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Revision K - Pain Science > Pain pharmacology > Flashcards

Pain pharmacology Flashcards

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1
Q

What are the 2 major types of pain relieving medications, and the 4 sub-types?

A

Analgesics - alleviate pain (opioids/ narcotics and non-narcotics)

Anti-inflammatories - reduce the inflammatory response (NSAIDs and corticosteroids)

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2
Q

What are examples of medications for each of the 4 sub-types of pain medication?

A

Opioids - Panadeine, Endone, Oxycodone

Non-narcotic analgesics - Paracetemol, Pandol

NSAIDs - Nurofen, Ibuprofen, Voltaren, aspirin

Corticosteroids (steroidal anti-inflammatories)

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3
Q

What are the potential side effects of opioid analgesics?

A
  • high addictive potential
  • respiratory depression (can be fatal)
  • hallucinations
  • hypothermia
  • constipation
  • nausea / vomiting
  • drowsiness
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4
Q

What are the side effects of non-narcotic analgesics?

A
  • liver damage (because metabolized in liver)

- kidney damage

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5
Q

Which populations are contraindicated for the use of non-narcotic analgesics ie: paracetemol and panadol?

A

Patients with high alcohol intake or liver/kidney damage - non-narcotic analgesics can damage the liver & kidney because they are metabolized by these organs

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6
Q

What are examples of non-narcotic analgesics?

A

Paracetemol

Panadol

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7
Q

What are examples of opioid analgesics?

A 
Panadeine
Endone
Oxycodone
morphine
heroin
fentanyl
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8
Q

What are examples of non-steroidal anti-inflammatories (NSAIDs)?

A

Nurofen (ibuprofen)
Voltaren (diclofenac)
Aspirin

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9
Q

What are side effects of NSAIDs?

A

Non-selective NSAIDs:

  • GI distress
  • hypertension
  • kidney injury
  • impaired renal drug metabolism
  • stroke
  • myocardial infarction
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10
Q

Which side effects are specific to aspirin?

A
  • tinnitus (overdose)
  • Reye’s syndrome in children - causes encephalopathy

(aspirin contraindicated for children)

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11
Q

What is the mechanism of action of opioids?

A

In the PNS:
- binds to peripheral nociceptor, causing hyperpolarization & making nerve less likely to generate an action potential transmitting pain signal

In the spinal CNS (dorsal horn):

  • inhibits release of nociceptive transmission from 1st order neuron
  • hyperpolarizes 2nd order neuron and makes it less likely to generate an action potential

In the supraspinal CNS:

  • activates descending neural pathways
  • alters perception of pain
  • induces euphoria
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12
Q

What are the mechanisms of non-narcotic analgesics?

A

Poorly understood - believed to act upon prostaglandin synthesis in the CNS

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13
Q

What are the mechanisms of NSAIDs?

A
  • inhibit COX enzymes that synthesize prostaglandins (role in inflammation & pain pathway)

COX1: role in inflammatory response & also homeostatic functions / GI protection

COX2: role in inflammatory response

Selective COX inhibitors inhibit COX2 only (less chance of GI distress and disruption of homeostatic function)

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14
Q

What are the 4 types of alternative medications used for pain reduction, and examples of each?

A

Anti-epileptics (Gabapentin, Pregabalin)

Anti-depressants (Amitryptyline, SSRI)

Muscle relaxants (Baclofen, Diazepam, Valium)

Local anaesthetic

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15
Q

What is the mechanism of action for local anaesthetic?

A
  • interferes with conduction of nerve impulses in sensory neurons by blocking influx of sodium to cell membranes
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16
Q

What is the mechanism of action for anti-epileptic medications, and for which conditions are they used?

A
  • inhibit neuronal discharge

For neuropathic pain:

  • Gabapentin
  • Pregabalin

For trigeminal neuralgia:
- carbamazepine

17
Q

What is the mechanism of action for anti-depressants, and for which (pain) conditions are they used?

A

Inhibit reuptake of seratonin and noradrenaline at synaptic cleft

SNRI (seratonin and noradrenalin reuptake inhibitors)
TCA (tricyclic anti-depressants)

Can be used as first line defence for neuropathic pain

18
Q

What is the mechanism of action for muscle relaxants?

A

Baclofen - stimulates GABA inhibitory neurotransmittor reception at spinal cord, and blocks release of substance P

Diazepam - binds to benzodiazepine receptor and enhances inhibitory actiono of GABA in spinal cord

19
Q

What is the mechanism of action for corticosteroids?

A

Mimic effects of endogenous steroid hormone cortisol and disrupts enzymes that regulate inflammatory response

20
Q

What are the side effects of corticosteroids?

A
  • depression / psychosis
  • peptic ulceration
  • immunosuppression
  • HPA axis suppression
  • blood hypercoagulability menstrual disorders
  • fever
  • cataracts / glaucoma

Safe for children & pregnant women

21
Q

Which medications are safe and which are contraindicated for pregnant women?

A

Safe:

  • analgesics (opioids, paracetemol, panadol)
  • corticosteroids

Contraindicated:
- NSAIDs

Revision K - Pain Science (5 decks)

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