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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
Q

Centrally acting analgesic

A

Tramadol, MOA=weakly binds Mu receptor, inhibits uptake of NE and 5-HT, for moderate pain

26
Q

Tramadol ADE

A

drowsiness, GI upset and diaphoresis (perspiration), minimal respiratory depression, may increase risk of seizures, lower risk of dependence, Ultracet

27
Q

Tramadol ADE

A

drowsiness, GI upset and diaphoresis, minimal respiratory depression, may increase risk of seizures, lower risk of dependence, Ultracet

28
Q

Adjuvants

A

TCA, SNRI, Gabapentinoids, Bisphosphonates, Corticosteroids

29
Q

SNRI

A

Cymbalta/Effexor, reuptake inhibition of NE and 5-HT, used for neuropathic pain, ADE= drowsiness, dizziness, GI upset

30
Q

TCA

A

inhibition of re-uptake of NE, mainstay for many neuropathic pain state, Anticholinergic ADE

31
Q

SNRI

A

Cymbalta/Effexor, reuptake inhibition of NE and 5-HT, used for neuropathic pain, ADE= drowsiness, dizziness, GI upset

32
Q

Bisphosphonates & Corticosterids

A

used for bone metastases and related pain / used for certain malignant pain states

33
Q

Gabapentinoids

A

Neurontin, Lyrica, increase activity of GABA, blocks new synapse formation, used for epilepsy and seizures and neuropathic pain

34
Q

Gabapentin ADE

A

dizziness, drowsiness, lethargy, ataxia (lack of muscle control during voluntary movements)

35
Q

Bisphosphonates & Corticosterids

A

used fro bone metastases and related pain / used for certain malignant pain states

36
Q

Opioids for cough

A

doses less than those required for analgesia, DM, Codeine and hydrocodone, DM may cause constipation

37
Q

Opioid uses

A

Analgesia, cough suppression, slow gut motility, from opium poppy

38
Q

Opioid Organ System Effects

A

CNS- analgesia, euphoria, sedation, respiratory depression
CV- bradycardia, hypotension
GI-constipation
Renal- ADH effect
Genitourinary- decreased uterine tone, prolonged labor

39
Q

Opioid MOA

A

bind opioid receptors in CNS or GI tract, inhibit transmission from periphery to spinal cord, activate inhibitory pathways, alter limbic system activty

40
Q

Opioid Receptors

A

Mu - Endorphins
Delta- Enkephalins
Kappa- Dynorphins

41
Q

Opioids for cough

A

doses less than those required for analgesia, DM, Codeine and hydrocodone, DM may cause constipation

42
Q

Opioids for diarrhea

A

reduce peristaltic movements in the bowel, increased water absorption, Loperamide, diphenoxylate (combined with atropine to reduce abuse potential)

43
Q

Opioid Organ System Effects

A

CNS- analgesia, euphoria, sedation, respiratory depression
CV- bradycardia, hypotension
GI-constipation
Renal- ADH effect
Genitourinary- decreased uterine tone, prolonged labor

44
Q

Opioid ADE

A

Euphoria, sedation, respiratory depression, miosis, NV, constipation, Puritis (itching), tolerance can develop to all but constipation

45
Q

Euphoria

A

results from opioid action in the limbic system, dysphoria possible, does not denote addiction

46
Q

Sedation

A

may be enhanced with concomitant use of hypnotics and alcohol, tolerance developed with continuous around the clock opioid use

47
Q

Miosis

A

No tolerance develops to this, mediated by parasympathetic pathway

48
Q

NV

A

opioids activate the brainstem CTZ producing nausea and emesis, antiemetics drugs can be used

49
Q

Opioid Constipation

A

avoid bulk forming laxatives like Metamucil b/c it can make constipation worse

50
Q

Puritis

A

least associated with Fentanyl, could treat with antihistamine

51
Q

Phenanthrene Opioids

A

morphine, hydromorphone, oxymorphone, heroin, oxycodone, hydrocodone, codeine (agonists) / agonist-antagonists are nalbuphine and buprenorphine

52
Q

Phenylheptylamine Opioids

A

Methadone, Propoxyphene

53
Q

Phenylpiperidine Opioids

A

Fentanyl, meperidine, diphenoxylate, loperamide

54
Q

Know Equipotent Dosages Chart

A

30mg Morphine = oxy 20mg = hydrocodone 20mg

55
Q

Morphine

A

ER dosed every 8-12 hours, IR doses every 4hrs

56
Q

Fentanyl

A

Duragesic or Actiq, most potent, transdermal for long term analgesia, IV fentanyl for procedural sedation

57
Q

Methadone

A

Dolophine or Methadose, used for detoxification, may be used for neuropathic pain, main drawback is unpredictable half-life

58
Q

Meperidine

A

Demerol, used for short duration pain, not recommended for chronic conditions b/c of toxic metabolites that cause convulsions

59
Q

Codeine

A

pro-drug, some people are poor metabolizers of this mediation

60
Q

Opioid Overdose

A

overdose triad= miosis, respiratory depression, coma, other effects like bradycardia and seizures, use naloxone to treat

61
Q

Opioid antagonists

A

naloxone, naltrexone, nalmefene, high affinity for Mu receptor

BBDA Spring (Exam 6) (5 decks)

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