Pain Opioids I Flashcards
The absence of pain without loss of consciousness is _
Analgesia
Pain is transmitted by _ types of fibers. (2)
A delta
C
True or false, pain intensity is indirectly related
to stimulus intensity
This is a false statement. The relation is direct
What is the effect of analgesic drugs on the sensitized state (hyperalgesia)?
Analgesics should reduce the sensitization
Pain consists of two components, the sensory discriminative component and the motivational-affective component. Which of these 2 are opioids most effective against?
The motivational affective component
Majority of opioids used for pain relief target which opioid receptor? Are these drugs agonists or antagonists?
Mu
Agonists
What are the 4 endogenous opioid peptides? What are their target receptors? Where are they made?
Endomorphins (mu) Endorphins (mu, delta) Enkephalins (delta) Dynorphins (kappa) CNS and PNS
Identify the opioid receptor. Found in brain, spinal cord, peripheral sensory neurons and intestinal tract. Involved in physical dependence, respiratory depression, GI motility and euphoria.
Mu receptor
Identify the opioid receptor. Found in brain spinal cord and peripheral sensory neurons. Involved in dissociative and delirium, diuresis, anticonvulsant effects and dysphoria.
Kappa receptor
Identify the opioid receptor. Found in the brain only. Has antidepressant and convulsant effects.
Delta
What is the net effect of opioids presynaptically? Postsynaptically? What is the mechanism?
Pre - Reduces depolarization
Post - Causes hyperpolarization
Blocks Ca++ influx and increases K+ efflux
Vomiting, euphoria, seizures, reduced sex hormone release and itching are all side effects of what class of drug ?
Opioids
Orthostatic hypotension, bradycardia and peripheral vasodialtion are all effects of _ on the cardiovascular system
Opioids
What are the components of the acute opioid intoxication triad?
Sedation/stupor/coma
miosis (pin point pupils)
respiratory depression
What drug is indicated for reversing acute opioid intoxication?
Naloxone
While tolerance to opioids manifests in most organ systems, what 2 systems are exempt?
Occular
GI
There is no maximum dose of morphine for
malignant pain management. This is because of what phenomenon? How long before tolerance occurs?
Tolerance
As short as days
What are 2 reasons why pain management if harder following tolerance?
Tolerant patient more sensitized to pain
Drug in tolerant patient not as effective
What are 2 ways that withdrawal symptoms from opioids can be caused? How can this be prevented?
Abrupt cessation
Opioid antagonist
Gradual tapering of the dose
What is physical dependence? What is a common cause?
Withdrawal symptoms upon stopping use of the drug.
Prolonged use of drug
What is psychological dependence? What is the brain pathway associated wit its development
Impaired control over drug use for the reinforcement it provides
Mesolimbic dopamine system
A primary, chronic, neurobiologic disease,
with genetic, psychosocial, and environmental factors
influencing its development and manifestations. This is the definition of _
Addiction
True or false. Even with appropriate medical treatment of acute pain, addiction is a common result.
False, addiction produced by appropriate medical treatment of acute pain is uncommon
The drug of choice for the treatment of acute post op pain and cancer pain is _
Opioids
The drug of choice for the treatment of chronic non malignant pain is _
NOT opioids, still under investigation
True or false: Opioids are great for the treatment of pain with activity.
True or false: Opioids will usually be used to completely eliminate pain
False
False
Placebo effect is mediated by _
Release of endogenous opioids
A patient with spinal cord transection can feel pain. True or false?
False, not pain because the information never reaches the cortex
restlessness, perspiration, abdominal
cramps, hot and cold flashes, insomnia, nausea,
vomiting, diarrhea, tachypnea, hypertension,
hypotension, tachycardia are all signs of _
Tolerance (Think autonomic signs)
