation

A

opioids, SSRIs, TCAs and gabapentin

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11
Q

Pain Classificaition

A

Nociceptive, neuropathic, or malignant / acute or chronic

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12
Q

Nociceptive vs Neuropathic

A

nociceptive= pain caused by activation of nociceptors by noxious stimuli (nervous system is functioning properly)
neuropathic pain= caused by abberant signal processing in the peripheral or CNS (nervous system not functioning properly)

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13
Q

Neuropathic Pain

A

Caused by metabolic diseases, infections, tumors, toxins, neurological diseases (described as burning, tingling, or shooting), poor response to NSAID

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14
Q

Chronic Pain

A

pain that serves no adaptive purpose (nociceptive or neuropathic)

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15
Q

Chronic Pain

A

pain that serves no adaptive purpose (nociceptive or neuropathic)

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16
Q

Tolerance

A

a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drugs effects over time

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17
Q

Physical Dependence

A

state of adaptation that includes tolerance and is manifested by specific withdrawal syndrome caused by abrupt cessation or rapid dose decrease

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18
Q

Addiction

A

primary, chronic, neurobiological disease, impaired control over use, compulsive use despite harm and craving

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19
Q

Non-pharmacologic pain treatment

A

relaxation, cold/heat, TENS hypnosis

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20
Q

Non-opioids

A

APAP, non-selective NSAID (Motrin & Naprosyn), Cox-2 selective (Celebrex)

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21
Q

Tylenol

A

inhibits prostaglandin synthesis in CNS and peripherally blocks pain impulse generation, atipyretic effect via actions on hypothalamus, onset 30min-1hr,

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22
Q

APAP toxicity

A

results from accumulation of toxic metabolites that are not adequately conjugated by glutathione, liver dysf. pts, and EtOH should have less than 2g/day

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23
Q

NSAID MOA

A

block COX-2 which inhibits prostaglandin synthesis, platelet, antipyretic effects

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24
Q

NSAID ADE

A

GI ulceration, renal insufficiency, prolonged bleeding times, interpatient variability

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25
Centrally acting analgesic
Tramadol, MOA=weakly binds Mu receptor, inhibits uptake of NE and 5-HT, for moderate pain
26
Tramadol ADE
drowsiness, GI upset and diaphoresis (perspiration), minimal respiratory depression, may increase risk of seizures, lower risk of dependence, Ultracet
27
Tramadol ADE
drowsiness, GI upset and diaphoresis, minimal respiratory depression, may increase risk of seizures, lower risk of dependence, Ultracet
28
Adjuvants
TCA, SNRI, Gabapentinoids, Bisphosphonates, Corticosteroids
29
SNRI
Cymbalta/Effexor, reuptake inhibition of NE and 5-HT, used for neuropathic pain, ADE= drowsiness, dizziness, GI upset
30
TCA
inhibition of re-uptake of NE, mainstay for many neuropathic pain state, Anticholinergic ADE
31
SNRI
Cymbalta/Effexor, reuptake inhibition of NE and 5-HT, used for neuropathic pain, ADE= drowsiness, dizziness, GI upset
32
Bisphosphonates & Corticosterids
used for bone metastases and related pain / used for certain malignant pain states
33
Gabapentinoids
Neurontin, Lyrica, increase activity of GABA, blocks new synapse formation, used for epilepsy and seizures and neuropathic pain
34
Gabapentin ADE
dizziness, drowsiness, lethargy, ataxia (lack of muscle control during voluntary movements)
35
Bisphosphonates & Corticosterids
used fro bone metastases and related pain / used for certain malignant pain states
36
Opioids for cough
doses less than those required for analgesia, DM, Codeine and hydrocodone, DM may cause constipation
37
Opioid uses
Analgesia, cough suppression, slow gut motility, from opium poppy
38
Opioid Organ System Effects
CNS- analgesia, euphoria, sedation, respiratory depression CV- bradycardia, hypotension GI-constipation Renal- ADH effect Genitourinary- decreased uterine tone, prolonged labor
39
Opioid MOA
bind opioid receptors in CNS or GI tract, inhibit transmission from periphery to spinal cord, activate inhibitory pathways, alter limbic system activty
40
Opioid Receptors
Mu - Endorphins Delta- Enkephalins Kappa- Dynorphins
41
Opioids for cough
doses less than those required for analgesia, DM, Codeine and hydrocodone, DM may cause constipation
42
Opioids for diarrhea
reduce peristaltic movements in the bowel, increased water absorption, Loperamide, diphenoxylate (combined with atropine to reduce abuse potential)
43
Opioid Organ System Effects
CNS- analgesia, euphoria, sedation, respiratory depression CV- bradycardia, hypotension GI-constipation Renal- ADH effect Genitourinary- decreased uterine tone, prolonged labor
44
Opioid ADE
Euphoria, sedation, respiratory depression, miosis, NV, constipation, Puritis (itching), tolerance can develop to all but constipation
45
Euphoria
results from opioid action in the limbic system, dysphoria possible, does not denote addiction
46
Sedation
may be enhanced with concomitant use of hypnotics and alcohol, tolerance developed with continuous around the clock opioid use
47
Miosis
No tolerance develops to this, mediated by parasympathetic pathway
48
NV
opioids activate the brainstem CTZ producing nausea and emesis, antiemetics drugs can be used
49
Opioid Constipation
avoid bulk forming laxatives like Metamucil b/c it can make constipation worse
50
Puritis
least associated with Fentanyl, could treat with antihistamine
51
Phenanthrene Opioids
morphine, hydromorphone, oxymorphone, heroin, oxycodone, hydrocodone, codeine (agonists) / agonist-antagonists are nalbuphine and buprenorphine
52
Phenylheptylamine Opioids
Methadone, Propoxyphene
53
Phenylpiperidine Opioids
Fentanyl, meperidine, diphenoxylate, loperamide
54
Know Equipotent Dosages Chart
30mg Morphine = oxy 20mg = hydrocodone 20mg
55
Morphine
ER dosed every 8-12 hours, IR doses every 4hrs
56
Fentanyl
Duragesic or Actiq, most potent, transdermal for long term analgesia, IV fentanyl for procedural sedation
57
Methadone
Dolophine or Methadose, used for detoxification, may be used for neuropathic pain, main drawback is unpredictable half-life
58
Meperidine
Demerol, used for short duration pain, not recommended for chronic conditions b/c of toxic metabolites that cause convulsions
59
Codeine
pro-drug, some people are poor metabolizers of this mediation
60
Opioid Overdose
overdose triad= miosis, respiratory depression, coma, other effects like bradycardia and seizures, use naloxone to treat
61
Opioid antagonists
naloxone, naltrexone, nalmefene, high affinity for Mu receptor

BBDA Spring (Exam 6) (5 decks)

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