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SBM neurology > PHARM - opioids and pain > Flashcards

PHARM - opioids and pain Flashcards

1
Q

what are the 5 types of pain?

A
  • acute
  • chronic
  • visceral
  • somatic
  • neuropathic
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2
Q

allodynia

A

A nonpainful stimulus felt as painful in spite of normal-appearing tissues

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3
Q

analgesia

A

inability to feel pain

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4
Q

dysesthesia

A

abnormal response to touch

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5
Q

hyperalgesia

A

increased sensitivity to pain

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6
Q

hyperesthesia

A

Increased sensitivity to stimulation, excluding the special senses.

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7
Q

hyperpathia

A

Increased pain reaction to any stimulus, with increased threshold

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8
Q

paresthesia

A

An abnormal sensation, whether spontaneous or evoked

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9
Q

hypesthesia

A

Decreased sensitivity to stimulation, excluding the special senses.

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10
Q

hypesthesia

A

Decreased sensitivity to stimulation, excluding the special senses.

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11
Q

chronic pain

A
  • persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process.
  • Chronic defined as pain greater than 3 months duration
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12
Q

neuropathic pain

A

is typically burning in nature . It can be electrical, deep and aching, heavy, and cramping in nature

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13
Q

somatic pain

A

typical pain felt when one breaks a bone or cuts the skin. generally well-localized pain that results from the activation of peripheral nociceptors

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14
Q

visceral pain

A

pain is pain from ureteral colic, bowel obstruction, or urinary obstruction. nociceptors of the (organs). Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation/ generalized aching or squeezing,
Acute and chronic pain can share any one of these characteristics.

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15
Q

nocireceptive pain

A

includes both somatic and visceral pain.

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16
Q

peripheral nerve fibers enter the….

A

dorsal horn

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17
Q

three important types of peripheral sensory fibers

A
  • A Delta fibers are sparsely myelinated, large-diameter, fast-conducting fibers, and transmit well-localized, sharp pain
  • C fibers are unmyelinated, small diameter, slow-conducting, transmit poorly localized, dull, aching pain
  • A Beta fibers are heavily myelinated, largest diameter, very fast, transmit touch, vibration, position sense
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18
Q

five categories of analgesics

A
  • NSAIDs
  • opioids
  • anti-depressants
  • anti-convulsants
  • adjunctive drugs
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19
Q

NSAIDs work on what? which does what?

A

PGH synthase and COX

- convert arachidonic acid to prostaglandins and thromboxanes

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20
Q

key mediator of both central and peripheral pain sensitization

A

PGE2 (prostaglandin)

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21
Q

two types of COX and their importance in pain management

A

COX1 - constantly active, side effect of NSAID is its inhibition

COX2 - released in inflammation, inhibited by NSAIDs for analgesia

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22
Q

NSAID classification

A 
Carboxylic Acids
- Salicylic Acids & Esters
- Acetic Acids
- Propionic Acids
- Antrancillic Acids 
Enolic Acids
- Oxicams
Cox-2 Inhibitors
Analine Derivatives
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23
Q

contrast the three acetic acid derivatives

A 
indomethicin 
- COX inhibitor
- gout and osteoarthritis (synovial fluid)
- high incidence of side effects
diclofenac (potassium immediate, sodium delayed)
- COX2 selective
- post-operative pain relief
ketorolac
- COX inhibitor
- bad for kidney
- post-operative pain
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24
Q

contrast the three propionic acid derivatives

A

naproxen (aleve) - intermediate half life

ibuprofen - headache and migraine, menstrual pain, and acute postoperative pain, short half life

oxaprozin - long half life, once a day (shoulder pain)

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25
Q

what is the primary enolic acid derivative?

A

meloxicam - COX2 preferential, less GI issues than propionic and acetic acid derivatives, don’t need to adjust dose for elderly

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26
Q

what is the primary analine derivative?

A

acetaminophen (tylenol)

  • mechanism not clear
  • overdose can cause liver failure
  • safest and most cost effective non opioid analgesic
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27
Q

what is the primary analine derivative?

A

acetaminophen (tylenol)

  • mechanism not clear
  • overdose can cause liver failure
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28
Q

two NSAID hypersensitivity syndromes

A
  • asthma

- angioedema and urticaria

29
Q

gastrointestinal side effects of NSAIDs

A
  • gastric distress
  • superficial mucosal lesion
  • serious ulceration
30
Q

what is the most common cause of acute liver failure in the US?

A

salicylic acid and acetaminophen use for pain

31
Q

when should NSAIDs be avoided in pregnancy?

A

third trimester

32
Q

approved NSAIDs during breast feeding

A 
naproxen
acetominophen
piroxicam
ibuprofen
indomethicin
33
Q

lithium and NSAIDs

A

lithium toxicity

34
Q

NSAIDs to avoid in renal disease and those to use

A

indomethicin
ketorolac

use none, or maybe acetaminophen

35
Q

NSAIDs to avoid in sulfa allergies and those to use

A

celecoxib (celebrex)

use non-selective NSAID

36
Q

NSAIDs to avoid in sulfa allergies

A

celecoxib (celebrex)

37
Q

NSAIDs to avoid in hypertension

A

all but aspiring and sulindac

38
Q

NSAIDs to avoid in elderly and those to use

A

diclofenac and ibuprofen

use meloxicam or celecoxib

39
Q

NSAIDs to avoid in cardiac disease

A

diclofenac and ibuprofen

40
Q

NSAIDs to avoid in GI disease

A

ketorolac

41
Q

what is the important anticonvulsant to know

A

gabapentin

42
Q

gabapentin mechanism

A

prevents Ca influx at dorsal horn

43
Q

TCAs used for

A
  • neuropathic pain
44
Q

caution using TCAs in

A
  • elderly

- those who don’t want to gain weight

45
Q

venlafexine and duloxetine are what type of drug?

A

SNRIs

46
Q

SNRIs used for what type of pain?

A
  • neuropathic pain
47
Q

caution in using SNRIs

A
  • weight gain

- other SNRIs

48
Q

what are the natural opiates?

A

codein and morphine

49
Q

caution in using morphine

A
  • not with MAOIs

- dangerous in renal failure

50
Q

when is morphine a good option?

A
  • ok with hepatic failure but use lower doses
51
Q

what are the fully synthetic opioids?

A

meperidine

fentanyl

52
Q

cautions of meperidine

A
  • not with MAOIs

- not for routine use

53
Q

when use meperidine?

A

acute severe pain

54
Q

what are the semi-synthetic opioids?

A

oxycodone
oxymorphone
hydrocodone

55
Q

cautions with oxycodone

A
  • additive with CNS depressants

- half life drastically lengthened in hepatic disease

56
Q

half life of oxycodone

A

2-3 hours

57
Q

caution with oxymorphone

A
  • end product of oxycodone metabolism

- very addictive and twice as powerful as morphine

58
Q

caution with methadone

A
  • can cause arrhythmias and long QTc

- tremendous caution in elderly

59
Q

methadone mechanism

A
  • modulation phase of nocireception

- NMDA antagonist

60
Q

methadone half life

A

8.5-47 hours, highly variable

61
Q

fentanyl caution

A
  • 80 times stronger than morphine
  • half life increases in renal failure
  • skin permeability can increase in hepatic failure
62
Q

fentanyl administered by….

A

patch

63
Q

hydrocodone caution

A
  • most abused drug in US
64
Q

hydromorphone potency

A

7.5 time stronger than morphine

65
Q

hydromorphine best used in

A

renal failure patients

66
Q

hydromorphone caution

A
  • avoid sustained release in hepatic failure
67
Q

tramadol cautions

A
  • caution with methadone or with SNRIs
68
Q

strategy for opioids in elderly

A
  • do not withhold

- begin cautiously and monitor well

69
Q

how do we know blood tests are not consistent with poppy seed use?

A
  • morphine level greater than 1000 ng/ml

- no codeine detected

SBM neurology (22 decks)

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