PAIN- Partial Agonist and CAM Flashcards
Buprenorphine is this typer of receptor?
Mu receport partial agonist 1. activates receptor at lower level 2. less abused, less reinforcing
What is bupprenorphine affinity so important?
Affinity is strength to receport. It binds so strong that it will displace heorin and methadone off. NOT same as receptor activtion
How is dissociation affected with Bup?
stays on receport for a long time
How is BUp important in platue at High does?
Low dose inc activity 2. Hig does plaute at lowe receptor activity
How should BUp be used?
Avoid combo with opioid. Wil knock it off. SE similar to opioid, WD in chronic
Pt has body aches, lacrimation, rhinorrhea, puplis dialted,sweating, NVD, insomina, yawing (craving O2) What is the patient experinecing?
Opiod W/D- Common w/ dependence, and High dose
What is spontaneous W/D syndrome?
Sudden stop or dec in opiods. Less w/ longer t1/2 drugs. WD sx- Heroin severe, Bup mild severe mild duration. Methodone mild sever long duration of sx
What drug will kick someone in WD w/in minutes and last 20min, dose may need adjustment?
Opiod antaganist-Naloxone. BUP less WD when kickin opiod off. Would need High dose of BUP to start WD
Why does heroin and methoadone have higher abuse?
- Shorter half life 2. Multiple fast routes 3. BBB high lipophilicty
What can decrease abuse potential with partial agonist?
Naxolone + Bupprenorphine DEC potentioal. 4:1. DONT inject INC WD for opioid dependent
Naloxone is what type of fx at a receptor?
- occupies w/o activating receptor 2. Not reinforcing 3. Blocks agonist at mu receptor. NOT DOSE dependent
Nalxone and Naltrexone are sued for what?
- OD-naloxone 2. Alcoholism- naltrexone
What are warning with opioid antagonists?
- reverses OD, N/V, INC HR, INC BP, trembling. 2. AVOID opioid depend, preg, CVD
How are drugs graded in classes?
Class I-V. Lower the number higher the abuse and less medical use-LSD. V-Lomotil, codeine
Which classes have refills?
- CIII-CV 5 refills 2. CII no refills(morphine
Which opioid can be used for pain or addiction?
Medtahdone- MUST descirbe purpose on outpatient RX
When do we refer to CURES?
CII-CIV pt. W/in 24hrs of 1st time RX. Check Q4m
What is Opioid induced Hyperalgesia?
Pt pain threshold is lowered. Pain worsen despite inc. dosage. Abnormal pain response to non painful stimuli. Allodynia
What is Breakthrough pain therapy ?
Spikes in pain 1. Malignant pain 2. Use same agent for LTC but fast onset is goal
How are safety measures applied with PCA?
- Single standard {} 2. Read label, Capnography 3. Pt ed 4. RARELY used, AVOID
What are some monitoring objective tools?
- Pain scales 2. RASS, POSS 3. RR- count 30s if less 12, count min
If pt is Scored at Level 3 POSS, drifts off during convo, what should you do?
DEc next dose 50% or withhold, until they are back ot LEVEL 2- droswy
How should you convert to PCA to PO?
CHeck amount of adminstration
Which opioid has the most itching pruritic effect?
Meperidine and Least Fentanyl. 1. Meperidine 2. Cdeine 3. Morphine 5. Hydrocone(vicodine) 6. oxycodone 7 Hydormorphone 8. Fentanyl
If SE of opioids itching is too much, what can be used?
Ideal Loratadine (claritin) less sedation
Instead of methylnaltrexone, what is preferred?
Laxatives. Lactulose
Which drugs have been used in combo with other opiods?
TCA- amitriptyline, nortriptyline 2. SSRI, NRI 3. Steroids 4. Topicals 5. CNS depressans cyclobenzaprine 6. Alpha 2 Adrengi Agoins-clonidine
What are expectation for neuropathic pain?
Neves hold grude, 6wk + for diff. #1Gabepenitin, Carbamazepine, lamotrigine, pregabaline. SLOW titration
Which drug is avoided in Elderly?
TCA- anticholingeric.
Due to cycle of depressionn and pain, which drug is used?
Amitriptyline and SSRI- 4-6wk trial w/ titration. NO SUDDEN STOP
Which muslce relaxants are good?
NONne- baclofen,dantrolene. Cyclbenzaprine-similar to amitriptyline.
What is Dana favorite topical?
Lidocaine patch- post hepetic neurolagia, back pain
When you stub you toe, what happens?
Smile, it release endorphins. We grin when in pain, body natural
