Unit 9: Analgesia Flashcards
Name some of the body’s responses to pain
bradykinin serotonin histamine K+ ions acids prostaglandins substance P
Arachadonic Acid is a precursor to what? (Think: pain modulation)
prostaglandins
leukotrienes
Name the cyclooxygenase enzymes
COX-1
COX-2
Where are COX-1 receptors typically found?
CNS mucosa kidney endothelium bronchi GI Tract PLT
Where are COX-2 receptors typically found?
bone brain kidneys GI tract female reproductive system
What is the main function of COX-1?
housekeeping
protective effects
Name some effects of COX-1
decrease in gastric acid secretion
increase in mucous secretion
regulate blood circulation
regulate vascular tone and PLT function
What typically induces COX-2?
trauma
inflammatory chemical mediators causing pain
What 2 prostanoids work together to regulate BP?
thromboxane
prostaciclin
What do prostaglandins do?
regulate inflammatory mediation
construct vascular smooth muscle
regulate PLTs
induce labor
Name 3 prostanoids
prostaglandins
thromboxane
prostacyclin
What does prostacyclin do?
stop continual bleeding
What does thromboxane do?
brings PLTs to the site of injury (PLT aggregation) to prevent bleeding
What causes pain/edema in the body?
bradykinin/histamines in the inflammatory process
How do the NSAIDs work?
inhibit prostaglandin synthesis by inhibiting COX-1 and COX-2
Why are the NSAIDs good for joint pain?
all can be found in the synovial fluid after repeated dosings
Benefit of newer NSAIDs
more selective for COX-2 –> do not inhibit PLT function
Risk of children taking ASA
Reye’s Syndrome
Symptoms of ASA Toxicity
increased heart rate tinnitus hearing loss dimness of vision headache N/V/D dizziness confusion
How is ASA toxicity treated?
charcoal + dialysis
Only 2 COX-2 selective inhibitors on the US market
celecoxib (Celebrex)
meloxicam (Mobic)
major risks of COX-2 selective inhibitors
increased risk of:
MI
stroke
What is diclofenac?
non-selective COX inhibitor
Advantages of diclofenac
older
cheaper
GI ulceration less frequent
diclofenac dosing + caution with dosing
50-75mg QID
>150mg/day can cause renal impairment
What is indomethacin (Indocin) used for?
drug of choice for gout closure of PDA in children arthritis tendonitis bursitis
Adverse effects of indomethacin
GI ulceration bone marrow depression mental confusion depression psychosis
Because ketorolac (Toradol) has a MAJOR RISK of GIB, how many times can it be given?
5x
Drug classes used for Rheumatoid Arthritis
DMARDs
corticosteroids
What does DMARD stand for?
Disease-Modifying Anti-Rheumatic Drugs
Two classes of DMARDs
Biologics
Non-biologics
Drug class of Azathioprine
non-biologic DMARD
Drug glass of Chloroquine and Hydroxychloroquine
non-biologic DMARD
Drug class of cyclosporine
non-biologic DMARD
Drug class of methotrexate
non-biologic DMARD
name a 1st line DMARD for RA
methotrexate
major adverse effect of methotrexate…so monitor ____
hepatotoxicity
monitor LFTs
