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ClinMed > Pharmacology part 3: Final > Flashcards

Pharmacology part 3: Final Flashcards

1
Q

what are 2 types of analgesics

A

opiods and nonopiods

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2
Q

what are 2 types of antinflammatory agents

A

NSAIDS and glucocorticoids

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3
Q

function of opioids

A

alter pain perception

used with moderate to severe pain

indicated for use in chronic or acute pain

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4
Q

common opioids

A

codeine
fentanyl
hydrocodone
meperidine
morphine
oxycodone
propoxyphene
tramadol

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5
Q

what is an opioid agonist

A

binds to receptor and stimulates

strong and moderate types

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6
Q

what is an opioid antagonist

A

receptor blocker

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7
Q

how does a mixed agonist/antagonist opiod work

A

stimulates some receptors while blocking others

good for pts with addictive potential

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8
Q

where can opioids act

A

at pre/post synaptic neurons on brainstem or on peripheral neurons right in the joints to decrease excitability

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9
Q

where do opioids primarily react

A

brain and spinal cord

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10
Q

what are 3 ways opioids control pain

A

decreased synaptic activity in ascending pain pathways

decreased sensitivoty of sensory neurons that send painful impulses to cord

activate descending anti-pain pathways

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11
Q

minor adverse effects of opioids

A

sedation
mood changes
confusion
N&V
constipation

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12
Q

serious adverse effects of opioids

A

orthostatic hypotension
respiratory depression
potential for tolerance, dependence, and addiction

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13
Q

what is opiod tolerance

A

need more drug to achieve same effect

begins at 1st dose

obvious after 2-3 weeks

lasts up to 1-2 weeks after stop taking

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14
Q

what is opioid physical dependence

A

onset of withdrawal if drug is suddenly stopped

can begin 6-10 hours after last dose and peaks at 2-3 days

symptoms last about 5 days

NOT addiction

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15
Q

symptoms of phsycial dependence

A

body aches
gooseflesh
fever/shivers
N&V
diarrhea
cramps
uncontrollable yawn
weak/fatigue
leg cramps/tremors
sneezing/runny nose
loss of appetote
sweating
tachycardia

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16
Q

what is opioid addiction

A

chronic relapsing disease characterized by compulsive drug seeking and use despite negative consequences and by ling lasting changes in brain

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17
Q

risks of opioid addiction is low if…

A

only used for a limited period of time (i.e. 3-7 days)

dosage matches pt pain level

pt has no hx of substance abuse

pt doesn’t not misuse opioid

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18
Q

what is chronic opioid analgesic therapy (COAT)

A

more than 90 days continuous therapeutic use

misues can occur in 21-29% pts

tolerance/dependence likely but addiction is only estimated to 8-12%

19
Q

what is the role of a patient controlled analgesia

A

patient activates pump and self administers a small amount of opioid

pump is programmed to prevent overdose

20
Q

benefits of PCA

A

may allow better pain control with fewer side effects

increased pt satisfaction

requires pt awareness and cognitive ability

21
Q

what is opioid induced hyperalgesia

A

opioids may be ineffective or increase pain in certain patients

possible mechanism = opioids turn on nociceptive pathways that use glutamate

more likely in pts with hx of addiction

22
Q

rehabilitaion concerns for opioids

A

be alert for orthostatic hypotension

monitor signs of respiratory depression

monitor pain levels and watch out for hyperalgesia

watch for signs of abuse/overdose

23
Q

characteristics of NSAIDs

A

analgesics

anti inflammatory

anti coagulant

24
Q

mechanism of NSAIDS

A

inhibits prostoglandins by oxyclyonase

*prostoglandins cause fever, inflammation, and pain when cell is injured

25
Q

examples of over the counter NSAIDS

A

asprin
ibuprofen
naproxen
ketoprofen

26
Q

examples of prescription NSAIDS

A

fenoprofen
piroxicam

27
Q

major difference between over the counter and prescription NSAIDS is what

A

the cost

28
Q

side effects and rehab concerns for NSAIDS

A

gastric irritation
liver/kidney damage
cardio problems (increase BP and cause cardiac/stroke)
impair bone/cartilage healing

overdose can cause hearing loss, tinnitis, HA, or confusion

29
Q

describe type COX-1 enzyme

A

normal in certain cell types

produce prostoglandins to protect cell

i.e. in stomach, kidneys, and platelets

30
Q

describe COX-2 enzyme

A

induced when cell is injured
synthesizes PG to mediate pain and inflammation

i.e. like RA

31
Q

function of COX-2 selective drugs

A

inhibit synthesis of PGs in pain and inflammation

they spare production of beneficial PGs in the stomach, kidneys, and platelets

can decrease pain and inflammation with less toxicity compared to other drugs

32
Q

concern with COX-2 inhibiting drugs

A

evidence that they promote infarction

can cause heart attack or stroke

some drugs have been recalled

33
Q

only COX-2 drug remaining on market

A

celebrex

34
Q

mechanism in which COX-2 inhibiting drugs promote infarction

A

normal body = nalance between PGs that cause vasodilation and vasoconstriction

COX-2 selsctive drugs = inhibit the dilators and allow constricting PGs to dominate

35
Q

characteristics of acetaminophen

A

analgesic and antipyretic effects

no GI irritaion

no anti inflammatory or anti coagulant effects

high dose = liver toxicity

36
Q

how can acetampnophen be liver toxic

A

too much byproduct of benzo can build up and damage liver due to not enough GSH

37
Q

signs of liver toxicity

A

yellow skin
loss of appetite
bleeding/bruising
N&V
fever

38
Q

how can acetominaphen combined with opiods be beneficial

A

allows better overall pain control with low overdose

39
Q

what are anti infalmmatory steroids

A

aka glucocorticoids or adrenocorticosteroids

powerful antiinflammatory and immunosupressive agents

40
Q

common anti inflammatory steroids

A

betamethasone
cortisone
dexamethasone
hydrocortisone
paramethasone
prednisolone
prednisone

41
Q

how do the anti inflammatory effects of anti inflammatory steroids

A

act on inflammatory cells

drug binds to glucocorticoid receptor in cytoplasm

drug receptor travels to nucleus and decreases expression of inflammatory proteins and increases expression of antiinflammatory proteins

42
Q

administration methods of anti-inflammatory steroids

A

oral = for systemic; regular maintenance dose; dose packs

injection = intra articular; 3-4 per year

other = inhalation, topical, nasal, ophthalmic, otic, etc

43
Q

primary problem with anti inflammatory steroids as well as other concerns

A

catabolic effect on bone, muscle, ligament, tendon, and skin

other = salt/water retention, increased infextion, gastric ulcers, glucose intolerance, glaucome. adrenal supression

ClinMed (10 decks)

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