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Pharmacy Practice I > Pain Notes Week 5 > Flashcards

Pain Notes Week 5 Flashcards

1
Q

Non-pharmacological options for pain

A 
Acupuncture
Massage
Exercise therapy 
Physical therapy
Cognitive behavioral therapy 
TENS/ External Stimuli
Biofeedback/ Behavioral Therapy
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2
Q

What is neuropathic pain and what are some drug classes/meds discussed in class?

A

Alternatives for people who are opioid resistant to relieve pain
EX: antidepressants (TCAs, SNRIs) - Gabaptentin, Pregablin
Anticonvulsants - Carbamazepine, lamotrigine

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3
Q

What drug class is considered a complementary agent to manage pain and what are some drug examples?

A 
Muscle relaxants:
Cyclobenzaprine (Flexeril)
Methocarbamol (Robaxin)
Tizanidine (Zanaflex)
Carisoprodol (Soma)
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4
Q

Acute Pain examples from class (what’s causing the acute pain)

A

Injury
Post-operative
Flare

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5
Q

T/F CDC guidelines can be used as a guide for both acute and chronic pain management

A

True

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6
Q

T/F opioids are considered to be a first line of therapy for mild to moderate pain according to the CDC

A

False, they should not be considered

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7
Q

Do muscle relaxants act on skeletal muscle for relaxation?

A

No

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8
Q

WHO’s Pain Relief Ladder (the 4 steps)

A

Step 1: non-opioid agent (NSAIDS, acetaminophen)
Step 2: Opioid for mild to moderate pain + non-opioids
Step 3: opioids for moderate to severe pain + non-opioids
Step 4: invasive and minimally invasive treatments

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9
Q

Two non-opioid pharmacological options for mild to moderate localized pain

A

Local anesthetic

Capsaicin

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10
Q

Local Anesthetics

Action, therapeutic use, safety

A

Action: blocks neuronal sodium channels resulting in loss of neuronal excitability
Therapeutic use: causes anesthesia- can be topical to injection for nerve blocks
Safety: possible CNS or cardiovascular side-effects with excessive use, hypersensitivity

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11
Q

Capsaicin
Actions
Therapeutic use
Safety

A

Actions:
TRVP1 receptor agonist
Inc release and depletion of substance P
Chronic stimulation to disrupt neuronal function

Therapeutic use:
topical analgesic for moderate pain
Requires repeated application that can take several days for max effect
Used for joint pain, osteoarthritis, shingles, diabetic neuropathic pain

Safety:
rash or burning sensation
Wash hands after applying

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12
Q

NSAIDs/aspirin
Actions
Therapeutic use
Safety

A

Actions: NSAIDs compete on the cyclooxygenase enzyme inhibiting production of prostaglandins

Therapeutic use:

  • analgesia
  • antipyresis (reduce fever due to inhibiting prostaglandins)
  • anti-inflammatory (in higher doses)
  • anti-platelet: prostaglandins involved in platelet generation in individuals who have already had a cardiac event
Safety:
GI (common effects)
Cardiovascular (inc cardiac work, risk of vascular/platelet effects)
Renal (potential acute renal failure)
Neurologic (headache, dizziness)
Hematologic (vascular/platelet effects
Hypersensitivity (common with salicylates - aspirin)
Hypersensitivity
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13
Q

Commonly used NSAIDs/Aspiring from lecture

A 
Aspirin
Ibuprofen 
Naproxen
Diclofenac (top)
Celecoxib
Meloxicam
Ketorolac
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14
Q 
Acetaminophen
Action
Therapeutic use
Safety
Max recommended daily dose
A

Action:
A poor inhibitor of COX

Therapeutic use:
Analgesia
Antipyretic: reduce fever

Safety:
Safer than NSAIDs
Acutely hepatotoxic at high doses
3200mg max recommended daily dose

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15
Q 
Opioids
Actions
Therapeutic use
Safety
*what other drug class should not be used with opioids?
A

Actions:
analgesics

Therapeutic use:
pain relief

Safety:
Nausea
Constipation (should use stool softeners)
Sedation
Respiratory depression (cause of death in overdose)
Allergic response (not common)
Tolerance (uncommon with short term use)
Addiction
*benzodiazepines
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16
Q

Most common full opioid agonists (full cellular response when they bind to receptor)
Are all fully effective?
Is immediate release preferred?
How should dosing start?

A 
Morphine
Hydromorphone
Oxycodone
Hydrocodone
Fentanyl

Yes
Yes
Start low

17
Q

Fentanyl notes

A

Very high potency, used for well informed patients

Don’t disrupt dosage or apply heat

18
Q

Buprenorphine notes

A

Not a full agonist, very potent partial agonist

19
Q

Why combine acetaminophen with oxy/hydrocodone

A

To decrease dose of opioid required for pain

20
Q

Codeine
Actions
Therapeutic use
Safety

A

Actions:
Weak opioid agonist
Must be activated to morphine by CYP2D6 enzyme
If processed by CYP3A4 becomes inactive

Therapeutic:
antitussive: relieve cough

Safety:
GI upset common
Rapid CYP2D6 metabolizes have inc risk of respiratory depression

21
Q

Tramadol
Actions
Therapeutic use
Safety

A

Actions:
Alternative to full opioid agonists
One isomer is metabolized to an opioid receptor agonist by CYP2D6
Activation required for full efficacy

Therapeutic:
Treat pain

Safety:
GI upset common
Rapid CYP2D6 metabolizes have inc risk of respiratory depression

Pharmacy Practice I (15 decks)

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