pharma treatment of pain Flashcards
what is mech and use of acetpminophen
- indirect inhib of COX in brain
- excellent anti-pyretic
- some hepatotoxicity
- careful in alcoholics and elderly
what is dose equivalent for NSAIDs
2-3/10 for chonic, can be 10 for acute
what are different types of NSAIDs
6 combos of
- high/low potency
- fast/intermed./slow elim
what are 2 types of muscle relaxants and which should be used
- anti-spamodics - yes
non-benzo and benzo - use the non - antispacticity - don’t use
how do anti-dep work
S and N are pain inhibiting in the dorsal horn
- SNRI are best
main indications for anti-deps
neuropathic pain
- duloxetine for fibro and low back
- trazadone (TCA) - for sleep
conta-indications for anti-deps
- glaucoma
- BPH
- prolonged QT
- liver impariment
for duloxetine , CrCl
mech of anti-convusants
- both epilepsy and neuropathic pain are abnormal firing
- volagte gated Na chanel blockers
what are uses of anti-convulsant
neuropathic pain
- gabapentin - mod. reduction
- pregabalin - same risk benefit, but more expensive
2 weak opiods
- codeine
2. tramadol
strong opiods
- morphine
- hydromorphone
- oxycodone
- methadone
- buprenophone
- tapentadol
2 natural opiods
codeine
morphine
5 things that must be done before prescribing opiods
- pain diagnosis
- goal setting
- assess risk of OD
- assess risk of habit formation
- involve patient in decision
3 parts of optimal dose
- effectiveness- improved function
- plateauing - more doesn’t help much
- adverse effects
5 issues in monitoring
- watch for abberant use
- switch opiod when necc
- driving safety
- collborative care
- special pops
when to stop opiods
- resolved
- risk worse than benefit
- complications
- not working
how to stop
- taper
withdrawal
- not life threatening
- very unpleasant
issues with canabanoids
- wide range of doses
- adverse effects at higher doses
- no tolerance
- sleep and mood improved
- trials not great
4 types of cannabanoids
- cannabis
- nabilone
- nabixamols
- dronabinol - discontinued
indications for cannabis
no formal approval for pain
indications for nabilone
severe N/V post chemo
indications for nabiximols
spacticity in MS
3 issues in choosing the right analgesic
- type of pain
- severity and patterns of pain
- pain chars
3 steps on WHO analgesic ladder
- non-opiod
- opiod for mild/mod pain
- stronger opiods
what to do for neuropathic pain
start CPS algorithm
what to do for nociceptic pain
start WHO ladder
