Week 5 - pain part 2 Flashcards
opioid indication
analgesia
antitussive (codeine)
opioid MOA
bind to opioid receptors in CNS to inhibit ascending pain pathway
Main opioid receptors
mu, kappa, delta
common AE with opioid
constipation
respiratory depression
opioids contra indication
GI obstruction, respiratory depression, paralytic ileus
strong mu agonist opioids
morphine fentanyl hydromorphone meperidine methadone oxycodone
mid-moderate mu agonist (weak opioids)
codeine
what is a prodrug
must convert to morphine through metabolic process to get effects
what is the main effect of codeine
antitussive
opioids agonist-antagonist (partial mixed agonist)
pentazocine
butorphanol
nalbuphine
buprenorphine
most common opioids agonist-antagonist (partial mixed agonist)
buprenorphine
buprenorphine
high affinity with mu receptors
antagonist at delta and kappa receptors
tramadol
weak mu agonist
inhibit reuptake of norepinephrine and serotonin
increased risk of seizure
less risk of dependence
first pass effect
With oral medication
Absorption by liver
which opioids is the comparator
morphine
AE for opioids
CNS effects: sedation, resp depression, cough suppression, miosis
Peripheral effects: constipation, urinary retention, reduced GI motility
most common AE for opioids
sedation and nausea
Tolerance can be develop for every opioids AE except…
miosis and constipation
AE of opioids to consider
resp depression cognitive impairment cough suppression truncal rigidity delayed gastric emptying
what schedule are opioids
schedule II
tolerence
decreased AE and decrease analgesic effect
physical dependence
withdrawal symptoms after missed dose
addiction
compulsive cravings
opioid antagonist
Naloxone
highest affinity for mu receptors
Naloxone
opioid antagonist
for acute opioid overdose or respiratory depression
PT concerns with opioids
fall risk
drug seeking behaviour
what should be avoided with patches
heat, exercise, pressure in area
neuropathic pain
disease or injury to peripheral or central NS
cause of neuropathic pain
damage in peripheral or central nociceptive pathways
types of neuropathic pain
stimulus independent - nerve pain
stimulus dependent - stimuli reaction
1st line treatment for NICe guideline (neuropathic pain)
Duloxetine (Cymbalta)
Pregabalin (Lyrica)
Gabapentin (Neurontin)
Amitriptyline
