Week 4 - pain control part 1 Flashcards
categories of pain
nociceptive - localize - stabbing, aching
neuropathic - nerve involvement - burning, tingling
psychogenic - related to psyc
substantia gelatinosa
dorsal horn of spinal cord
gate keeper to regulat nociceptive fibers
NSAID
cox 1 and cox 2
reduce inflammation, fever and pain
reduce prostaglandins
corticosteroids
reduce inflammation
DMARD
work on inflammatory response
opioids
binds to opioids receptors
cannabinoids
mediate receptors in brain
modulate both ascending and descending pathway
anaesthesia
alter nociceptive input
gabapentinoids, SNRI, Trycyclic, antidepressant
alter NT level to modify nociception and pain perception
NSAID
aspirin, ibuprofen, naproxen, indomethacin, diclofenac, celecoxib, meloxicam
NSAID MOA
inhibits cox 1 and cox 2 enzyme - stop prostaglandins - decrease inflammation (anti-inflammatory) , pain (analgesic), fever (antipyretic)
may inhibit muscle fiber repair
most reversibly inhibit cox 1 and 2
aspirin
NSAID - irreversibly inhibit cox 1 and 2
analgesia, antipyretic, anti inflammatory, antithrombotic
avoid if GI bleeding
avoid infant, teens
Celecoxib
NSAID -
only cox 2 selective
do not use if CV issues
NSAIDS risk
GI (COX 1)
kidney, CV (COX 2)
Naproxen
NSAID - usually the safest
best NSAID for GI issues
celecoxib or ibuprofen
best NSAID if CV issues
naproxen
avoid this NSAID if CV issues
celecoxib
Acetaminophen (Telenol)
NOT NSAID
decrease pain, fever
AE = hepatotoxicity –> avoid if liver issues
good for elder
OA : osteoarthritis
most common joint disease
OA tx
acetaminophen (watch for unintentional overdose)
topical NSAID (voltaren)
intraarticular hyaluronate (for knee or hip)
intraarticular steroids
over the counter tx for OA
glucosamine-chondroitin
gold standard for RA tx
MTX
RA tx
non biological DMARD
biological DMARD
corticosteroids
Non biological DMARD
MTX, hydoxychloroquine
biological DMARD
TNF inhibitor - humira, enbrel
non TNF inhibitor - rituxan
janus kinase inhibitor
boxed warning
TNF inhibitor
humira, enbrel
non TNF inhibitor
rituxan
Prednisone
corticosteroid tx for RA
decrease inflammation, suppress immune system
short term AE: increase blood glucose
long term AE: osteoporosis, fracture risk, muscle waisting
should take calcium and vitamin D
Methotrexate (MTX)
gold standard non biological DMARD AE: liver kidney damage delay progression boxed warning
Hydrocychloroquine
non biological DMARD
only address symptoms not progression
AE: GI, skin rxn
biological DMARD
fight inflammation
AE: infusion rxn, infection
rehab concern with DMARD
liver function + infection
cannabinoids
endogenous
exogenous
CB1 receptors
THC
primary psychoactive compound in marijuana
CBD (cannabidiol)
non psychoactive compound of marijuana
marijuana
schedule 1
types of anesthesia
General
Regional
Local
Phases of anesthesia
Analgesia / induction
Delirium / disinhibition
Surgical anesthesia
Medullary paralysis
What type of anesthesia result in hangover effect and why?
General (inhaled)
stored in adipose tissue
Lidocaine
regional and local anesthesia
Proposal
General anesthesia
what do we need to look out for anesthesia?
respiratory depression
