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Ada - Neuro 2 > [PHARM] Pharm approach to Pain [Iszard] > Flashcards

[PHARM] Pharm approach to Pain [Iszard] Flashcards

1
Q

Define:

Analgesics

A

Drugs that relieve pain without causing loss of consciousness

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2
Q

What are examples of MSK indications for NSAIDs?

A

Osteoarthritis

Bursitis

Gout ‘flare’

Ankylosing spondylitis

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3
Q

What are (2) other indications for NSAIDs?

A

Headache

Dysmenorrhea

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4
Q

What are the (2) isoenzyme forms of COX?

A

Cyclooxygenase 1 (COX1)

Cyclooxygenase 2 (COX2)

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5
Q

What are the similarities between COX1 and COX2?

A

Both…

  • Use same substrates
  • Make the same products
  • Role in inflammation
  • Physiological role in renal function
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6
Q

What are the features of COX1 that make it distinct?

A

Its expressed in all tissues all the time [constituitive]

Prominant role in responding to physiological stimuli

ALSO contributes to a response in any pathological stimuli that release AA from cells

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7
Q

What are the features of COX2 that make it distinct?

A

Induced in SOME tissues SOMEtimes

Physiological role in kidney, complements COX1

Prominant role in response to any pathological stimuli that release AA from cells

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8
Q

All NSAIDs, but particularly COX2 selective agents should be avoided in patients with:

A

Cardiovascular risk factors

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9
Q

What is the NSAID of choice to give a patient that needs NSAID thearpy but also has cardiovascular risk factors?

A

Naproxen

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10
Q

In addition to cardiovascular risk, what ar the other contraindications for NSAID use?

A

Chronic kidney disease

Active duodenal or gastric ulcer

NSAID allergy

Warfarin use

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11
Q

What are the beneficial actions of NSAIDs (Aspirin)?

A

Supression of inflammation

Relief of mild to moderate pain

Reduction of fever

Prevention of MI and stroke

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12
Q

How does aspirin prevent MI/stroke?

A

Inhibition of COX-1 in platelets

This suppresses platelet aggregation

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13
Q

Aspirin causes ________ inhibition of cyclooxygenase

A

Aspirin causes irreversible inhibition of cyclooxygenase

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14
Q

Because of it’s anti-platelet effects, aspirin can ____________ in patients taking warfarin, heparin and other anticoagulants

A

Because of it’s anti-platelet effects, aspirin can INCREASE THE RISK OF BLEEDING in patients taking warfarin, heparin and other anticoagulants

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15
Q

By impairing renal function, aspirin can cause ______________, ___________

A

By impairing renal function, aspirin can cause Sodium and water retention, edema and hypertension

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16
Q

What population should NOT take aspirin due to REYE SYNDROME risk?

A

Chilren w/ chicken pox or influenza

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17
Q

What is the MOA of non-aspirin NSAIDs?

A

Same as aspirin:

Inhibit COX-1 and COX-2

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18
Q

What are the major differences of non-aspirin NSADIS from aspirin?

A
  • They are REVERSIBLE
  • Suppress platelet aggregation but actually INCREASE RISK OF MI and STROKE
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19
Q

Ketorolac

Indications:

Warnings:

Risks:

A

Indications: Short term management of moderately severe acute pain, usually postoperative

Warnings: Peptic ulcers, GI bleeding

Risks: Bleeding, CV thrombotic events, Renal risk

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20
Q

Indomethacin

MOA:

Indications:

Warnings:

Contraindicated:

A

MOA: NSAID

Indications: RA, Ankylosing spondylitis, Osteoarthritis, Bursitis, Gouty arthritis

Warnings: C/V and GI risks

Contraindicated: Peri-operative pain in setting of coronary artery bypass graft (CABG) surgery

21
Q

Ibuprofen

Indications:

Contraindications:

Warnings/precautions:

Adverse effects:

A

Indications: Fast effective relief of (millions of things); HA, menstrual pain, dental pain, minor aches and pains in muscles, reduction of fever

Contraindications: Active gastric or duodenal ulcer

Warnings/precautions: Pts with heart dz or HTN

Adverse effects: Decreased appetite, edema, fluid retention

22
Q

Flurbiprofen

Indications:

Contraindications:

A

Indications: Opthalmic use; indicated for inhibition of intraoperative miosis

Contraindications: Pts who are hypersentitive to any components of the med; including ibuprofen

23
Q

Naproxen

Contraindications:

Warnings/precautions:

A

Contraindications: Hx. of asthma, uticaria or other allergic type reactions after taking aspirin or other NSAIDs

Warnings/precautions: Hepatotoxicity, Thrombotic effects (BBW)

24
Q

Diclofenac

Warnings/precautions?

A

Increased risk of serious cardiovascular thrombotic events;

Including MI and Stroke

BBW

25
Q

Coxibs

Class:

Benefit:

Risk:

A

Class: 2nd gen NSAID

Benefit: May cause less gastric ulceration than non selective inhibitors

Risk: Increases risk of MI and stroke

26
Q

Acetaminophen

Suppresses?

DOES NOT SUPPRESS?

A

Suppresses = Pain and fever

DOES NOT SUPPRESS = Inflammation

27
Q

Acetaminophen

MOA

Benefits?

A

Inhibition of prostaglandin synthesis in the CNS, but not in the periphery

As a result:

  • Does NOT cause GI ulceration
  • Does NOT suppress platelet aggregation
  • Does NOT impair renal function
28
Q

What is the major risk in taking acetaminophen?

A

Hepatic necrosis

29
Q

What is acetaminophen overdose treated with?

A

Acetylcysteine

30
Q

What is a class of drugs used for patients that have depression and pain symptoms?

A

Tricyclic antidepressants (TCAs)

31
Q

Duloxetine

MOA:

Indications:

Contraindications:

Warnings:

A

MOA: SNRI

Indications: Chronic MSK pain, fibromyalgia, diabetic neuropathic pain, GAD, MDD

Contraindications: MAO inhibitor use

Warnings: Suicidality, Hepatotoxicity

32
Q

Pregabalin

Indications:

Func fact?

A

Indications : Neuropathic pain w/ diabetic neuropathy, postherpetic neuralgia, adjunctive therapy for partial seizures, fibromyalgia

Func fact : First drug approved for fibromyalgia

33
Q

Gabapentin

MOA?

Indications?

Caution?

A

MOA : Anticonvulsant

Indications : Post-herpetic neuralgia, Diabetic neuropathy, prophylaxis for migraine, treatment of fibromyalgia, restless legs syndrome

Caution : Can intensify depressant effects

34
Q

Tramadol

MOA:

Indications:

Side effects:

A

MOA: Codeine analog, weak mu agonist, block NE and 5-HT reuptake

Indications: Moderate to moderately severe pain, more effective than codeine, less effective than morphine

Side effects: Rare, seizures in epileptics, precipitate HTN crisis, Serotonin syndrome w/ SSRI, TCA etc

35
Q

Tapentadol

Who is this drug reserved for?

A

Patients who are not effectively treated with other non-opioids and opioids

36
Q

Ketamine

MOA:

Indications:

Side effects:

Tendencies:

A

MOA: NDMA antagonist

Indications: Starting and maintaining anesthesia, post-operative pain

Side effects: Psychological reactions

Tendencies: Elevate blood pressure

37
Q

Dexmedetomidine

MOA:

Indications:

A

MOA: Alpha2 adrenergic agnoist

Indications: Analgesia and sedation

38
Q

Clonidine

MOA:

Indications:

Route:

Side effects:

A

MOA: Alpha2 adrenergic agonist

Indications: HTN, Relief of severe pain, SEVERE CANCER PAIN

TEST Q***Route: Continuous infusion through epidural catheter***

Side effects: Enhances hypotensive and depressive effects of other drugs

39
Q

Ziconotide

MOA:

Indications:

Adverse effects:

A

MOA: Prevents transmission of pain signals from periphery to brain; Antagonist of N-type voltage sensitive calcium channels

Indications: ***ONLY for chronic severe pain in those whom INTRATHECAL ADMIN is warrented and refractory to other treatments

Adverse effects: CNS effects w/ cognitive impairment

40
Q

What are the topical anti-pain agents?

A

Capsaicin

Camphor

Menthol

Topical NSAIDs

Topical Na+ channel blocker

41
Q

Pentazocine

Indications:

Precautions:

Reversed by?

A

Indications: Agonist-antagonist opioid used to treat mild to moderate pain

Precautions: Unpleasant reactions (nightmares), respiratory depression

Reversed by: Naloxone

42
Q

Butorphanol

Indications:

Reversed by?

Contraindications:

A

Indications: mild to moderate pain

Reversed by: Naloxone

Contraindications: MI

43
Q

Buprenorphine

Indications:

Side effects:

A

Indications: Treat addicts, mild to moderate pain

Side effects: Respiratory depression

44
Q

What are the (3) Anti-migraine agents?

A

Ergotamine

Dihydroergotamine

Sumatriptan

45
Q

What is the drug of choice for terminating an ongoing migraine attack?

A

Ergotamine

46
Q

What are the adverse effects of ergotamine?

A

N/V, weakness in legs, myalgia, numbness and tingling of fingers

47
Q

What is a benefit of using dihydroergotamine over ergotamine?

A

Does NOT cause N/V, has NO physical dependence and MINIMAL peripheral vasoconstriction

48
Q

What is the 5-HT agonist used for terminating migraine attacks?

A

Triptans

Ada - Neuro 2 (4 decks)

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