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Pharmacology > Pain Relief > Flashcards

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
Q

Methadone

A

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
Q

Levorphanol

A

μ, δ, and κ agonist
MOA: serotonin and NE reuptake inhibitor, NMDA receptor antagonist
Use: severe pain

27
Q

Oxycodone

A

Use: moderate to severe pain

28
Q

Hydrocodone

A

Use: moderate to severe pain

*combo w/ acetaminophen or NSAID

29
Q

Codeine

A

Use: mild to moderate pain
Metabolism: converted to morphine by CYP2D6

30
Q

Pentazocine / Butorphanol / Nalbuphine

A

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
Q

Buprenorphine

A

κ antagonist and μ agonist
Use: tx opioid addiction (there is ceiling effect)
*2nd line drug

32
Q

Tramadol

A

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
Q

Naloxone

A

μ, δ, and κ antagonist

Use: tx of acute opioid overdose (if respiratory center is compromised)

34
Q

Naltrexone

A

μ, δ, and κ antagonist

Use: opioid and ETOH addiction

35
Q

Dextromethorphan and Codeine

A

Antitussives

MOA: different receptors, effect is achieved at lower doses than for analgesia

36
Q

Diphenoxylate and Loperamide

A

MOA: μ receptors on enteric nerves, epithelial cells and muscle
Effect: decrease motility of smooth muscle
Use: tx diarrhea

37
Q

TCAs (names)

A

Secondary amines: Desiparimine / Notriptyline *(preferred in elderly pt’s)
Tertiary amines: Amitryptyline / Imipramine

38
Q

Venlafaxine / Duloxetine

A

Selective serotonin and NE reuptake inhibitor (SNRI)
Use: tx of chronic musculoskeletal/neuropathic pain (osteoarthritis)
SE: nausea, sexual dysfunction, somnolence

39
Q

Gabapentin / Pregabalin

A

MOA: block voltage gated Ca2+ channels
Effect: decrease release of Glu, NE, and substance P
SE: dizziness, somnolence, peripheral edema

40
Q

Carbamazepine

A

Anticonvulsant
MOA: block voltage gated Na+ channels
Use: DOC for trigeminal neuralgia
SE: drowsiness, dizziness, N/V, leukopenia, aplastic anemia

41
Q

Dexamethasone

A

Use: DOC for acute nerve compression, increased IOP, bone pain ,anorexia, nausea, depressed mood

42
Q

Hydroxyzine

A

May add to analgesic effects of opioids, can manage pruritis and N/V SEs caused by opioids

43
Q

Clonidine

A

Available as oral and transdermal patches, may improve pain and hyperalgesia in sympathetically maintained pain

44
Q

Lidocaine

A

Patch approved for postherpetic neuralgia

45
Q

Capsaicin

A

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
Q

Caffeine

A

May enhance analgesic effect of acetaminophen and NSAIDs

47
Q

TCA Precautions/CIs

A

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
Q

TCAs SE

A

Constipation, dry mouth, blurred vision, AMS, tachycardia, urinary hesitation…sexual dysfunction, orthostatic hypotension, wt gain, sedation

Pharmacology (27 decks)

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