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#Pharmacotherapeudics > Pain Non-COX (2) > Flashcards

Pain Non-COX (2) Flashcards

1
Q

Acetaminophen how works and 4 effects

A

Inhibs prostaglandins in CNS but min effect on COX in periphery

analgesic
antipyretic
weak anti-inflam
no anti-platelet effects

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2
Q

Acetaminophen is rapidly absorbed in the GI subject to _________ and can attack the ________. It’s excreted in ______

A

1st pass metabolism
attack of the liver
urine

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3
Q

N-acetylcystine

A

Tx for acetaminophen OD

don’t exceed 3G acetaminophen/24hrs

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4
Q

schedule __ drugs are a high risk for abuse, you need a new prescription every month…(4 ex)

A

II

morphine, oxycodone, methadone, meperidine

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5
Q

Mu receptor agonists cause.. (7)

A

resp depression, phys depression, tolerance, constipation, euphoria, miosis; primary analgesic response

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6
Q

Kappa receptor agonists cause… (4)

A

spinal-level analgesia and sedation, w/o respiratory depression, miosis

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7
Q

Sigma receptor agonist cause… (4)

A

vasomotor stimulation, psychotomimetic effects, miosis,

BINDS NON-OPIOID AGENTS

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8
Q

Delta receptor agonists cause…

A

Enkephalins (natural opioids) more selective w/the delta receptors in the periphery

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9
Q

Pure agonists bind __ receptors to produce analgesia that inc with dose w/o ceiling effect
Name the 3 groups

A

mu

Phenanthrenes
Phenylpiperidine
Diphenylheptane

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10
Q

Partial agonists/antagonists partially stimulate the mu receptor and antagonize the ___ receptor

A

kappa

reduced sfx at mu receptor, psychomimetric effects d/t kappa antagonism

possible w/drawl sx in pt dependent on pure agonists

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11
Q

Name the 2 strong phenanthrenes

A

morphine

hydromorphone (dilaudid)

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12
Q

what is the strong phenylheptylamine

A

methadone

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13
Q

Most widely used phenylpiperdines are strong agonists, but _________ and _________ specifically

A

meperidine and fentanyl

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14
Q

Morphine action

A

Mu receptor

works in CNS and GI, inhibs pain by inhib NT release

extensive 1st pass effect

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15
Q

Morphine effects (3)

A

suppress cough
relieves diarrhea (eventual constipation)
histamine release

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16
Q

PT on morphine needs to be monitored for

A

respiratory or CV depression

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17
Q

Meperidine action

A

Binds to opioid receptors and kappa

antimusc activity, can precipitate tremors or sz.

causes mydriasis rather than miosis seen in morphine b/c kappa effect

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18
Q

Meperidine is usually given__________, it is excreted in _________; caution 1/2 life longer in ______and _____ pts

A

post surgery
excreted in urine
inc in liver and kidney

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19
Q

Meperidine contraindicated in pts taking _________ in past 2-3 wks
3 other meds also interact

A

MAOI (metabolize NE=bp changes, excitatory and rigidity)
barbiturates
chlorpromazine
phenytoin

20
Q

Meperidine NOT to be used in pts with_______

A

chronic pain (build up of metabolite)

21
Q

with meperidine moniter pt for________

A

sx of jerking/twitching (indicates normeperidine accumulation)

22
Q

Methadone action

A

greatest action at mu receptor

equal potency to morphine with less euphoria

analgesic substituted for morphine/heroin to control w/drawl

23
Q

methadone is a good addiction tx because

A

less euphoric

1/2 life is loooonnng (therefore inc risk for toxicity)

24
Q

2 cautions with Methadone

A

variable kinetics

wide range of dose equivalents

25
Q

7 signs of methadone withdrawal

A 
lacrimation
rhinorrhea
diaphoresis
yawning
restlessness
insomnia
dilated pupils
26
Q

Fentanyl is more/less potent

A

more potent than morphine

27
Q

Fentanyl is used for ___________ combined with droperidol.

A

anesthesia

esp patches in post-operative pain

28
Q

Fentanyl cautions..(3)

A

abuse
lack of titration
variable absorption

29
Q

Fentanyl has more/less allergy risk

A

LESS allergy risk b/c no histamine release

prefered in pts with CV issues

30
Q

Fentanyl causes _____ depression and when taken with P450 inhib effect of fentanyl is _____

A

CNS depression

increased

31
Q

what are the three mild-moderate phenanthrenes

A

codeine
oxycodone
hydrocodone

32
Q

what are the 3 mild-moderate phenypiperidines

A

diphenoxylate
diphenoxylate

loperamide

33
Q

2 partial agonist/antagonist phenanthrenes

A

nalbuphine

buprenorphine

34
Q

what is the partial agonist/antagonist morphinans

A

butorphanol

35
Q

what is the partial agonist/antagonist benzomorphans

A

pentazocine

36
Q

buprenorphine action

A

20x more potent than morphine (long acting)

partial mu agonist

can antagonize resp dep caused by morphine

37
Q

butorphanol and nalbuphine action

A

analgesic, also 20x more potent than morphine

kappa agonist~ spinal analgesia

38
Q

Pentazoxine action

A

mild mu and kappa agonist
sigma activity may account for dysphoria

made in an attempt to have little or no abuse potential

39
Q

Naloxone binding

A

Pure antagonist

high affinity for mu receptor and competitive antagonist of kappa and delta..

40
Q

naloxone use

A

no effect in normal individuals but in pts taking opiates it can reverse OD, respiratory depression and coma
DOA up to 48 hours

41
Q

Tramadol

A

weak mu agonist

inhibit NE/SE CNS reuptake

42
Q

what are the 4 centrally acting skeletal musc relaxants and why are they used

A

cyclobenzaprine
baclofen
tizanidine
carisoprodol

releif from musc spasm and hyper-reflexia

43
Q

centrally acting skeletal musc relaxants are metabolized by ________, and the 3 side effects are

A

hepatic metabolism

drowziness and xerostomia

N/V seen in Baclofen

44
Q

Peripherally acting skeletal musc relaxants are aka ________________ agents

A

neuromuscular blocking agents

45
Q

what are the 2 peripheral neuromuscular blocking agents

A

succinylcholine

Vecuronium

46
Q

how do neuromusc blocking agents work?

A

block the transmission of cholinergics between somatic motor neuron and skeletal fibers at neuromuscular jxn

#Pharmacotherapeudics (15 decks)

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