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Ahmed Neuro 2 Depression > Pharm - Pain > Flashcards

Pharm - Pain Flashcards

1
Q

describe nociceptive pain

  • what is somatic pain
  • what is visceral pain
A

perception of input from a nocicpetor, a nerve fiber preferentially sensitive to noxious stimulus

somatic: arises from injury to body tissues, well localized
visceral: arises from viscera stretch receptors, poorly localized

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2
Q

describe neuropathic pain

  • what is sympathetically mediated pain
  • what is peripheral neuropathic pain
  • what is central pain
A

arises from abnormal neural activity secondary to dz/injury/dysfunction of the nervous system

sympathetically mediated: arises from peripheral nerve lesion and associated w/ autonomic change

peripheral neuropathic: due to damage to a peripheral nerve W/O autonomic change

central pain: arises from abnormal CNS activity

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3
Q

compare mononeuropathy, mononeuropathy multiplex, and polyneuropathy

A

mononeuropathy: one nerve affected

mononeuropathy multiplex: several nerves affected in different areas

polyneuropathy: sx are diffuse and bilateral

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4
Q

what are the two types of pain sensation

A

1) tissue damage –> release of local inflammatory mediators –> hyperalgesia (exagerrated response to pain)/allodynia (pain from repeated exposure)
2) gluatamate stimulation of spinal NMDA receptors —> secondary hyperalgesia

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5
Q

what do these abbreviations stand for

  • AA
  • coxibs
  • PG
  • PGI2
  • PUFA
  • TxA2
A
  • AA: arachidonic acid
  • coxibs: selective inhibitors of cox-2
  • PG: prostaglandin
  • PGI2: prostacylin
  • PUFA: polyunsaturated fatty acid
  • TxA2: thromboxane A2
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6
Q

describe the arachidonic acid pathway

A

arachidonic acid –> COX –> PGI2, TXA2, PGD2, PGE2

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7
Q

what are the effects of thromboxane A2 (produced in the arachidonic acid pathway)

A

vasoconstriction

increased platelet aggregation (thrombotic)

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8
Q

what are the effects of prostacyclin (produced in the arachidonic acid pathway)

A

vasodilation

decreased platelet aggregation (anti-thrombotic)

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9
Q

what are the effects of PGE2 (produced in the arachidonic acid pathway)

A

joints: swelling, pain, edema

gastric mucosa: gastric protection

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10
Q

compare COX 1 and 2

A

both use AA, both make PGs, both have physiological role in renal function

COX1:
constitutive expression, all tissue all the time, responds to PHYSIOLOGICAL stimuli, contributes to response to pathological stimuli that release AA

COX2:
some tissues some times, prominent role in response to PATHOLOGICAL stimuli that release AA

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11
Q

when NSAID therapy is required for a patient at risk of CV complications, _______ is recommended as the NSAID of choice

A

naproxen

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12
Q

what are come contraindications for NSAID use

A

1) chronic kidney disease w/ creatinine clearance <60
2) active duodenal or gastric ulcer
3) CV dz
4) NSAID allergy
5) ongoing tx with anticoags (warfarin)

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13
Q

4 major actions of aspirin

A

1) suppression of inflammation
2) relief of mild–>moderate pain
3) reduction of fever
4) prevention of MI and stroke

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14
Q

MOA aspirin

A

irreversible Inhibition of COX

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15
Q

common indications for aspirin

A
  • rheumatoid arthritis
  • chronic inflammatory conditions
  • post-operative pain
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16
Q

adverse effects of aspirin can occur in what patients

A
  • advanced age
  • pre-existing renal function
  • hypovolemia
  • HTN
  • hepatic cirrhosis
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17
Q

long-term aspirin use may lead to ______ and other forms of renal injury

A

renal papillary necrosis

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18
Q

why should aspirin not be used in children with chicken pox or influenza?

A

due to reye syndrome

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19
Q

effect of using aspirin during labor and elivery

A
  • can suppress spontaneous uterine contractions
  • can induce premature closure of ductus arteriosus
  • can intensity uterine bleeding
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20
Q

compare non-aspirin NSAIDs vs aspirin

A

both:

  • inhibit COX 1 and COX2
  • suppress inflammation, pain, and fever
  • increase risk of

non-aspirin NSAIDs:

  • reversible
  • suppress platelet aggregation but increase risk of MI and stroke
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21
Q

indications ketorolac

who cannot take it

A

short term (<5 days) management of moderately severe acute pain that requires analgesia at the opioid level

  • usually post-operative state

NOT indicated in peds patients, or for minor or chronic conditions

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22
Q

warnings for ketorolac

A

can cause peptic ulcers,GIbleeding and/or perforation of the stomach or intestines, which can be fatal

  • risk of bleeding
  • CV thrombotic events
  • renal risk
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23
Q

indications for indomethacin

A
  • Moderate to severe rheumatoid arthritis including acute flares of chronic disease
  • Moderate to severe ankylosing spondylitis
  • Moderate to severe osteoarthritis
  • Acute painful shoulder (bursitis and/or tendinitis)
  • Acute gouty arthritis
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24
Q

indomethacin is contraindicated in the treatment of _____

A

peri-operative pain in the setting of CABG surgery

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25
contraindications ibuprofen
- Active gastric or duodenal ulcer, a history of recurrent ulceration, gastrointestinal bleeding, or active inflammatory disease of the gastrointestinal system - Significant hepatic impairment or active liver disease - Severely impaired or deteriorating renal function
26
warning and precautions ibuprofen (what pts should not take it)
- Patients with heart disease and high blood pressure - patients with heart failure, hypertension or other conditions predisposing to fluid retention - patients w/ gastrointestinal tract irritation, history of peptic ulcer, diverticulosis or other inflammatory disease of the gastrointestinal tract such as ulcerative colitis and Crohn’s disease - Increased risk of renal toxicity
27
adverse effects ibuprofen
- decreased appetite - edema - fluid retention
28
indications flurbiprofen
sterile, topical produce for ophthalmic use for inhibition of intraoperative miosis
29
MOA flurbiprofen
COX inhibition
30
precautions flurbiprofen
may slow or delay healing
31
indications meloxicam
- Osteoarthritis - Rheumatoid Arthritis - Juvenile Rheumatoid Arthritis (JRA) in patients 2 years of age or older
32
contraindications meloxicam
- History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs - In the setting of CABG surgery
33
warnings and precautions meloxicam
- Hepatotoxicity - HTN - HF, Edema - Renal Toxicity
34
adverse reactions meloxicam
- diarrhea - upper respiratory tract infections - dyspepsia - influenza-like symptoms
35
indications naproxen
- RA - osteoarthritis - ankylosing spondylitis - polyarticular juvenile idiopathic arthritis - tendonitis, bursitis - acute gout
36
contraindications naproxen
- History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs • In the setting of CABG surgery
37
warnings/precautions naproxen
- Hepatotoxicity - CVR effects, HF, Thrombotic effects (BBW) and Edema - Can significantly compromise renal function in geriatric patients
38
black box warning for naproxen
thrombotic effects can occur with use
39
adverse rxn naproxen
- Dyspepsia, abdominal pain, nausea - headache - rash, ecchymosis, and edema
40
indications diclofenac
- Ankylosing spondylitis - Dysmenorrhea - Migraine - Osteoarthritis Pain - Rheumatoid arthritis
41
contraindications diclofenac
- CABG surgery | - pts w/ moderate to severe renal impairment
42
warnings/precautions diclofenac
increased risk of serious cardiovascular thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal this risk may occur early in treatment and may increase with duration of use. (BBW)
43
adverse effects diclofenac
- CV: edema, CV accident, HTN, MI - CNS: HA, dizziness - skin: pruritis, rash, stevens-johnson syndrome, toxic epidermal necrolysis - endocrine/metabolic: fluid retention - GI: constipation, abd pain, dairrhea
44
MOA celecoxib
selectively blocks COX-2
45
compare risks between celecoxib (selective COX2 inhibitor) and the non-selective cox inhibitors (COX 1 and 2)
celecoxib: - causes less gastric ulceration - does not inhibit platelet aggregation (no risk of bleeding) - increased risk of MI and stroke
46
indications acetominophen
inhibition of prostaglandin synthesis in CNS suppressed pain and fever but NOT inflammation
47
compare adverse effects b/w acetominophen and NSAIDs
- does NOT cause GI ulceration - does NOT suppress platelet aggregation - does NOT impair renal function
48
acetominophen overdose is treated with _______
acetylcysteine
49
why is using acetominophen with warfarin contraindicated
acetominophen inhibits metabolism of warfarin and can increase the risk of bleeding with its use
50
why are antidepressants (TCAs) used to treat pain
they have independent analgesic effects as well as an ability to relieve the depressive sx associated with chronic pain
51
what is the most widely studied TCA for chronic pain
amitriptyline
52
what anti-depressants are used to treat neuropathic pain
- duloxetine - venlafaxine (both SNRIs)
53
indications duloxetine (in terms of pain management)
- chronic MSK pain - fibromyalgia - diabetic peripheral neuropathic pain
54
contraindications duloxetine
- Use of a MOAI concomitantly or in close temporal proximity | - Not used in patients with uncontrolled narrow-angle glaucoma
55
warning duloxetine
- Suicidality: Monitor for clinical worsening and suicide risk - Hepatotoxicity: Hepatic failure, sometimes fatal, has been reported in patients.
56
indications pregabalin
1) Neuropathic pain associated with diabetic neuropathy 2) Postherpetic neuralgia 3) Adjunctive therapy for partial seizures 4) Fibromyalgia
57
pregabalin is a schedule V drug and a pregnancy category C
remember that
58
indications gabapentin
mostly anti-seizure med, but for pain: 1) post-herpetic neuralgia 2) diabetic neuropathy 3) prophylaxis for migraine 4) treatment of fibromyalgia 5) restless legs syndrome
59
gabapentin is a pregnancy category C
remember that
60
MOA tramadol
codeine analog weak mu agonist works primarily by blocking NE and 5-HT reuptake
61
indications tramadol
moderate to moderately severe pain more effective than codeine, less effective than morphine
62
side effects tramadol
sedation, dizziness, headache, dry mouth, constipation Serious side effects: 1) can cause seizures in epileptics 2) can precipitate hypertensive crisis if combined with MAO 3) serotonin syndrome if combined with SSRI, TCA, triptans, MAO, etc
63
MOA tapentadol
moderate to strong opioid agonist similar to oxycodone at mu receptors blocks re-uptake of NE
64
compare adverse effects of tapentadol w/ traditional opioids
tapentadol causes less constipation
65
indications tapentadol
reserved for patients who are not effectively treated with other non-opioids and opioids
66
MOA ketamine
NDMA antagonist
67
indications ketamine
- starting and maintaining anesthesia | - post-operative pain
68
side effects ketamine
- psychological reactions (agitation, confusion, hallucinations) - elevates blood pressure
69
MOA dexmedetomidine
alpha 2 adrenergic agonist
70
indications dexmedetomine
analgesia and sedation - Short-term sedation in critically ill patients who were intubated and are undergoing mechanical ventilation - Sedation prior to/during surgical procedures
71
how is dexmedetomine administered
IV
72
adverse effects dexmedetomidine
- hypotension, bradycardia - nausea - dry mouth - transient - hypertension - agitation - constipation - respiratory depression
73
dexmedetomidine is a pregnancy category C
remember that
74
MOA clonidine
alpha 2 adrenergic agonist blocks transmission of pain signals from periphery to brain
75
indications clonidine
1) used for HTN 2) relief of severe pain 3) treating severe cancer pain in those not treated effectively by an opioid alone
76
how is clonidine administered
continuous infusion through epidural catheter
77
adverse effects clonidine
enhances hypotensive and depressant effects of other drugs
78
MOA ziconotide
selective antagonist at N-type voltage sensitive calcium channels on nociceptive afferent neurons in dorsal horn of spinal cord blocks transmission of pain signals from periphery to brain
79
indications ziconotide
only for chronic severe pain in those for whom intrathecal administration is warranted and when refractory to other treatments
80
adverse effects ziconotide
Confusion, memory impairment, speech impairment, hallucinations, etc. also causes muscle injury (from elevated serum creatinine kinase levels) **enhances depressant effects of other drugs *generally resolve within 2 weeks of drug discontinuation
81
ziconotide is a pregnancy category C
remember that
82
MOA and indications capsaicin
stimulation of TRPV1 (heat reeptor) and desensitizes and/or depletes substance P nociceptive and neuropathic pain
83
MOA camphor and menthol (ICY HOT)
camphor: TRPV1 receptors menthol: stimulates TRPM8 (cold)
84
MOA pentazocine
prototype for the agonist-antagonist opioids used to treat mild to moderate pain kappa opioid receptor agonist and mu opioid receptor antagonist
85
indications pentazocine
analgesia and sedation
86
MOA butorphanol
prototype for the agonist-antagonist opioids used to treat mild to moderate pain
87
contraindications butorphanol
pts w/ history of MI | b/c it increases cardiac work
88
how is butorphanol administered
usually given IM or IV, but nasal spray is opioid tx of choice for migraine
89
indications buprenorphine
used primarily to treat addicts, but also to treat mild to moderate pain
90
adverse effects buprenorphine
prolongs QT interval can cause spasm of sphincter of oddi --> poses risk for pts w/ pancreatitis or biliary dz
91
indications ergotamine
drug of choice for terminating ongoing migraine attack
92
MOA ergotamine
blocks inflammation associated w/ trigeminal vascular system and suppresses release of CGRP
93
adverse effects ergotamine
- nausea vomiting - weakness in legs, myalgia, numbness and tingling of fingers and toes - angina-like pain and tachycardia or bradycardia
94
overdose of ergotamine causes _____
ergotism - constriction of peripheral arteries cause extremities to become cold, pale and numb with gangrene a possibility
95
ergotamine is a pregnancy category X
remember that
96
indications dihydroergotamine
drug of choice for terminating ongoing migraine attack
97
MOA dihydroergotamine
blocks inflammation associated w/ trigeminal vascular system and suppresses release of CGRP
98
compare ergotamine and dihydroergotamine
both drug of choice for terminating ongoing migraine attack dihydroergotamine does not cause N/V, has no physical dependence, and minimal peripheral vasoconstriction, BUT diarrhea is prominent
99
MOA sumatriptan
5-HT agonist
100
indications sumatripan
first line drug for terminating migraine attacks constricts intracranial blood vessels and suppresses release of CGRP relieves HA and nausea, neck pain, photophobia, and phonophobia
101
sumatriptan should not be combined with what other drugs
ergot alkaloids, MAOIs, SSRIs, SNRIs

Ahmed Neuro 2 Depression (16 decks)

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