Pain Pharmacology Flashcards
NSAIDs Classic Indications (7) Contraindications (4)
Osteoarthritis Rheumatoid Arthritis Bursitis Gout Ankylosing Spondylitis Dysmenorrhea Headache
Cardiovascular Disease (use naproxen)
Active Peptic/Gastric Ulcers
Chronic Kidney Disease (Cr clearance < 60)
Anticoagulant Drug Therapy
Aspirin
MOA, Uses (4) Adverse Effects (6)
Irreversible inhibition of COX-1 and COX-2
Inflammation
Pain
Fever
MI/Stroke Prevention
Reye syndrome (kids with flu or chicken pox) Risk of bleeding Edema HTN Papillary Necrosis Suppress uterine contractions
Ketorolac
MOA, Indication, Adverse Effects (4)
Reversible COX-1 and COX-2 inhibition
Acute post-operative pain
Peptic ulcers
Risk of bleeding
Cardiovascular thrombotic events
Renal impairment
Indomethacin
MOA, Indications, Risks (2), Contraindication
Reversible COX-1 and COX-2 inhibition
Cardiovascular and GI risks
Classic NSAID indications
Coronary Artery Bypass Graft Surgery (CABG)
Ibuprofen
MOA, Indications, Contraindications (3) Cautions (3)
Reversible COX-1 and COX-2 inhibition
Classic NSAID indications
Active GI ulcers
Hepatic failure
Renal failure (renal toxic)
CHF, HTN or other conditions at risk of edema
Flurbiprofen
Indication, Warnings (2)
Opthalmic drops for inhibition of intra-operative miosis
Delays healing
Increased bleeding time
Meloxicam
MOA, Indications (3) Adverse Effects (4)
Reversible COX-1 and COX-2 inhibition
Rheumatoid Arthritis
Osteoarthritis
Juvenile Rheumatoid Arthritis
Upper Respiratory Infection
Dyspepsis
Diarrhea
Flu-like symptoms
Naproxen
MOA, Indications, Contraindications (2) Black Box Warning, Adverse Effects (2)
Reversible COX-1 and COX-2 inhibition
Classic NSAID indications
Asthma, urticaria or other allergy reactions with NSAIDs
CABG surgery
Risk of Thrombotic events
Hepatotoxic
Renal impairment
Diclofenac
MOA, Indications, Contraindications (2) Black Box Warning (2)
Reversible COX-1 and COX-2 inhibition
Classic NSAID indications
CABG surgery
Renal Failure
Increased risk of Stroke and MI
Celecoxib
MOA, Benefits (2) Adverse Effects (2)
Selectively blocks COX-2
Less GI ulcer risk
Less bleeding risk (no platelet aggregation block)
Increased risk of MI and Stroke
Acetaminophen
MOA, Effects (2) Benefits (2) Overdose Description (2) and Treatment
Prostaglandin inhibition in CNS but not periphery
Supresses pain and fever
Useful for patients with:
Gastric Ulcers
Renal failure (does not impair renal function)
Hepatotoxins accumulate due to depletion of glutathione during overdose
Treat OD with N-Acetylcysteine
Amitriptylline
Drug Class, Indication (2)
Tri-Cyclic Antidepressant
Depressive symptoms with associated Chronic Pain
Duloxetine
MOA, Indications (3) Contraindications (2) Black Box Warning
SNRI
Chronic MSK pain
Fibromyalgia
Diabetic Neuropathy
MAOI use
Narrow Angle Glaucoma
Increased risk of suicidality
Pregabalin
Indications (4) Warnings (2)
Fibromyalgia (first approved drug)
Post-Herpetic Neuralgia
Diabetic Neuropathy
Seizures
Pregnancy Category C
Depressants amplify depressant effects
Gabapentin
Indications (6) and Warnings (2)
Broad Spectrum Anti-Seizure Fibromyalgia Diabetic Neuropathy Post-Herpetic Neuralgia Migraines Restless leg syndrome
Pregnancy Category C
Depressants amplify depressant effects
Tramadol MOA (2) Minor Side Effects (5) Serious Side Effects (3)
Weak mu agonist
SNRI (activates monoaminergic spinal pain inhibition)
Dizzy Dry Mouth Constipation Headache Sedation
Seizures in Epileptics
Hypertensive Crisis (if with MAOI)
Serotonin Syndrome
Tapentadol MOA (2) Indication
Mu agonist
Blocks NE reuptake
Pain not effectively treated by other opioids and non-opioids
Ketamine
MOA, Indications (2) Adverse Effects (2)
NMDA receptor antagonist
Anesthesia
Post-Operative pain
Psychological Reactions
Elevated BP
Dexmedetomidine
MOA, Indications (2) Administration, Adverse Effects (2) Warning
alpha-2 Agonist
Analgesia
Short term anesthesia in critically ill patients
IV administration
Hypotension
Bradycardia
Pregnancy Category C
Clonidine
MOA, Indications (2) Administration, Adverse Effects, Warning
alpha-2 Agonist
HTN
Severe cancer pain
Continuous epidural catheter infusion
Hypotension
Pregnancy Category C
Ziconotide
MOA, Effect, Adverse Effects (2) Warnings (2)
Selective N-type voltage sensitive Calcium channel antagonist
Prevents pain signaling from periphery
Cognitive impairment
Muscle damage
Pregnancy Category C
Amplifies depressant effects of depressants
Mixed Opioid Agonists/Antagonists
Pentazocine MOA
Butorphanol Administration and Contraindication
Buprenorphine: Indication, Warnings (2)
Pentazocine: kappa agonist, mu antagonist
Butorphanol
Nasal administration for migraines
Myocardial Infarction (increases cardiac work)
Buprenorphine
Opioid addiction treatment
Not readily reversed with Naloxone (tightly binds)
QT prolongation can cause fatal arrhythmias
Ergotamine MOA (2), Indication, Overdose (3) Warnings (2)
Supresses CGRP to decrease inflammation in Trigeminal vascular system
Terminate Ongoing Migraines
Ergotism: Constriction of peripheral vasculature, can cause gangrene
Physical dependence
Pregnancy Category X
Dihydroergotamine
MOA (2), Indication, Adverse Effect, Contraindications ()
Supresses CGRP to decrease inflammation in Trigeminal vascular system
Terminate Ongoing Migraines
Prominent Diarrhea
CAD
Peripheral vascular disease
Pregnancy
Hepatic/Renal Impairment
Sumatriptan
MOA (3) Indication, Adverse Effect (5)
5-HT agonist
Suppress CGRP inflammatory neuropeptides
Constrict intracranial blood vessels
First line to terminate ongoing migraine
Serotonin Syndrome when combined with:
Ergot Alkaloids, SSRIs, MAOIs, SNRIs
