Pharmacology of Pain Control Flashcards

1
Q

what does somatic pain feel like?

A

Localised aching, gnawing, throbbing

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2
Q

Examples of somatic pain (3)

A

Sunburn
Muscle spasticity
Bone metastasis

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3
Q

What does visceral pain feel like?

A

Poorly localised, deep, aching, cramping, pressure

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4
Q

Examples of visceral pain?

A

Bowel obstruction, pancreatic cancer, pancreatitis

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5
Q

What does neuropathic pain feel like?

A

electric shock, burning, shooting, altered sensation

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6
Q

sites analgesics can act on (4)

A

Injury site
Local nerve conduction
Transmission in dorsal horn
Centrally

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7
Q

adjuvants to analgesics

A

drugs designed for other conditions (off label use)
secondary treatment along w/analgesics
smaller dose of analgesics e.g. steroids, antidepressants, anxiolytics

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8
Q

Any drug or agent with affinity for opioid receptors and reversed by …

A

Naloxone

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9
Q

Where are opioid receptors located?

A

CNS, enteric plexus gut, immune cells, peripheral sensory nerves

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10
Q

mu receptors endogenous ligand

A

beta-endorphine

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11
Q

what effects do mu receptors have? (5)

A
analgesia
respiratory depression
euphoria
dysphoria
hallucinations
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12
Q

other effects of opioids

A
respiratory depression
suppress cough
CTZ stimulation
miosis
constipation
histamine release
hormonal change
SA node depression
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13
Q

what effect does opioid stimulation of CTZ cause?

A

nausea and vomiting

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14
Q

How do opioids cause constipation?

A

delay gastric emptying and inhibit peristalsis

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15
Q

how do opioids cause miosis?

A

Excitatory action on PNS innervation of pupils

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16
Q

What is drug tolerance?

A

increased resistance to a drug’s effects over time so increased doses required to cause same effect

17
Q

What is physical dependence ?

A

sudden withdrawal of a drug provokes withdrawal syndrome, physiological effects

18
Q

Drug addiction - define

A

Pattern of behaviour characterised by craving of psychic effect of a drug

19
Q

Signs of opioid overdose?

A

coma, respiratory depression, pinpoint pupils, confusion, myoclonic jerks

20
Q

Morphine metabolism

A

By the liver and excreted by the kidneys, in renal failure toxic metabolites can accumulate

21
Q

Oxycodone metabolism and excretion

A

metabolised extensively in liver, excreted by the kidneys, less toxic metabolites, still need caution in renal failure

22
Q

Renal failure - fentanyl, morphine or oxycodone?

A

Fentanyl
Oxycodone with caution
Not morphine as metabolites can accumulate

23
Q

1st choice opioids

24
Q

alfentanil - what is this?

A

fentanyl derivative, metabolised in liver, 3rd line opioid, very specialist

25
Fentanyl (transdermal)
potent opioid patch, wide variability in drug delivery
26
Indications of a syringe driver
palliative care | loss of ability to absorb oral medication e.g. NBM, vomiting
27
Opioid switch
Substituting one opioid for another to achieve better balance of analgesia and side effects
28
What is opioid rotation?
Rotating around one opioid to another or alternative route based on patient preference or to improve side effects