Pharm: Pain Meds - Iszard Flashcards by Elizabeth Mazza

what does aspirin irreversibly inhibit?

cyclooxygenase 1 AND 2

causes decrease in thromboxane (platelets can’t make more)
effects persist until cells make more COX (platelet half lie approx 8 days)

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what does prostacyclin cause?

vasodilation, inhibits platelet aggregation (anti-thrombotic)

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what does thromboxane A2 cause?

vasoconstriction, promotes platelet aggregation (thrombotic)

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what does PGD2, PGE2 cause?

vasodilation, increased vascular permeability (inflammation)

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expressed in all tissues, all the time

prominent role responding to physiologic stimuli
also contributes to response of any pathologic stimuli (inflammation)

COX-1

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induced in “some” tissues, sometimes

physiologic role in KIDNEY
prominent role is response to any pathological stimuli (inflammation)

COX-2

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which COX isozyme should especially be avoided in pt with CV risk factors?

COX-2

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what NSAID is drug of choice for pts at risk of CV complications?

naproxen

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what are the contraindications for NSAID use?

chronic kidney dz
active duedenal/gastric ulcer
CV disease
NSAID allergy
tx w/ anticoagulants (Warfarin)

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what are the major beneficial actions of aspirin?

suppresses inflammation
mild/moderate pain relief
fever reduction
prevents MI/stroke -> d/t inhibition of COX-1 in platalets

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what does aspirin increase the risk of?

bleeding in pts taking anticoagulants (d/t antiplatelet effects)

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when are adverse outcomes of sodium and water retention seen?

pts with advanced, pre-existing renal dysfunction

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why should aspirin be avoided in children with chicken pox/influenza?

risk of Reye syndrome (swelling of liver and brain)

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why should aspirin be avoided in labor/delivery?

it can suppress spontaneous uterine contractions, induce premature closure of ductus arteriosus, and intensify uterine bleeding

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what is the treatment of hypersensitivity to aspirin?

epinephrine

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what are the important differences between aspirin and non-aspirin NSAIDs?

they are REVERSIBLE, so effects decline as blood levels decline
suppress platelet aggregation, but increase risk of MI/stroke (so should use lowest dose possible)

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indicated for short-term (<5days) management of moderately severe pain

usually after surgery
NOT for pediatric pts, or minor pain

Ketorolac

NOTE: can cause peptic ulcers GI bleed, performation of stomach/intestines

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indicated for:

moderate/severe RA
moderate-severe ankylosing spondylytis
moderate-severe osteoarthritis
painful bursitis/tendinitis
acute gouty arthritis

indomethacin

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what is the contraindication for indomethacin use?

treatment of peri-operative pain in CABG surgery

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indicated for:

mild-moderate HA pain, menstrual pain
minor aches/pains

ibuprofen

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what are the contraindications for ibuprofen?

active gastric/duodenal ulcer

- significant hepatic or renal impairment

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what are the warnings/precautions for ibuprofen?

heart failure, HTN
GI tract irritation
increased risk of renal toxicity

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a sterile topical NSAID for opthalmic use

- inhibits intraoperative miosis

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flurbiprofen

NOTE: contraindicated in pts who are allergic to IBUPROFEN

NSAID used for:

osteoarthritis
RA
juvenile RA

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meloxicam

what are the contraindications of meloxicam?

hx of asthma, or other allergic-type reactions after taking NSAIDs - CABG surgery

NSAID used for relief of: - RA - osteoarthritis - anylosing spondylytis - tendonitis/bursitis - acute gout - *pain*

naproxen

what are the contraindications of naproxen?

hx of asthma, urticaria, or other allergic-type rxn after taking NSAID

what are the warnings/precautions of naproxen?

- hepatotoxicity - thrombotic effects - **can significantly compromise renal function in geriatric pts**

what are the warnings/precautions of diclofenac?

increased risk of SERIOUS CV thrombotic events, including MI/stroke - **risk may occur early and may increase with duration of use**

selctively blocks COX-2 - suppresses inflammation, pain, fever - ***may cause LESS GASTRIC ULCERATION than nonselective inhibitors*** - does NOT inhibit platelet aggregation

celecoxib NOTE: increases risk of MI/stroke, d/t blockade of prostacyclin synthesis in blood vessels

suppresses pain and fever, but NOT **inflammation** - inhibition of prostaglandin synthesis in CNS, but not in periphery - **does NOT impair renal function!**

acetaminophen NOTE: inhibits metabolism of warfarin, can increase risk of bleed

what does acetaminophen overdose cause?

hepatic necrosis, from accumulation of toxic metabolite that forms when glutathione is depleted

how is acetaminophen overdose treated?

**acetylcysteine** know this!

what causes hepatic cell death in acetaminophen overdose?

an alternate metabolic route causes buildup of toxic products when glutathione is depleted

what is the preferred end product of acetaminophen metabolism?

Ac-mercapturate

pain relievers, with independent analgesic effects as well as ability to relieve depressive sx assoc w/chronic pain (MOA unknown)

TCA's - duloxetine, venlafaxine used to treat neuropathic pain - WARNING: suicidality

what are the 4 specific indications for pregabalin?

1. neuropathic pain assoc w/diabetic neuropathy 2. postherpetic neuralgia 3. adjunctive therapy for partial seizures 4. **fibromyalgia** first drug approved for it! but benefits are modest and fade

broad-spectrum anti-seizure med | - 80% of prescriptions written for post-herpetic neuralgia, diabetic neurophathy, migraines, fibromyalgia, **RLS**

gabapentin NOTE: alcohol, opioids and benzo's may intensify depressant effects

widely used for moderate/severe pain - **codeine analog (blocks NE and 5HT)** - more effective than codeine when combined w/aspirin or acetaminophen - less effective than morphine

tramadol

what are the serious side effects of tramadol?

1. seizures in epileptics 2. can precipitate HTN crisis if combined w/MAOI 3. serotonin syndrome if combined w/SSRI, TCA, MAOI

what drug is reserved for patients who are not effectively treated w/other non-opioids and opioids?

tapentadol - moderate opioid agonist, similar to oycodone - *causes less constipation than traditional opioids*

NMDA-antagonist used to - start/maintain anesthesia - post-operative pain - common psychological side effects (agitation, confusion)

ketamine NOTE: has tendency to elevate BP

a2-adrenergic agonist used for analgesia and sedation - short-term sedation in critically ill pts who were intubated - sedation prior to/during surgery - administered via IV

dexmedetomidine NOTE: pregnancy category C, adverse effects on development

a2-adrenergic agonist used for: - HTN (enhances hypotensive/depressant effects) - relief of severe pain (approved for treating severe cancer pain)

clonidine NOTE: pregnancy category C, adverse effects on development

what is the administration route of clonidine?

**continuous infusion through epidural catheter** KNOW this

selective antagonist at N-type voltage gated Ca-channels on nociceptive neurons - prevents transmission of pain signals from periphery to brain - **indicated only for CHRONIC SEVERE pain**

ziconotide NOTE: has adverse CNS effects that generally resolve w/in 2 weeks of drug discontinuation

what is the administration route for ziconotide?

intrathecal (injection into spinal canal)

prototype for agonist-antagonist opioids used to treat mild/moderate pain - produces analgesia, sedation, respiratory depression

pentazocine

how can toxicity of pentazocine be reversed?

higher levels of naloxone

prototype for agonist/antagonist opioids used to treat mild/moderate pain - produces analgesia, sedation, respiratory depression - usually given IM or IV - primarily used to treat addicts - binds very tightly to receptors and cannot be readily reversed by naloxone

butorphanol NOTE: **prolongs QT interval**, increasing cardiac work -> contraindicated in MI

what is the treatment method of choice for using butorphanol for migraines?

nasal spray

what is the drug of choice for terminating ongoing migraine attacks? - well tolerated at usual doses, can cause N/V, weakness in legs, myalgia, numbness/tingling of fingers/toes

ergotamine NOTE: pregnancy category X

less effective than sumatriptan for terminating ongoing migraine atack, but has lower incidence of recurrence - does NOT cause N/V, but **DIARRHEA** is prominent

dihydroergotamine

5HT agonists, first-line drugs for terminating migraine attacks - relieved headache and assoc sx: nausea, neck pain, photophobia, phonophobia - rapid onset of effects (15min after subQ or intranasal)

sumatriptan

what should sumatriptan NOT be combined with?

- ergot alkaloids (ergotamine, dihydroergotamine) | - MAOI, SSRI, SNRI

Pharm: Pain Meds - Iszard Flashcards

(55 cards)