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Pharm 225B > Pain Meds > Flashcards

Pain Meds Flashcards

1
Q

Strong/full opioid agonists

A
  • Morphine
  • Hydromorphone/Dilaudid
  • Oxymorphone
  • Methadone –> long acting, Tx of opioid addiction
  • Fentanyl, Meperidine –> short acting
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2
Q

mild-moderate/partial agonists

A
  • Codeine ( + acetaminophen = Tylenol #2, 3, 4 )
  • Hydrocodone ( + acetaminophen = Vicodin) - most widely prescribed
  • Oxycodone ( + acetaminophen = Percocet)
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3
Q

Fentanyl

A
  • IV or transdermal
  • only for persistent pain in patients already opioid tolerant
  • contra-indicated < 2y/o or under 18 < 110 lbs
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4
Q

Buprenorphine

A
  • partial agonist used as tx for addiction
  • analgesia if used alone; if paired with opioid (as in someone with opioid addiction) can precipitate withdrawal reactions
  • low abuse potential
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5
Q

Naloxone

A
  • pure opioid antagonist
  • used in overdose situations
  • IV, IM, Sub Q, Nasal Spray
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6
Q

Opioids IV vs PO

A
  • PO dosage will be higher than IV/IM
  • PO is higher dose b/c higher 1st pass effect
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7
Q

Opioids MoA for analgesia

A
  • mimic actions of endogenous opioid peptides; agonists at the mu receptor
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8
Q

Opioid AEs

A
  • respiratory depression (fatal in infants & elderly)
  • cough suppression
  • constipation/urinary retention
  • emesis
  • euphoria/dysphoria
  • drowsiness/sedation
  • orthostatic hypotension
  • miosis (pupillary constriction)
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9
Q

Naloxegol Moa/use

A
  • peripherally acting opioid receptor antagonist
  • blocks opioid effects in the gut while preserving centrally mediated analgesia; helps with opioid induced constipation
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10
Q

NSAIDs moa

A
  • inhibits COX enzyme that converts arachidonic acid into prostaglandins and related compounds
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11
Q

NSAIDs desired target/outcome

A
  • COX-2 enzyme specificlaly @ sites of inflammation, parts of brain and kidneys
  • inhibition causes reduced inflammation, pain and fever
  • AEs: renal impairement
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12
Q

ASA moa/AEs

A
  • non-selective irreversible COX-1/2 inhibitor/NSAID
  • mild/moderate pain + antipyretic; protects against thrombotic disorders
  • AEs: heartburn, nausea, ulceration; bleeding; renal impairment; Reye’s syndrome (avoid ASA use in children < 16 y/o)
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13
Q

ASA interactions & poisoning

A
  • increased bleeding with warfarin, glucocorticoids, alcohol, ibuprofen
  • acidosis, hyperthermia, sweating dehydration, resp. failure; treat by cooling, IV bicarbonate to accelerate excretion and reduce acidosis
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14
Q

Ibuprofen moa/use

A
  • non-selective reversible COX-1/2 inhibitor/NSAID
  • used for dysmenorrhea, if risk for MI/stroke, arthritis
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15
Q

Ketorolac moa/use

A
  • non-selective reversible cox-1/2 inhibitor/NSAID, powerful analgesic, less anti-inflammatory
  • for post operative pain, as effective as morphine
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16
Q

other non-selective/reversible nsaids & BBW

A
  • naproxen
  • meloxicam –> some COX-2 selectivity, arthritis; less GI AEs

BBW for all NSAIDs –> increased risk of CV thrombotic events and serious GI bleed

17
Q

Celecoxib moa/use

A
  • COX-2 specific inhibitors
  • analgesic and anti-inflamm

*lower GI toxicity

18
Q

Celecoxib AEs

A
  • less risk of CVD, but should be avoided
  • impaired renal function –> avoid in CKD patients
19
Q

Acetaminophen/Tylenol moa/use

A
  • moa not fully understood, possible cox-2 inhibition in the CNS
  • no anti-inflamm/anti platelet/gastric effects
  • used as analgesic & antipyretic; DOC in pregnancy
20
Q

Acetaminophen/Tylenol AEs

A
  • chronic hepatitis effects (with 4g/day for 14 days)
  • overdose –> serious liver injury. esp if heavy alcohol use
    *antidote: acetylcystiene/mucomyst which inactivated toxic metabolites
21
Q

Abortive therapy drugs for migraines

A
  • Triptans (moderate to severe) –> Sumatriptan PO, SQ, nasal spray, transdermal patch
  • Ergots (moderate to severe) –> Ergotamine SL & Dihydroergotamine SubQ, IM, IV, nasal
22
Q

Triptans (sumatriptan) moa

A
  • 5-HT agonist –> potent peripheral vasoconstrictor; blocks development of neurogenic inflammation
  • selective for 5HT 1B/1D receptor agonists
23
Q

Ergots (ergotamine/dihydroergotamine) moa & BBW

A
  • can alter seritoninergic, dopaminergic and alpha adrenergic transmission
  • BBW - contraindicated with potent CP3A4 inhibitors –> risk of vasospasm and cerebral ischemia
    *contraindicated with ischemic heart disease and in pregnancy (can induce abortion)
24
Q

Other abortive therapies

A
  • NSAIDs –> mild to moderate migraine, less commonly used acutely
  • Acetaminophen + ASA
  • Opioids analgesics –> for severe migraine that has not responded to first-line medication
25
Q

Preventative therapy purpose/types

A
  • to reduce frequency of episodes, esp. when acute medications fail/are being overused
  • Beta-blockers –> propranolol
  • Tri-cyclic antidepressants –> amitriptyline
  • anticonvulsants –> divalproex sodium & topiramate
  • Botox
26
Q

Tri-cyclic antidepressants (amitriptyline) use in migraines

A
  • used at lower dose
  • inhibit 5-HT re-uptake which increases serotonin, reducing re-occurrance
26
Q

Beta-blockers (propranolol) use in migraines

A
  • depresses action potentials
  • bind to beta-adrenergic receptors on pial vessels
27
Q

Anti-convulsants (divalproex sodium & topiramate) use in migraines

A
  • GABA agonist, neuronal hyper-polarization
  • usually requires lower dose, slowly taper off
28
Q

Botox in migraines

A
  • migraine prophylaxis
  • acts pre-synaptically –> inhibits ACh release at the NMJ –> cause temporary local paralysis of injected muscle
29
Q

CGRP agents for migraines

A
  • Erenumab (subQ)
  • Ubrogepant & remegepant (PO)
30
Q

Erenumab

A

up to 50% reduction in episodes; monoclonal antibody that antagonizes CGRP receptor function
for prevention

31
Q

Ubrogepant & remegepant

A

small molecule CGRP receptor antagonist
for acute use

AEs: N/V, tiredness

32
Q

Anti-emetics

A

Metoclopramide & Prochlorperazine
(see slide)

Pharm 225B (9 decks)

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