Week 4 - Pain Medications and Management Flashcards
What is multimodal therapy? (2)
- There is no single, universal treatment for pain
- using two or more classes of analgesics or interventions to target different pain mechanisms in the PNS or CNS
How does multimodal therapy work? (3)
- purposeful combination of pain medications to maximize relief and prevent gaps in treatment is effective
- may allow lower doses to each of the drugs, which can lead to few side effects
- offers promise of reducing the incidence of prolonged or persistent postsurgical pain
Why is multimodal therapy different for complex chronic pain?
- combining analgesics like anticonvulsants, antidepressants and local anesthetics to target differing underlying mechanisms
What are the 3 analgesic groups for pain?
- Nonopioid analgesics
- opioid analgesics
- Adjuvant analgesics
What are the different nonopioid analgesics? (3)
- acetaminophen
- nonselective NSAIDS (ibuprofen, naproxen, ketorolac)
- COX-2 selective NSAIDS (celecoxib)
What are the different opioid analgesics? (4)
- morphine
- fentanyl
- hydromorphone
- oxycodone
i think they are a brand class that block transmission of nocireception to CNS
What are the different adjuvant analgesics? (3)
- local anesthetics (bupivacaine, ropivacaine, lidocaine)
- Anticonvulsants (gabapentin, pregabalin)
- Antidepressants (desipramine, nortiptyline, duloxetine)
What are the medications on the WHO step-ladder for mild pain? (5)
NON-OPIOIDS, pain 1-3
- ASA
- Acetaminophen
- NSAIDS
- Adjuvants
What are the medications on the WHO step-ladder for moderate pain? (7)
WEAK OPIOIDS, pain 4-6
- A/Codeine
- A/Hydrocodone
- A/Oxycodone
- A/Dihydrocodeine
- Tramadol
+- Adjuvants
What are the medications on the WHO step-ladder for severe pain? (8)
- pain 7-10
- Morphine
- Hydromorphine
- Methadone
- Levorphanol
- Fentanyl
- Oxycodone
+- Adjuvants
As mentioned earlier, what is the first rung of WHO analgesic ladder medications? (8)
- NSAIDS
- salicylates
Aspirin
- propionic acid derivates
—–Ibuprofen (motrin, Advil)
—– Naproxen (naprosyn)
- Selective COX-2 inhibitors (celcoxib (celebrex))
- Acetaminophen - similar to NSAIDS, but no anti-inflammatory action
What are the characteristics of non-opioids? (3)
- used for mild pain
- available OTC
- There is a ceiling, so exceeding doses has no benefits
How NSAIDS work in the body diagram
The second rung on the pain ladder are opioids with non-opiods. What level of pain are they used to treat? (2)
- Most effective and primary drugs for moderate to severe pain
- Weak opioids with Acetaminophen
What can opioids with non-opioids cause? (5)
- sedation
- euphoria
- constipation
- Respiratory depression
- urinary retention
The second rung on the pain ladder are opioids with non-opioids. Why can they be risky to use? (2)
- with continuous use, tolerance develop (may need.a stronger opioid or increase the dosage)
- can also result in physical dependence (NOT the same as addiction)
What type of pain is opioid analgesics used for? (2)
- Mainstay in management of moderate to severe nociceptive types of pain
- postoperative, surgical trauma and burn pain
How do opioid analgesics work (3)
- produces effects by interacting with opioid receptor sites located throughout the body
- like in peripheral tissues, GI system, spinal cord and brain
- binds to receptor sites, produces analgesia AND unwanted side effects
What are the unwanted side effects of opioid analgesics? (3)
- slowing of GI
- Constipation
- respiratory depression
How do pure opioid agonists work? (2)
- bind primarily to the mu-type receptors in the CNS
- first line for mild-moderate pain
What does it mean for pure opioid analgesics to have to ceiling effect? (3)
- increase dosage produces increased pain relief
- can adjust based on pain severity
- subject to abuse but rare when used appropriately
What are the 3 pure opioid agonist?
morphine, fentanyl, hydromorphone
