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Pharm exam 2 > PPT pain and opioids > Flashcards

PPT pain and opioids Flashcards

1
Q

What is nociception?

A

detection and perception of noxious stimuli

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2
Q

where are the receptors for pain?

A

free nerve endings in the skin, muscle, viscera.

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3
Q

NT for nociceptors include?

A

substance P

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4
Q

Inhibition of the release of substance P is the basis of pain relief by?

A

opioids

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5
Q

What fibers are responsible for fast sharp pain and what fibers are responsible for slow chronic pain?

A

A delta fibers = fast sharp pain

C fibers =Slow chronic pain

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6
Q

A delta fibers

A

rapid onset and offset and is well localized

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7
Q

C fibers

A

aching, burning, throbbing that is poorly localized

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8
Q

size of A-delta fibers?

A

thicker and mylinated

diameter 1-4um

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9
Q

size of C fibers?

A

thinner and unmyelinated

diameter 0.4-1.2 um

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10
Q

Neo-spinothalamic tract is what nerve fibers?

A

fast-sharp pain fibers (A)

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11
Q

Paleo-spinothalamic tract

A

Slow-chronic pain fibers (C)

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12
Q

Where is the substantia gelatinosa?

A

Lamina II and III

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13
Q

Which fibers ascend or descend in the track of Lissauer?

A

A-delta and C fibers

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14
Q

where do the A delta and C fibers enter at?

Where do the cell bodies lie?

A

posterior horn

DRG

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15
Q

what is the NT for A delta fiber?

A

glutamate

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16
Q

what is the NT for C fibers?

A

substance P which binds to NK-1 receptor on the postsynaptic membrane.

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17
Q

tell me the pathway for fast sharp pain?

A

A-delta fibers terminates in Lamina I , cross to the contralateral, lateral spinothalamic tract and ascend to the brain

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18
Q

Tell me the pathway for slow chronic pain?

A

C fibers terminates in Lamina II and Lamina III (Substantia Gelatinosa ).

Interneuron transmit C fibers impulses to Lamina V from Lamina II and III.

Neurons leaving Lamina V cross immediately to the contralateral, lateral spinothalamic tract and ascend to brain

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19
Q

which fibers cross over Lamina V?

A

C fibers

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20
Q

name the main hydrophilic opioid?

A

MORPHINE

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21
Q

Neuraxial (spinal and epidural) placement of hydrophilic opioids, onset, duration, ventilation effects?

A

SPINAL:
slow onset, long duration.
No early depression of ventilation, LATE DEPRESSION OF VENTILATION occur due to rostral spread of CSF.

EPIDURAL:
slow onset and long duration.
early depression of ventilation (within 2 hours) due to systemic uptake. LATE DEPRESSION of ventilation occur due to rostral spread.

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22
Q

If you place one of the fentanyl sisters in the dural space what will the patient have?

A

itchy nose

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23
Q

Neuraxial placement of lipophilic opioid, name the three examples of those opioids as well as spinal and epidural onset, duration, ventilation effects.

A

fentanyl, alfentanil, sufentanil

SPINAL AND EPIDURAL
rapid onset, short duration of analgesia.
EARLY DEPRESSION OF VENTILATION due systemic uptake.
late depression of ventilation DOES NOT OCCUR!

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24
Q

spinal analgesia, when does it occur?

A

Occurs when transmission of pain through substantia gelatinosa (L II) is suppressed

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25
Q

mu-2 is the dominant receptor in what kind of analgesia?

A

SPINAL analgesia

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26
Q

After IV administration of spinal analgesia what specific area do the opioids act?

A

periventricular and periaquaductal gray

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27
Q

opioids produce both what and what analgesia?

A

spinal and supraspinal analgesia

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28
Q

Supraspinal analgesia, where do the opioids act?

A

on limbic system, hypothalamus and thalamus.

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29
Q

mu-1 is the dominant receptor in relation to what type of analgesia?

A

SUPRAspinal analgesia

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30
Q

With IV administration of opioids does it make the pain go away?

A

“I feel pain but I don’t care”

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31
Q

Acupuncture releases what?

A

Endorphins

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32
Q

Descending neurons form periventricular and periaqueductal gray terminates on interneuron in substantia geletinosa (Enkephalin neurons)
WHAT do the interneurons release?

A

enkephalin

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33
Q

Enkephalin inhibits the release of substance P and this leads to what?

A

Spinal Analgesia

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34
Q

How does the dorsolateral tract modulate pain?

A

by hyperpolarizing second order neurons.

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35
Q

What are the three opioid receptors located in the CNS, nerve terminals, GIT, and ANS?

A

u - Mu (1-2)
K- Kappa
d - Delta

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36
Q

list three endogenous opioids?

A

enkephalins, endorphins and dynorphins

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37
Q

which receptor is responsible respiratory depression and addiction (bad stuff)?

A

mu-2

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38
Q

mu -1

A 
analgesia
euphoria
low abuse potential
miosis (PPP)
Bradycardia
Hypothermia
Urinary retention 
C/I in BPH
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39
Q

mu-2

A

analgesia (just spinal)
respiratory depression
addiction
constipation (marked)
decreased motility and tone of GI muscles
increased CSF pressure (cerebral edema) C/I in head injury

40
Q

which opioid receptor (if activated) is contraindicated in head injuries?

A

mu-2

41
Q

K (kappa)

A 
analgesia 
dysphoria
low abuse potential
miosis (PPP)
Diuresis
42
Q

all opioid receptors if activated cause supraspinal and spinal analgesia except for which one that only causes spinal?

A

u-2 (Mu 2)

43
Q

d (Delta)

A

analgesia
respiratory depression
physical dependence
constipation (mild)

44
Q

which opioid receptors cause constipation?

A

mu-2 (maked)

delta (mild)

45
Q

Which opioid receptor causes addiction?

A

mu-2

delta is physical dependence

46
Q

which opioid receptors cause respiratory depression?

A

mu-2 and delta

47
Q

which opioid receptors cause PPP and have low abuse potential?

A

Mu-1 and Kappa

48
Q

which opioid receptor causes euphoria and which one causes dysphoria?

A 
mu-1 = euphoria (extreme happiness)
kappa = dysphoria (feeling negative)
49
Q

which endogenous opioids correlate to which opioid receptors?

A

mu=morphine
delta=enkephalin
kappa=dynorphin

50
Q

how do opioid agonist work?

A

act on opioid receptors

opening K channels and closing Ca++ channels which leads to decreased synaptic transmission and decreased release of neurotransmitters (Ach, NE, glutamate, substance P)

51
Q

cough suppression with opioids

A

dexomethorphan and codeine

52
Q

diarrhea relief with opioids

A

loperamide and diphenoxylate

53
Q

maintenance program for addicts with opioids

A

methadone

54
Q

opioids in general can clinically be used for?

A

pain, acute pulmonary edema

55
Q

toxicity with opioids can cause?

A

addiction, resp. depression, constipation, pinpoint pupils.

56
Q

pinpoint pupils and not being responsive would tell you what about someone who has taken opioids?

A

they have taken or been given too much.

57
Q

what can happen if you push narcan too fast?

A

Vfib

58
Q

opioid antagonist examples?

A

Naloxone (Narcan), Naltrexone (Trexate), Nalmefene

59
Q

What type of antagonist are opioid antagonist?

A

competitive antagonist of opioid receptor.

60
Q

Side effects of opioids antagonist?

A 
increased sympathetic activity. 
reversal of analgesia
excitement/ dysphoria
tachycardia
hypertension
V-fib
pulmonary edema
61
Q

what are mixed agonist/antagonist?

A

stimulate one receptor but block another

62
Q

example of mixed agonist/antagonists?

A

Stadol (Butorphanol) which is used in OB.

63
Q

mixed agonist/antagonist are less likely to cause what and is mediated by what receptors.

A

less likely to cause sever resp. depression and mediate their effect by kappa and delta receptors.

64
Q

due to the histamine release of opioids what happens?

A

pruritus (nose itching)

65
Q

urinary retention as a side effect of opioids, why does that occur?

A

inhibit sacral (parasympathetic) nerve.

Bladder relaxation leads to retention.

66
Q

If respiratory depression occurs as a side effect of opioid use what will you do?

A

monitor pulse ox
give supp. 02
prophylactic naloxone

67
Q

list some other opioid side effects (not the important first three)

A 
sedation
CNS excitation
viral reactivation
sustained erection
constipation
addiction
68
Q

what can cause CNS excitation in older people?

A

Ativan

69
Q

what is a Dart?

A

3ml IM needle for children who do not have an IV who are having laryngospasm.
2ml of sux which is 40mg and 1ml atropine which is 0.4mg.

70
Q

what will you do if someone has a bad reaction to morphine?

A

you will tube them bc have either overdosed or they have had a reaction to morphine.

71
Q

Morphine how does it work, what receptors does it work on?

A

acts on kappa receptors in the Lamina I and II (spinal analgesia) and acts on mu-1 receptors (supraspinal analgesia) and decreases the release of substance P.

72
Q

Does morphine cause loss of consciousness?

A

Analgesia- pain relief without loss of consciousness.

73
Q

alter’s brains pain perception “I feel the pain but I do not care” what drug does this describe?

A

Morphine - increases pain threshold

74
Q

How does morphine cause resp. depression?

A

decreases sensitivity to CO2

75
Q

How does morphine cause PPP

A

increases parasympathetic stimulation by III nerve. (occulomotor?)

76
Q

Is morphine contraindicated in head injuries and if so then why?

A

Yes, increased CO2 retention, increased CSF pressure.

77
Q

what would happen due to a histamine response to morphine?

A

itching and vasodilation (pressure drops)

bronchoconstriction, therefore C/I in asthma

78
Q

The increased ICP with morphine is due to?

A

decreased breathing

79
Q

urinary retention with morphine is due to?

A

relaxed bladder.

80
Q

Do people build up tolerance to morphine?

A

tolerance to analgesic, euphoric and sedative effect.

81
Q

What is morphine-6-Glucuronide?

A

650 x analgesia then morphine.
metabolite of morphine.
greater duration of action.
low permeability to BBB.

82
Q

mechanism of action of Meperidine (Demerol)? (receptors)

A

mu and kappa receptor

83
Q

when will you mostly use Meperidine?

A

post op shivering

84
Q

Meperidine actions?

A

increased total peripheral resistance increased CO

increased CSF pressure

85
Q

Methadone MOA (receptor)

A

mu receptors

86
Q

what is methadone used for?

A

control heroin withdrawal symptoms

87
Q

Fentanyl- potency? is it water or fat loving?

A

100 x analgesic potency than morphine.

Highly lipophilic

88
Q

adverse effect of fentanyl?

A

hypotension

89
Q

Sufentanil, Alfentanil, and Remifentanil?

A

related to fentanyl

Sufentanil is more potent than fentanyl!

90
Q

Codeine (moderate agonist), how does it allow for pain relief?

A

converts to morphine causing analgesia. much less analgesia than morphine.

91
Q

what can codeine be used for, but not over the counter?

A

cough suppression (with analgesia)

92
Q

Pentazocine, what receptors? and what patients would this med be bad for?

A

Agonist on kappa receptor and weak antagonist on mu and delta receptors

not good for heart patients, puts them at risk for MI.

93
Q

What opioid agaonist/antagonist type drug causes psychotic symptoms?

A

Nalbuphine and butorphanol

94
Q

what receptors does Tramadol act on and what kind of opioid is it?

A

mu receptors and it is a opioid agonist/antagonist.

95
Q

in relation to opioids what does Antagonist mean?

A

Bind to opioid receptor (mu) but fail to activate the receptor. Reverse the effects of agonist and precipitate opioid withdrawal

96
Q

What is naloxone (NARCAN) used for and how does it work?

A

Use to reverse respiratory depression of opioid over dose
Competitive antagonist of mu, delta, and kappa receptors
Produces opioid withdrawal syndrome in abusers

Pharm exam 2 (4 decks)

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