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Advanced Pharma > Pain: textbook > Flashcards

Pain: textbook Flashcards

1
Q

nociceptive pain

A

transient pain in response to a noxious stimulus at nociceptors

explained by ongoing tissue injury

classified as thermal, mechanical & chemical

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2
Q

functional pain

A

sustained by abnormal processing or functioning in the peripheral or central nervous system in response to normal stimuli

-fibromyalgia, IBS

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3
Q

neuropathic pain

A

spontaneous pain and hypersensitivity to pain associated with damage or pathological changes in the peripheral or central nervous system

-diabetic peripheral neuropathy, post-herpetic neuralgia, fibromyalgia, IBS

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4
Q

treatment for neuropathic pain

A

heavily relies on “adjunctive” therapies (transdermal lidocaine, antidepressants, anticonvulsants, etc)

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5
Q

treatment goals

A

-decrease pain
-improve functioning, mood & sleep

pt s/b involve in setting goals; it assures that outcomes are important to the patient

eg. pain score 3 or less at rest
pain score 5 or less w/ movement
able to have 6 hrs of uninterrupted sleep

chronic pain: cant be eliminated but should be managed

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6
Q

non-pharmacological interventions

A

s/b part of ongoing therapy

-PT, heat, ice, acupuncture, etc

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7
Q

WHO’s pain relief ladder: step 1

A

mild pain (1-3)

-non-opioid analgesics
-adjuvant drugs
-management of side effects

(NSAIDs):
ibuprofen 600mg q6h, APAP 1000mg q6h
naproxene
diclofenac

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8
Q

WHO’s pain relief ladder: step 2

A

moderate pain (4-6)

weak-opioid analgesic
non-opioid analgesic
adjuvant analgesics

APAP 325mg + oxycodone 5mg q4h

APAP 325mg + cod 60mg q4h

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9
Q

WHO’s pain relief ladder: step 3

A

severe pain (7-10)
strong opioids

hydromorphone 4mg q4h
morphine 10mg q4h
fentanyl

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10
Q

when starting on pain meds start with

A

PRN then switch to scheduled dosing if patient uses more than occasionally

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11
Q

adjust the scheduled dose depending on the

A

frequency or severity of breakthrough pain

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12
Q

monitor “four As”

A

-analgesia: pain relief?
-adverse events: tolerable?
-activities - functioning improved?
-aberrant drug-related behavior

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13
Q

when prescribing NSAIDs and/or tylenol consider

A

-renal fn
-platelet count
-risk of GI bleed (NSAIDs)
-transaminases (liver disease)
-current EtOH use (tylenol)

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14
Q

opioids side effects

A

-resp depression
-sedation
-N
-pruritus
-constipation
-urinary retention

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15
Q

when prescribing opioids high risk for respiratory depression occurs when

A

obstruction or central sleep apnea

concurrent benzodiazepine use

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16
Q

acute pain: sxs

A

physiologic responses are:
-tachypnea
-tachycardia
- inc sympathetic nervous system activity (pallor, diaphoresis, pupil dilation[mydriasis])

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17
Q

poorly treated pain causes psychological stress and

A

compromise the immune system due to the release of endogenous corticosteroids

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18
Q

somatic acute pain

A

arises from injury to skin, bone, joint, muscle, and connective tissue

usually localized to the site of injury

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19
Q

visceral pain

A

referred pain

injury to nerves on internal organs (intestines, liver) and can present as diffuse, poorly differentiated

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20
Q

4 main effects of chronic pain

A
  1. effects on physical fn (impaired activities of daily living & sleep disturbances)
  2. psychological changes (depression, anxiety, anger, loss of self-esteem)
  3. social & societal consequences (isolation, changes in relationships w/ fam/friends, intimacy)
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21
Q

management of chronic pain

A

-multimodal
-cognitive interventions
-physical manipulations
-pharma agents
-surgical interventions
-regional/spinal anesthesia

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22
Q

chronic malignant pain

A

associated w/ progressive disease (cancer, AIDS, dementia, etc)

tolerance, dependence & addiction NOT concern

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23
Q

chronic nonmalignant pain

A

not life-threatening; lasting more than 6mo

-associated w/ low back pain, osteoarthritis, previous bone fractures, peripheral vascular disease, genitourinary infection, RA, coronary heart disease

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24
Q

chronic pain management: initial tx

A

combination of non-pharmacologic and pharm modalities such as acetaminophen, oral and topical NSAIDs, adjunctive tx based on the cause of the pain

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25
PHN abbr
postherpetic neuralgia associated w/ acute herpetic neuralgia or an acute shingles outbreak
26
peripheral or polyneuropathic pain
associated with the distal polyneuropathies of diabetes, human immunodeficiency virus (HIV), and chemotherapeutic agents
27
central pain includes
central stroke pain, trigeminal neuralgia, and a complex of syndromes known as complex regional pain syndrome (CRPS)
28
sxs of neuropathic pain are
tingling, burning, shooting, stabbing, electric shock-like quality, or radiating pain -described as constant dull, throbbing or burning pain, or an intermittent pain that is stabbing or shooting
29
pain assessment includes
onset, duration, location, quality, severity, and intensity), pain relief efforts, and efficacy and side effects of current and past treatments for pain
30
VAS best used for children
older than 7 years
31
3 groups of analgesic drugs
-nonopioid -opioid -coanalgesic (adjuvants)
32
non-pharmacological therapy
psychological interventions and physical therapy for acute & chronic pain
33
Psychological interventions helpful in management of acute pain
imagery (picturing oneself in a safe, peaceful place) and distraction (listening to music or focusing on breathing)
34
Chronic pain patients might benefit from
relaxation, biofeedback, cognitive behavioral therapy, psychotherapy, support groups, and spiritual counseling
35
physical therapy: modalities are
heat, cold, water, ultrasound therapy, TENS, massage, and therapeutic exercise. Heat and cold therapy are utilized in a variety of musculoskeletal conditions (muscle spasms, low back pain, fibromyalgia, sprains, and strains)
36
1st line therapy for ***mild-to-moderate pain*** back pain & osteoarthritis
APAP
37
APAP
pts on warfarin: max does is 2,000mg/day -norm hepatic/renal pts: 4,000mg -hepatotoxicity -max dose w/ narcs: 325 mg per dosing -for renal/hepatic pts: reduce by 50-75% dose
38
aspirin
nonacetylated salicylates inhibit cyclooxygenase (cox-1 and cox-2) enzymes thus preventing prostaglandin synthesis (dec nociceptor sensitization and increased pain threshold) ****mild-to-moderate pain*** risk of GI irritation and bleeding
39
aspirin hypersensitivity is seen in
asthma, nasal polyps, or chronic urticaria (hives)
40
aspirin-sensitive pts rx...
nonacetylated salicylates (choline magnesium salicylate and sodium salicilate_
41
NSAIDs are preferred agents for
mild-to-moderate pain mediated by prostaglandins (RA, menstrual cramps, postsurgical pain), bony metastasis not helpful in neuropathic pain
42
if NSAIDs are ineffective of 2-3 wk, it is reasonable to
switch to another member of the class
43
ketorolac use limit to
5 days due to inc risk of serious GI s/e
44
NSAID dosing
high is the same as medium dosing (flat-dose response curve) -inc incidence of a/e (GI irritation, hepatic dysfunction, renal insuff, platelet inhibition, sodium retentions, CNS dysfn)
45
NSAIDs
-nonselective (inhibit COX-1 and COX-2): inc GI & renal toxicity -selective (inhibit only COX-2): anti-inflammatory effects
46
black box warning for **NSAIDs** and
**celecoxib** cardiovascular events and GI bleeding
47
opioids are classified
by their activity at the receptor site, usual pain intensity treated, and duration of action (short vs long acting)
48
opioids for moderate pain
-codeine -hydrocodone -tramadol -partial agonists
49
opioids for severe pain
morphine and hydromorphone
50
pure agonists (morphine) divided into 3 classes
phenanthrenes or morphine-like phenyl piperidine or meperidine-like diphenyl heptane or methadone-like
51
at low doses full and partial agonists
provide similar effects to their full agonists agents; however, partial agonists with increased doses will reach analgesic activity plateau (no additional relief; inc a/e)
52
Agents with high affinity for κ-receptors
(pentazocine, nalbuphine, and butorphanol) are more likely to cause psychomimetic effects
53
Hepatic impairment can decrease the
metabolism of most opioids, particularly methadone, meperidine, and pentazocine. Furthermore, the clearance of meperidine and morphine and their metabolites is reduced in renal dysfunction.
54
Normeperidine
the active metabolite of meperidine, can produce tremors, myoclonus, delirium, and seizures
55
meperidine
should not be used in the elderly, those with renal impairment, in patients using patient-controlled analgesia (PCA) devices, or for more than 1 to 2 days of intermittent dosing
56
Methadone
several mechanisms (μ-agonist, NMDA-receptor antagonist, and inhibition of reuptake of serotonin and norepinephrine) long half-life: 30 hours permits extended dosing intervals concern: resp depression, arrhythmias (QT prolongation)
57
tramadol
synthetic opioid w/ a dual mechanism of action (μ-agonist & inhibition of serotonin and norepinephrine reuptake) ***efficacy & safety similar to codeine/APAP*** neuropathic pain & chrnoc pain
58
tramadol is associated wtih
risk of seizures in pts w/ a seizure disorder, those at risk for seizures, and those taking meds that can lower the seizure threshold
59
tramadol and serotonergic drugs
such as SSRIs can lead to serotonin syndrome dependence can occur
60
for severe pain in opiate-naive pts, starting dose for IV morphone is
5 to 10mg q4h rescue doses for breakthrough pain are 10% to 20% of the total daily opioid requirements and administered q 2-6hrs if needed
61
long-term opioid use
3 days or less will often be sufficient; more than 7 days will rarely be needed eval q3m
62
reverses opioid
naloxone (think benzo) relieves itching that accompanies intermittent bolus or con't infusion
63
opioids should not be prescribed with
benzos
64
patients with opioid use disorder
Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies)
65
onset for opioids
oral: 45m IV/SC is more rapid relief IM: not recommended
66
morphine equivalnets
10 mg of IV morphine is equivalent to 1-mg epidural morphine and 0.1 mg of intrathecally administered morphine
67
combination products
are short acting and often not suitable for chronic therapy. Single agents offer greater dosing flexibility than combination products
68
opioid allergy
when an individual is allergic to one drug in a chemical class of opioids, it is reasonable to select an agent in another chemical class. For the purpose of drug selection in patients with allergies, mixed agonists/antagonists should be treated as morphine-like agents
69
tapering opioids
dose should be reduced by 10% per week to avoid withdrawal symptoms
70
s/e of opioids
-sedation -hallucinations -constipation -nausea and vomiting -urinary retention -myoclonus -respiratory depression
71
methadone is a substrate of CYP3A4 and its metabolism is
increased by phenytoin and decreased by cimetidine -CNS depressants might potentiate the sedative effects of opiates
72
adjuvant analgesics
drugs that have indications other than pain but are useful as monotherapy or in combination with nonopioids and opioids
73
examples of adjuvant analgesics
-antiepileptic drugs (AEDs) -antidepressants -antiarrhythmic drugs -local anesthetics -topical agents (eg, capsaicin) -variety of other drugs (eg, NMDA antagonists, clonidine, and muscle relaxants)
74
1st line therapy for neuropathic pain
-gabapentin or pregabalin -transdermal lidocaine -tricyclic antidepressants (TCAs) ***SSRIs NOT as effective as TCAs***
75
SNRI drugs used for painful diabetic peripheral neuropathy (DNP)
-duloxetine -venlafaxine
76
chronic pain: medication regimen
instead of “as-needed” dosing should be used when treating chronic pain, and the effectiveness of therapy should be reassessed regularly add topical agents (capsaicin)
77
CAM abbr. and examples w/ dosing
complementary and alternative medicine -acupuncture -chiropractic -botanical -nonbotanical dietary supplements -homeopathy glucosamine (1500 mg/day):OA chondroitin

Advanced Pharma (27 decks)

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