week 2 - Pain and Analgesia, Local Anaesthetics and Sedatives

Question 1

What is pain

Answer 1

the unpleasant sensory and emotion experience with action or potential tissue damage

Question 2

Acute vs chronic pain

Answer 2

acute - short duration, identifiable pathology

chronic - pain for 3 months of longer, sometime no identifiable pathology

Question 3

Nociecptive pain vs neuropathic pain

Answer 3

nociceptive = sharp, dull, aching pain (NSAIDS and opiods)

neuropathic = tingling, strange, burning pain (resistant to NSAIDS - use SSRIs or SSNIs)

Question 4

How do you measure pain

Answer 4

on pain scale 0-10

Question 5

Impact of pain

Answer 5

inability to work
inability to perform ADRS
loss of worth
loss of self esteem
cost on WC and medicare

Question 6

WHO analgesic step ladder

Answer 6

Mild pain - non opioid analgesic
Persistent pain - weak opioid
severe pain - strong opioid

Question 7

Compare a non-selective COX1 and 2 compared to a selective cox 2 inhibitor

Answer 7

Cox 1 pathway = GI increase mucous, vasoconstriction and aggravation of platelets
Cox 2 pathway = inflammatory effect and increase in fluid excretion
COX 1 and 2 inhibitors = ibeprofen, diclofenac etc
+ves = antiinflammortary via cox 2 pathway, interfere with platelets via cox 1

Selective cox 2 inhibitor - follow the cox 2 pathway = less cox 1 effects. good for patients with GIT issue as it has less impact on GIT system, more impact on CVD system however

Question 7

Triple whammy

Answer 7

ACE inhibitor - inhibiting arteriolar vasoconstriction
Loop diuretic - contraction of circulating blood volume
NSAID - decrease renal vasodilation

Question 7

Local anesthetics work

Answer 7

work by blocking sodium ion channels = na cant travel down which inhibits the transmission of APs along the neurons

Question 7

Adjuvant analgesics

Answer 7

medications not designed to decrease pain but can be used to decrease pain - i.e antidepressants SSRIs and SNRIs

Question 7

Esters and amides

Answer 7

Esters - short, moderate, long duration. metabolised by the blood and skin

Amides - long duration. metabolised by the liver
(have ‘i’ in the name seperate to the ‘caine’)

Question 8

Purpose of the component of the local anesthetic drug molecule

Answer 8

aromatic drug - confers lipid soluability
intermediate linkage - dictates mode of metabolism
terminal amide - allows molecule to be water soluable

Question 9

clinical properties of Las

Answer 9

onset
potency
duration

Question 10

AEs of LAs

Answer 10

• systemic features
• AEs increase is renal impairment as they secrete out of the kidney
• actions on other parts of the body
• can pass into the BBB