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Pharmacology > Week 9 Pain > Flashcards

Week 9 Pain Flashcards

1
Q

Pain Background

A

No tests can measure or confirm pain
Subjective
Both a sensation and an emotion
The 5th vital sign

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2
Q

Pain Epidemiology

A

Affects many pts – #1 chief complaint
Costly illness
¾ pain suffers receive inadequate pain management

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3
Q

Tolerance?

A

larger dose is required to produce same response formerly elicited by a smaller dose

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4
Q

Dependence?

A

withdrawal syndrome can occur if drug is stopped or dose is rapidly reduced
can be physical or emotional

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5
Q

Addiction

A

Compulsive substance use despite known harmful consequences
Characterized tolerance and dependence

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6
Q

Type of pain
Nociceptive?

A

direct stimulation of pain receptors

Body response to trauma
Most common pain

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7
Q

Nociceptive/Somatic?

A

Skin, bone, joint, muscle, connective tissue
Localized pain

Dull/aching/throbbing pain

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8
Q

Nociceptive/Visceral?

A

internal organs (large intestine, pancreas, kidney)
Referred or localized pain

Deep/aching/squeezing pain

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9
Q

Neuropathic?

A

Peripheral nerve injury not stimulation of pain receptors

Damage of nervous

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10
Q

Radiation?

A

Pain moves one to other
1st shoulder pain then it moved to the hand

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11
Q
A

Numeric Pain Intensity Scale
Most common

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12
Q

Non-pharmacological therapies
Somatic/ simple

A

Heat/cold
Exercise
Massage/relaxation

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13
Q

Non-pharmacological therapies
Somatic/ Minimally Invasive

A

TENS
Acupuncture
Ultrasound

TES= trans-electrical nerve stimulation

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14
Q

Non-pharmacological therapies
Somatic/ Invasive

A

Surgery
Radiation
Nerve Block

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15
Q

Psychological therapies

A

Psychotherapy
Counseling
Support groups
Meditation
Hypnosis
Patient education

心理的

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16
Q

What are pharmacological therapies? 3

A

Primary analgesics
-Simple analgesics
-Opioid
Adjuvant medication
Neuropathic pain treatment

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17
Q

Simple analgesics
Products? 3

A

Aspirin
NSAIDs
Acetaminophen

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18
Q

Simple analgesics
a) Use for?
b) What effect?
c) DO NOT produce what two?

A

a) acute mild-moderate pain
b) ceiling effects
c) tolerance or physiological dependence

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19
Q

Effects of Simple Analgesics 4

A

Analgesic – dec pain
Anti-inflammatory
Antipyretic – dec fever
Anti-platelet – dec clotting

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20
Q

Aspirin daily dosages
Low?
Medium?
High?

Primary Uses?

A

Low (75-81mg/day) for antiplatelet
Medium (650-4000 mg/day) antipyretic and analgesic
High (4000-8000 mg/day) antiinflammation

Commonly used as an antiplatelet agent

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21
Q

Aspirin
Mechanism of action

COX1?
COX2?
Central?

A

Inhibits cyclooxygenase(enzyme) and therefore reduces prostaglandins

COX1
GI protection
Renal perfusion
Platelet aggregation/prevents the formation of thromboxane A2

COX2
Inflammation
Swelling pain

Central
Pain
Fever

Inhibits platelet action permanently
=little dose everyday=can inhibit permanently

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22
Q

Aspirin Complications

A

Gastrointestinal
-Ulceration
Anticoagulant Effects
Risk of bleeding!
Impaired kidney function
Salicylism
– Tinnitus, headache, dizziness
Reyes Syndrome
-Don’t use for fever(viral illness)

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23
Q

NSAID (1st Generation)
Product name

A

Naproxen
Ibuprofen
Ketoprofen
Etodolac
Ketorolac
Indomethacin
Diclofenac

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24
Q

Selective COX-2 inhibitors
NSAIDs 2nd generation
Product name

A

Celecoxib
Meloxicam

cele ib
Melo cam
ox add between

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25
Q

NSAID (1st Generation)
action?

A

Inhibits prostaglandin synthesis via inhibition of COX 1 & 2

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26
Q

What is the difference between aspirin and NSAIDs?

A

NSAIDs cannot permanently inhibit platelet action

NSAIDs work for antiplatelet?
Yes, but not PERMANENT

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27
Q

NSAID
Use for?

A

Analgesic
Antipyretic
Anti-inflammatory

mild to moderate pain

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28
Q

Which NSAIDs are OTC? 3

A

ibuprofen
ketoprofen
naproxen

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29
Q

Which NSAIDs can only use for 5days?

A

Ketorolac

Very potent NSAIDs
for sever pain

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30
Q

NSAIDs
Cautions?

A

Renal dysfunction
inhibition of renal prostaglandin synthesis
vasoconstriction

GI
Inhibition of protective prostaglandin on the GI mucosa

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31
Q

Selective COX-2 inhibitors
action?

A

Selectively inhibit COX2
Protective effects of prostaglandins on
GI mucosa
-decreases GI bleeding/ulcers

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32
Q

Selective COX-2 inhibitors
ADRs?

A

Inc risk of cardiac events

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33
Q

What NSAIDs Black Box Warning?

ALL NSAIDs

A

Inc Cardiovascular Thrombotic Events
-MI, stroke

Gastrointestinal risk
-bleeding, ulceration
-perforation(hole) stomach

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34
Q

NSAIDs
Drug interactions

Anticoagulants

A

Heparin. warfarin
Inc risk of bleeding

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35
Q

NSAIDs
Drug interactions

Inc risk of GI bleeding
ulceration

A

Glucocorticoids
Steroids

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36
Q

NSAIDs
Drug interactions

Inc bleeding
Dec antiplatelet effect

A

Alcohol
Ibuprofen+ low dose aspirin

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37
Q

Acetaminophen
a) action
b) use for?

A

a) inhibits only central COX
b) Analgesic
Antipyretic

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38
Q

Acetaminophen
Maximum dose

a) Acute
b) Chronic
c) Hepatically impaired
Heavy alcohol user

A

a) Acute 1-7days 4g/day
b) Chronic after 8 days 3g/day
c) 2g/day

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39
Q

Opioid Analgesics

a) Use for?
b) action?

A

a) Moderate to severe

b) binds to opiate receptors and alters our perception/response to pain

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40
Q

a) Opiate?
b) Opioid?

A

a) naturally derived drug from opium poppy plant
b) all-encompassing category containing any drug that interacts with the opiate receptors in the body

41
Q

Opioid Classification
Full Agonists 7

A

Morphine
Meperidine
Methadone
Fentanyl
Oxycodone
Codeine
Hydrocodone

42
Q

Opioid Classification
Partial Agonists

A

Pentazocine
Nalbuphine
Butorphanol
Buprenorphine

43
Q

Opioid Classification
Pure Antagonists

A

Naloxone
Naltrexone

44
Q

Opioid Classification
Morphine-Like 7

A

Morphine
Hydromorphone
Hydrocodone
Oxymorphone
Oxycodone
Levorphanol
Codeine

45
Q

Opioid Classification
Meperidine-Like

A

Meperidine
Fentanyl
Remifentanyl
Sufentanil
Alfentanil

46
Q

Opioid Classification
Methadone-Like

A

Methadone

47
Q

Morphine

a) Classification
b) route

A

a) full
b) IV, IM, subQ
Pre rectal
Intrathecal

48
Q

Morphine

a) release type
b) nursing note

A

a) immediate to sustained
b) Most flexible
Natural substance from opium plant
First line for moderate to severe

49
Q

Hydromorphone

a) Classification
b) route

A

a) Morphine -like full
b) IV, IM, SubQ

50
Q

Hydromorphone

nursing note

A

More potent than morphine
Poor oral absorption

51
Q

Oxycodone

a) Classification
b) route

A

a) Morphine -like full
b) Only PO!

52
Q

Oxycodone

a) release type
b) nursing note

A

a)
immediate to sustained
b)
2/3 potency to morphine
Available as combination products with aspirin, acetaminophen, ibuprofen

53
Q

Meperidine

a) Classification
b) route

A

a) Meperidine-like full
b) IV, IM, SubQ, PO

54
Q

Meperidine

a) nursing note
b) caution to which pt?

A

1/10 potency to morphine
Shorter duration of action than morphine
Active metabolite cause tremors, muscle twitching, seizures

renal impairment
elderly

55
Q

Fentanyl

a) Classification
b) route

A

a) Meperidine-Like

b) IV, Patch

56
Q

Fentanyl
a) Most of what?
b) Nursing note

A

a) Most potency
80X potency than morphine

b) Shortest duration
Reversibility is good
during surgery

57
Q

Methadone
a) Classification
b) route

A

a) Methadone like full
b) PO
IV, IM, subQ

58
Q

Methadone

nursing note

A

Delayed onset, LONGEST duration
Used for chronic pain
Narcotic treatment programs

59
Q

Partial Opioid Agonists

a) Advantage
b) Disadvantage

A

a)
Less addictive potential
Less respiratory depression
Less abuse potential

b)
Ceiling effect
Withdraw ADRs

If pt taking full and switch to partial, then occur withdraw ADRs

60
Q

Partial Opioid Agonists

Product name

A

Butorphanol
Buprenorphine
Nalbuphine
Pentazocine

61
Q

Opioid Antagonists
Product name

A

Naloxone
Naltrexone
Pure antagonist

62
Q

Opioid Antagonists
a) Advantage
b) Disadvantage

A

a)
Affinity for all opioid receptors
Can reverse a drug overdose
b)
Sever withdrawal reaction
Short duration

63
Q

Opioid Antagonists
a) route
b) uses

A

a) IV, IM, Sub Q
Nasal spray

b) Rapidly reverse respiratory depression
Treatment of opioid induce pruritis

64
Q

Central Analgesics
product name

A

Tramadol
Tapentadol

Bonds to mu opioid receptors

65
Q

Central Analgesics

a) advantage
b) disadvantage

A

a) Less respiratory depression than natural opioids

b) Addicting
C-IV controlled substance

66
Q
A
67
Q

Naloxone
Dosage form Vial +syringe

A

1ML/repeat in 2 minutes if necessary

IM 3mL

68
Q

Naloxone
Prefilled Syringe + Needle

A

1ML/repeat in 2 minutes if necessary

69
Q

Naloxone
Prefilled Syringe + MAD

A

1ML/repeat in 2 minutes if necessary

70
Q

Naloxone
Nasal Spray

A

4mg
repeat in 2 minutes if necessary

71
Q

Naloxone prescription
Standing Orders

A

Pharmacists can dispense naloxone without a prescription under the physician’s authority
No Dr visits require

72
Q

Naloxone prescription
Third-Party Prescribing

A

The person receiving naloxone does not have to be the person at risk for overdose

73
Q

Naloxone prescription
Liability Protection

A

Persons who prescribe/dispense/administer naloxone are protected from liability

74
Q

Opioid Related ADRs
What is the most common ADRs?

A

Constipation (90-95%)
Tolerance does not develop
Differs by agent

75
Q

Opioid-Related ADRs
How to treat the most common ADRs?

A

1st
Laxatives
– Stool softeners
– Osmotic

Then
Naldemedine and Naloxegol
GI upsets
headaches

76
Q

Opioid-Related ADRs
What is the most serious ADRs?

A

Respiratory Depression
Occurs if respiratory rate falls below 8 breaths/min

77
Q

Opioid-Related ADRs
a) CNS system related
b) parenteral administration related

A

a) Drowsiness and Sedation

b) Itching and pruritus
with parenteral administration

78
Q

Opioid-Related ADRs
N/V

A

Stimulates the chemoreceptor trigger zone
Usually at the start of therapy or with inc
in dose
Tolerance develops in 7-10 days
Can be treated with hydroxyzine or
ondansetron

79
Q

Opioid Drug Interactions
CNS depressants

A

Inc respiratory depression and sedation
Antihistamines
Sedatives
Anti-anxiety

80
Q

Opioid Drug Interactions
Anticholinergic drugs

A

Inc constipation and urinary retention
Antipsychotics
Antidepressants

81
Q

Opioid Drug Interactions
Hypotensive agents

A

Increased hypotension

82
Q

Neuropathic Pain

a) cause?
b) pain felt like?

A

a)
Pain from nerve injury
Diabetic peripheral neuropathy
HIV and Antiretroviral therapy

b)
Burning, tingling
“pins and needles”

83
Q

Neuropathic Pain
Tricyclic Antidepressants/name

A

Amitriptyline

84
Q

Neuropathic Pain
Anticonvulsants/name

A

Gabapentin
Pregabalin

85
Q

Neuropathic Pain
SSNRI/name

A

Duloxetine FDA approved

86
Q

Analgesic Treatment Failure

A

Inappropriate diagnosis or unknown etiology
Misunderstanding of pharmacology or pharmacokinetics
Adverse effects
Fear of addiction
Unrealistic goals for therapy
Patient barriers

87
Q

Muscle Spasms
what is the mechanism?

A

Involuntary contractions of a muscle or group of muscles.
Muscles become tightened and fixed
– Can cause intense pain

88
Q

Muscle Spasms
Causes?

A

-Inadequate blood supply
* Intermittent claudication
– Dehydration
* Cramps
– Pregnancy
– Muscle Injury or Overuse
– Neurodegenerative Disease
* Multiple sclerosis
* Myasthenia gravis
* Stroke/Spinal cord injury

89
Q

Muscle Spasms
Meds name?

A

Baclofen
Cyclobenzaprine
Dantrolene
Tizanidine

90
Q

Dantrolene
a) action
b) Uses

A

a)
Interferes with the release of calcium ions in skeletal muscle
– Calcium release required for contraction
*b)
Muscle spasms
Malignant hyperthermia

91
Q

Dantrolene
ADRs

A

– Liver toxicity/failure
– CNS
* Confusion, speech and visual disturbances, seizures, severe
sedation
– Pleural effusion
Muscle spasms

92
Q

Baclofen
a) action
b) Uses

A

a)
– May involve GABA inhibition
– Appears to affect monosynaptic reflexes
b)
– Muscle spasms
– Alcoholism

93
Q

Baclofen
ADRs

A

CNS
* Sedation, dizziness, weakness, fatigue
Anticholinergic
Withdrawal Syndrome(worse long time use)
Visual and auditory hallucinations
* Delusions
* Agitation
* Seizures
Muscle spasms

94
Q

Cyclobenzaprine
a) action

A

Works in the CNS to dec muscle spasm activity
No direct effect on muscle function

95
Q

Cyclobenzaprine
ADRs

A

Muscle spasms
Seizures
Arrhythmias
Anticholinergic effects
CNS depression
Sedation

96
Q

Tizanidine
a) action
b) Uses
C) ADRs

A

a)
Central alpha 2 agonist
b)
Back spasms
Multiple sclerosis
Anticonvulsant
c)
– Liver failure
– Hypotension
– Increased spasms
– CNS depression
– Constipation, diarrhea, stomach

Muscle spasms

97
Q

Opioid potency
Most to least

A

Fentanyl—- Heroin—- Morphine—- methadone—-codeine—-propoxyphene

98
Q

The most potent a drug is?

A

less amount that is required to produce an effect
Easily to get overdose

Pharmacology (34 decks)

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