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Pharmacology > Pain Mgmt > Flashcards

Pain Mgmt Flashcards

1
Q

What receptor gives you the most analgesia?

A

Mue opioid receptor

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2
Q

What is buprenorphine?

A

Partial opioid agonist

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3
Q

What is used for mild to moderate pain?

A

NSAIDS
Acetaminophen
Aspirin

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4
Q

T/F It is the acetyl group in aspirin that prevents platelet activation?

A

True

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5
Q

T/F Methadone is used for neuropathic pain because of its SNRI properties

A

True

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6
Q

Name the three type of opioid receptors?

A

Delta, Kappa, Mu

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7
Q

Which opioid receptors have slowed GI motility?

A

MU and Kappa

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8
Q

Which receptor has psycho mimetic effects?

A

Kappa

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9
Q

Which opioid receptor depresses respiration the most?

A

Mu

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10
Q

Which endogenous opioid acts on the kappa receptor?

A

Dynorphin

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11
Q

Which endogenous opioid acts on the delta receptor?

A

Enkephalins

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12
Q

Which endogenous opioid acts on the mu receptor?

A

Endorphins>Enkephalins>Dynorphins

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13
Q

What is noxious stimuli?

A

mechanical, thermal or chemical impulses

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14
Q

Which fibers are involved in pain transmission?

A

Alpha delta and C fibers

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15
Q

Alpha delta fibers

A

large diameter
sparsely myelinated
sharp localized pain

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16
Q

C fibers

A

small diameter
unmyelinated
-dull achy pain that is poorly localized

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17
Q

Where are opioid receptors found?

A

CNS

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18
Q

Where are NMDA receptors found?

A

dorsal horn

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19
Q

How is pain modulated?

A
  1. Endogenous opiates
  2. blocking of NMDA receptor
  3. descending system in brain can stop transmission of pain to dorsal horn (modulated by serotonin,NE, GABA, and endogenous opiates)
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20
Q

What is pathophysiological pain?

A

abnormally functioning of nerves in CNS and PNS

-pain circuits rewire themselves anatomically and biochemically= chronic pain

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21
Q

What is somatic nociceptive pain?

A

arises from skin, joints, muscles, or CT

-throbbing well localized pain

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22
Q

What is visceral nociceptive pain?

A

arises from internal organs

-referred pain

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23
Q

T/F The brain can only accommodate 1 or 2 pain stimuli

A

True

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24
Q

What is adaptive inflammation?

A
  • inflammation that results as a response to promote healing but subsequently reduces the pain threshold causing an area to be more sensitive to pain
  • central sensitization: increased excitability of neuron in CNS
  • major cause of hypersensitivity to pain after injury
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25
Q

Neuropathic pain?

A

nerve damage

Ex. diabetic neuropathy

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26
Q

Functional pain?

A

-abnormal operation of CNS

Ex. fibromyalgia, IBS

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27
Q

T/F Cancer pain has multiple etiologies and can be chronic or acute

A

TRUE

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28
Q

What is acute pain?

A
  • sharp, dull, shooting, radiating, shock that occurs with obvious pain stimulus in timely relationship
  • not usually dependent on pain meds
  • organic cause present
  • small environmental issues
  • insomnia unusual
  • depression unusual
  • goal: pain reduction
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29
Q

What is chronic pain?

A
  • can appear to have no noticeable suffering
  • anxiety depression can lower pain threshold
  • dependent on pain meds
  • significant environmental issues
  • insomnia present
  • depression present
  • goal: functionality
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30
Q

What are non pharmacological treatments to pain?

A
  1. exercise
  2. TENS (trans electrical nerve stimulation)
  3. Psychological interventions
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31
Q

Which salicylate lacks acetyl group and does not alter platelet function? (2)

A
  • Choline and Mg trisulfate

- Diflunisal

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32
Q

What is the limit of acetaminophen for the elderly? for general population?

A
  • 2mg

- 3-4 mg

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33
Q

What is pharmacokinetics of dicolfenac epolamine

A

transdermal patch applied BID for local pain

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34
Q

Which NSAID is used for osteoarthritis?

A

diclofenac sodium gel

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35
Q

How can Ibuprofen be delivered?What is max daily dose?

A

PO or IV , IV infused over 30 min

  • 3200mg for inflammation
  • 1200 for fever, dysmenorrhea,
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36
Q

What is the use Naproxen? Naproxen sodium?

A
  • osteoarthritis

- acute pain

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37
Q

What is maximum days you can use ketorolac? route/mode of delivery?

A

5 days

-route: parenteral, oral, nasal spray

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38
Q

What are selective COX-1 Inhibitors?

A

Ketorolac, low dose aspirin, Indomethicin

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39
Q

What are selective COX-2 inhibitors?

A

Diclofenac, celecoxib, Etodolac

40
Q

What are non selective cox inhibitors?

A

Naproxen, Ibuprofen and Diflunisal

41
Q

T/F In patients with CVD aspirin is given first before celecoxib

A

TRUE

42
Q

What are ADE of NSAIDS? What should you monitor?

A
  • GI bleeds, monitor CBC, stool guaiac

- Acute renal failure, monitor serum creatinine, GFR

43
Q

What is ADE of acetaminophen? monitor?

A

liver toxicity

-ALT/AST, PT/INR, albumin, acetaminophen serum concentration

44
Q

What do you give for severe pain?

A

levorphenol, fentanyl, morphine, hydromorphone, oxymorphone, meperidine, methadone

45
Q

Which opioids are used over morphine?

A

Fentanyl and Hydromorphone

46
Q

Which opioids are for moderate efficacy? Which one has low efficacy?

A
  • Hydrocodone and Oxycodone

- codeine

47
Q

PK of opioids?

A
  • oral form has high first pass effect
  • sub Q form
  • distributed to brain, lungs, kidneys, liver, spleen
  • skeletal muscle serves as reservoir
  • metabolized by CYP3A4
  • excreted by kidneys in urine
48
Q

T/F Heroin is metabolized by plasma esterase

A

TRUE

49
Q

Which two naturally occurring opioids release histamine?

A

Morphine and codeine

50
Q

What are two semi synthetic opioids?

A

Oxymorphone and Hydromorphone

51
Q

Why is hydromorphone used over morphine?

A

more potent

52
Q

T/F controlled release form helps with breakthrough pain in cancer and helps control misuse

A

TRUE

53
Q

Which semi synthetics opioids are given PO only

A

levorphenol
hydrocodone
oxycodone

54
Q

Which opioid suppresses cough? What is special about codeine?

A

codeine

-metabolized into morphine

55
Q

what is clinical use of levorphenol?

A
  • extended half life

- used in cancer patients

56
Q

Which synthetic opioid releases histamine?

A

meperidine

57
Q

What are routes of delivery for Fentanyl?

A

IM, transdermal, sublingual, nasal inhaled

58
Q

Why is meperidine avoided?

A
  • anti-cholinergic effects
  • precipitates seizures(from active metabolite normeperidine)
  • mydriasis
  • oral form not recomended
59
Q

Which opioid blocks shivering?

A

-Meperidine

60
Q

T/F Dont use transdermal Fentanyl patch in acute pain

A

TRUE- due to delayed onset of effect

61
Q

What are ADE of methadone?

A

QT prolongation

avoid dose titration more frequently than every 2 weeks

62
Q

T/F Naloxone may not reverse the resp depression with Buprenorphine

A

TRUE

63
Q

What is medication of choice for MAT?

A

Buprenorphine

64
Q

What are the three drugs used in MAT?

A

Methadone,
Buprenorphine
Naltrexone

65
Q

Which opioid in MAT has weak affinity for the mu receptor?

A

Methadone

66
Q

What is route of Tramadol? Tapendol? what is half life of each?

A
  • PO
  • 7 hrs for Tramadol
  • 4 hrs for Tapendol
67
Q

High degree of tolerance to some effects of opioids? (8)

A
  • Analgesia
  • Euphoria
  • Mental clouding
  • sedation
  • respiratory depression
  • anti-diuresis
  • N/V
  • cough suppression
68
Q

Medium degree of tolerance to some effects of opioids?

A

bradycardia

69
Q

Minimal degree of tolerance to some effects of opioids?

A

Miosis
Constipation
Convulsions

70
Q

**What are ADE of opioids with acute use? (10)

A 
respiratory depression
N/V
itchiness
constipation
urticaria 
urinary retention 
delirium
sedation
myoclonus
seizures
71
Q

*What are ADE of opioids with chronic use? (7)

A
  • hypogonadism
  • immunosuppression
  • increased Growth Hormone secretion
  • withdrawal effects
  • dependence/addiction
  • hyperalgeisa
  • impaired driving
72
Q

T/F Benzos with narcotics = DEATH

A

TRUE

73
Q

MAO-I and opioids can cause a hypyrexic coma?

A

TRUE

74
Q

What are drug drug interaction with opioids? (3)

A

sedative hypnotics: increases respiratory depression
anti-psychotic agents: increased sedation
MOA-I: hypyrexic coma

75
Q

What are ADE of opioids?

A 
Respiratory depression 
constipation 
sedation
tolerance
dependence 
N/V
76
Q

What should you monitor when taking opioids?

A
  • capnography-high risk of respiratory depression in sleep apnea
  • stool/bowel movements
  • tolerance
  • dependence
77
Q

T/F Opioids increase sphincter tone?

A

TRUE

78
Q

T/F You can use codeine in children and pregnant women

A

False

High degree of polymorphism

79
Q

T/F Codeine is a pro drug that is converted into morphine by CYP2D6

A

TRUE

80
Q

T/F Meperidine is a short acting drug that requires many dosing times and produces toxic side effects like convulsions

A

TRUE

81
Q

Who should not use tramadol?

A

elderly

people with renal insufficient

82
Q

T/F Tramadol is a prodrug that has high polymorphism and is metabolized by CYP2D6

A

TRUE

83
Q

T/F Some opioids may out last the effect of Naloxone so a dose may need to be repeated

A

TRUE

84
Q

T/F If no response to the Narcan you can repeat a dose with in 5 min?

A

TRUE

85
Q

What are are alternative tx for chronic pain?

A

TCA, SSRI, SNRI

-they block the reuptake of serotonin and NE increasing pain inhibition

86
Q

Name 2 ibuprofen patches?

A

Flector

Voltarin

87
Q

What are some ingredients in Tiger balm?

A

Capsacin
Menthol
Camphor

88
Q

How does doluxetine/cymbalta decrease pain?

A
  • potent serotonin reuptake inhibitor -decreases pain
  • weak dopamine re uptake inhibitor
  • can treat neuropathic pain
89
Q

What are ADE of cymbalta?

A

agitation, insomnia

90
Q

What is classification of a true opioid allergy?

A
  • IgE
  • T cell mediated
  • angio edema
  • bronchospasms
  • RARE
91
Q

What is classification of a pseudo opioid allergy?

A
  • more common
  • histamine release from cutaneous mast cells
  • itching, flushing, sweating
92
Q

What symptoms can be seen in both?

A

HIVES

  • increased HR
  • angioedema
  • low BP
93
Q

What is tx of a pseudo opioid allergy?

A

use NSAIDS if possible
DON’T USE codeine, morphine or meperidine
USE: hydrocodone, oxycodone, hydromorphone, levorphenol, fentanyl

94
Q

T/F The stronger the opioid the less likely it is to release histamine

A

TRUE

95
Q

What is tx for a true opioid allergy?

A

use NSAIDS if possible

choose an opioid in difference chemical class

96
Q

Give some examples of opioids and class?

A

diphenylheptane: methdone
phenylpiperidines: fentanyl
Morphine: codeine, morphine, hydrocodone,oxycodone, hydromorphone,oxymorphone, levorphenol

97
Q

How can you deter opioid abuse?

A
  • dont use tablets that crush or grind
  • controlled release formulation
  • gelling agents
  • depot shot

Pharmacology (47 decks)

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