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Pain Relief Flashcards

1
Q

Nonselective COX inhibitors

A

Aspirin / Diclofenac / Ibuprofen / Indomethacin / Ketorolac / Naproxen / Piroxicam

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2
Q

COX-2 Selective Inhibitors

A

Celecoxib / Meloxicam

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3
Q

Risks of GI SEs (lowest risk)

A

Celecoxib, then Ibuprofen / Aspirin / Diclofenac

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4
Q

Risk of GI SEs (high risk)

A

Piroxicam is highest, Naproxen / Indomethacin is medium risk

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5
Q

Celecoxib

A

Only selective COX-2 inhibitor available in US

SE: sulfonamide so may cause HS reactions (rashes)

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6
Q

Meloxicam

A

Preferential COX-2 inhibitor but not as selective as celecoxib

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7
Q

NSAIDs Uses

A

Tx of mild to moderate pain (especially related to inflammation), RA, OA, gout, ankylosing spondylitis, dysmenorrhea

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8
Q

Aspirin Uses

A

Tx flushing induced by release of PGD2 when pt is taking Niacin for lowering serum cholesterol

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9
Q

NSAIDs SEs

A

GI, CVS, renal and aspirin HS

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10
Q

NSAID renal SEs

A

Decrease in renal blood flow d/t decreased PG activity on the afferent arteriole, and Analgesic Nephropathy

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11
Q

NSAID interaction w/ ACEIs

A

NSAIDS may diminish the antihypertensive effect of ACE-inhibitors by blocking the production of vasodilating PGs

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12
Q

Triple Whammy drug interactions

A

Risk of acute kidney injury when ACEI (or ARB) is combined w/ a diuretic and NSAID

  • NSAIDs: constrict afferent and reduce GFR
  • ACEIs/ARBs: dilate efferent and decrease GFR
  • Diuretics: reduce plasma volume and GFR
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13
Q

NSAIDs interactions with Warfarin

A

NSAIDS may increase risk of bleeding in pt’s receiving Warfarin

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14
Q

NSAIDs Contraindications

A

Associated with Reye’s Syndrome, so CI in children and young adults < 20yo w/ fever associated viral illness; CI in pregnancy

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15
Q

Aspirin (general)

A

MOA: irreversibly inhibits COX
Metabolism: deacetylated by esterases in body producing salicylate
Effects: uncouple ox-phos leading to elevated CO2 and hyperventilation

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16
Q

Aspirin SE

A

Epigastric distress, prolonged BT, Reye’s Syndrome, HS, uricosuric effects (at low doses competes w/ uric acid for secretion and thus reduces uric acid secretion), hepatic injury,

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17
Q

Salicylate Intoxication

A

Sx’s: HA, dizziness, tinnitus, confusion, hyperventilation

Complication: mixed respiratory alkalosis and metabolic acidosis; cause of death usually respiratory failure

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18
Q

Acetaminophen

A

MOA: analgesic and antipyretic (not technically NSAID)
Use: mild to moderate pain, DOC for pain relief in OA, DOC for children with fever/flu, DOC for pain in pregnancy, adjunct to antiinflammatory therapy
SE: hepatotoxic (antidote - Acetylcysteine)

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19
Q

Opioids inhibiting Serotonin reuptake

A

Methadone / Meperidine / Tramadol / Fentanyl

*results in Serotonin Syndrome

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20
Q

Opioids CI

A

Not recommended to use concurrently with MAOIs d/t risk of developing Serotonin Syndrome

21
Q

Oxymorphone

A

MOA: high affinity for μ receptors, low affinity for δ and κ receptors
Use: DOC for severe pain

22
Q

Heroin

A

MOA: heroin is rapidly hydrolyzed to 6-MAM then hydrolyzed to morphine
Effects: heroin and 6-MAM are more liposoluble than morphine

23
Q

Meperidine

A

μ receptor agonist
PK: t1/2 of 3h
Use: short term tx of acute pain

24
Q

Fentanyl

A

μ receptor agonist
MOA: rapid onset w/ short duration of action, 100x more potent than morphine
Use: severe acute pain

25
Methadone
MOA: μ receptor agonist, NMDA receptor antagonist, 5-HT and NE reuptake inhibitor PK: long t1/2 and less profound sedation and euphoria Effect: abstinence syndrome is prolonged but less severe Use: detoxification for heroin addict SE: QT prolongation, torsades
26
Levorphanol
μ, δ, and κ agonist MOA: serotonin and NE reuptake inhibitor, NMDA receptor antagonist Use: severe pain
27
Oxycodone
Use: moderate to severe pain
28
Hydrocodone
Use: moderate to severe pain | *combo w/ acetaminophen or NSAID
29
Codeine
Use: mild to moderate pain Metabolism: converted to morphine by CYP2D6
30
Pentazocine / Butorphanol / Nalbuphine
κ agonist and μ antagonist Use: potent analgesics in opioid-naive patients but precipitate withdrawal in pt's that are dependent on opioids SE: psychotomimetic effects, not recommended as routine analgesics bc they have ceiling effect *2nd and 3rd line drugs
31
Buprenorphine
κ antagonist and μ agonist Use: tx opioid addiction (there is ceiling effect) *2nd line drug
32
Tramadol
Weak μ agonist and NE and serotonin reuptake inhibitor Use: moderate pain, neuropathic pain, osteoarthritis SE: increased risk of sz in pt w/ sz disorder
33
Naloxone
μ, δ, and κ antagonist | Use: tx of acute opioid overdose (if respiratory center is compromised)
34
Naltrexone
μ, δ, and κ antagonist | Use: opioid and ETOH addiction
35
Dextromethorphan and Codeine
Antitussives | MOA: different receptors, effect is achieved at lower doses than for analgesia
36
Diphenoxylate and Loperamide
MOA: μ receptors on enteric nerves, epithelial cells and muscle Effect: decrease motility of smooth muscle Use: tx diarrhea
37
TCAs (names)
Secondary amines: Desiparimine / Notriptyline *(preferred in elderly pt’s) Tertiary amines: Amitryptyline / Imipramine
38
Venlafaxine / Duloxetine
Selective serotonin and NE reuptake inhibitor (SNRI) Use: tx of chronic musculoskeletal/neuropathic pain (osteoarthritis) SE: nausea, sexual dysfunction, somnolence
39
Gabapentin / Pregabalin
MOA: block voltage gated Ca2+ channels Effect: decrease release of Glu, NE, and substance P SE: dizziness, somnolence, peripheral edema
40
Carbamazepine
Anticonvulsant MOA: block voltage gated Na+ channels Use: DOC for trigeminal neuralgia SE: drowsiness, dizziness, N/V, leukopenia, aplastic anemia
41
Dexamethasone
Use: DOC for acute nerve compression, increased IOP, bone pain ,anorexia, nausea, depressed mood
42
Hydroxyzine
May add to analgesic effects of opioids, can manage pruritis and N/V SEs caused by opioids
43
Clonidine
Available as oral and transdermal patches, may improve pain and hyperalgesia in sympathetically maintained pain
44
Lidocaine
Patch approved for postherpetic neuralgia
45
Capsaicin
Patch approved for postherpetic neuralgia Use: osteoarthritis (topical application) SE: severe skin burns and nerve damage at site of application; coughing/sneezing/eye irritation when the residue dries
46
Caffeine
May enhance analgesic effect of acetaminophen and NSAIDs
47
TCA Precautions/CIs
Caution: angle-closure glaucoma, BPH, urinary retention, constipation, CVD, liver dz CI: 2nd or 3rd degree ❤️ block, arrhythmias, prolonged QT, severe liver dz, recent acute MI
48
TCAs SE
Constipation, dry mouth, blurred vision, AMS, tachycardia, urinary hesitation...sexual dysfunction, orthostatic hypotension, wt gain, sedation

Pharmacology (27 decks)

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