Pharmacology - Pain and drug reactions Flashcards

1
Q

What are the different pain types?

A

Acute (nociceptive)
Cancer
Neuropathic (nerve pain)
Chronic non cancer (pain 3+ months, fibromyalgia)

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2
Q

Medications acting on gate controlled pathway?

A

NSAIDS, opioids, Local anaesthesia

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3
Q

What is step 1,2 & 3 on the pain ladder for pain meds?

A

Step 1 = Paracetamol / NSAID
Step 2 = Weak opioid (Codeine, tramadol)
Step 3 = stronger opioid (Morphine, Fentanyl, Methadone, Oxycodone)

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4
Q

What acronym is used for Adverse drug reactions?

A

ABCDSs (Rawlin Thompsons)

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5
Q

What does ABCDE stand for and mean?

A

Augmented (common) = is this presentation predictable
Bizarre (odd) - is there a history of allergy
Chronic - Has patient used drug for long time
Delayed - has patient used drug in past (could cause the issue now?)
End of use - Is patient withdrawing

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6
Q

Where are all adverse drug reactions reported?

A

Reported by MHRA YELLOW CARD SCHEME

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7
Q

Patient factors affecting drug interactions?

A

Old
Polypharmacy
Genetics
hepato/renal disease

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8
Q

What are drug factors?

A

Narrow therapeutic index, solubility

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9
Q

Examples of drug with small therapeutic window?

A

Digoxin
Very small therapeutic window
slight overdose can be very bad news

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10
Q

What is therapeutic range?

A

Where drug is effective
above or below this is negative

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11
Q

Pharmacokinetics influences drug action by influencing?

A

ADME

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12
Q

what is absorption affected by?

A

Acidity (Eg. using PPI)
Motility (eg. erythromycin increases GI motility, OCP + Abx interact therefore gut motility changes and affect contraceptive function)
Solubility

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13
Q

What is distribution affected by?

A

Protein binding

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14
Q

What is metabolism affected by?

A

CYP450 Induction (low therapeutic effect) eg. alcohol, St Johns wort
CYP450 Inhibition (high therapeutic effect) eg. erythromycin, grape juice

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15
Q

What is excretion affected by?

A

Urine pH
Acids cleared faster if urine weakly basic
Bases clear faster is urine weakly acidic

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16
Q

What are some naturally occurring opioids?

A

Morphine + Codeine

17
Q

Modified opioid ?

A

Diamorphine (heroin)
twice as strong as morphine - man made

18
Q

Oral Bioavailability?

A

50%

19
Q

Potency of morphine, diamorphine and pethidine for same effect?

A

5mg diamorphine
10mg morphine
100mg Pethidine (10x weaker than morphine)

20
Q

The receptors for these opioids are found where?

A

In CNS + GIT + resp centres (pontine)

21
Q

Use of opioids?

A

analgesia (strong)

22
Q

Side effects of opioids?

A

Addiction
GI - Constipation & N+V
Resp - Resp distress/depression

23
Q

Treatment for opioid induces resp depression?

A

Naloxone (Competitive opioid inhibitor)

24
Q

What is tolerance vs dependance?

A

Tolerance = Due to overstimulation of opioid receptor - desensitisation
higher dose required to achieve same effect

Dependence = Psychological state of craving euphoria (dependent on it)