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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
NSAID (1st Generation) action?
Inhibits prostaglandin synthesis via inhibition of COX 1 & 2
26
What is the difference between aspirin and NSAIDs?
NSAIDs cannot permanently inhibit platelet action NSAIDs work for antiplatelet? Yes, but not PERMANENT
27
NSAID Use for?
Analgesic Antipyretic Anti-inflammatory mild to moderate pain
28
Which NSAIDs are OTC? 3
ibuprofen ketoprofen naproxen
29
Which NSAIDs can only use for 5days?
Ketorolac Very potent NSAIDs for sever pain
30
NSAIDs Cautions?
Renal dysfunction inhibition of renal prostaglandin synthesis vasoconstriction GI Inhibition of protective prostaglandin on the GI mucosa
31
Selective COX-2 inhibitors action?
Selectively inhibit COX2 Protective effects of prostaglandins on GI mucosa -decreases GI bleeding/ulcers
32
Selective COX-2 inhibitors ADRs?
Inc risk of cardiac events
33
What NSAIDs Black Box Warning? ALL NSAIDs
Inc Cardiovascular Thrombotic Events -MI, stroke Gastrointestinal risk -bleeding, ulceration -perforation(hole) stomach
34
NSAIDs Drug interactions Anticoagulants
Heparin. warfarin Inc risk of bleeding
35
NSAIDs Drug interactions Inc risk of GI bleeding ulceration
Glucocorticoids Steroids
36
NSAIDs Drug interactions Inc bleeding Dec antiplatelet effect
Alcohol Ibuprofen+ low dose aspirin
37
Acetaminophen a) action b) use for?
a) inhibits only central COX b) Analgesic Antipyretic
38
Acetaminophen Maximum dose a) Acute b) Chronic c) Hepatically impaired Heavy alcohol user
a) Acute 1-7days 4g/day b) Chronic after 8 days 3g/day c) 2g/day
39
Opioid Analgesics a) Use for? b) action?
a) Moderate to severe b) binds to opiate receptors and alters our perception/response to pain
40
a) Opiate? b) Opioid?
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
Opioid Classification Full Agonists 7
Morphine Meperidine Methadone Fentanyl Oxycodone Codeine Hydrocodone
42
Opioid Classification Partial Agonists
Pentazocine Nalbuphine Butorphanol Buprenorphine
43
Opioid Classification Pure Antagonists
Naloxone Naltrexone
44
Opioid Classification Morphine-Like 7
Morphine Hydromorphone Hydrocodone Oxymorphone Oxycodone Levorphanol Codeine
45
Opioid Classification Meperidine-Like
Meperidine Fentanyl Remifentanyl Sufentanil Alfentanil
46
Opioid Classification Methadone-Like
Methadone
47
Morphine a) Classification b) route
a) full b) IV, IM, subQ Pre rectal Intrathecal
48
Morphine a) release type b) nursing note
a) immediate to sustained b) Most flexible Natural substance from opium plant First line for moderate to severe
49
Hydromorphone a) Classification b) route
a) Morphine -like full b) IV, IM, SubQ
50
Hydromorphone nursing note
More potent than morphine Poor oral absorption
51
Oxycodone a) Classification b) route
a) Morphine -like full b) Only PO!
52
Oxycodone a) release type b) nursing note
a) immediate to sustained b) 2/3 potency to morphine Available as combination products with aspirin, acetaminophen, ibuprofen
53
Meperidine a) Classification b) route
a) Meperidine-like full b) IV, IM, SubQ, PO
54
Meperidine a) nursing note b) caution to which pt?
1/10 potency to morphine Shorter duration of action than morphine Active metabolite cause tremors, muscle twitching, seizures renal impairment elderly
55
Fentanyl a) Classification b) route
a) Meperidine-Like b) IV, Patch
56
Fentanyl a) Most of what? b) Nursing note
a) Most potency 80X potency than morphine b) Shortest duration Reversibility is good during surgery
57
Methadone a) Classification b) route
a) Methadone like full b) PO IV, IM, subQ
58
Methadone nursing note
Delayed onset, LONGEST duration Used for chronic pain Narcotic treatment programs
59
Partial Opioid Agonists a) Advantage b) Disadvantage
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
Partial Opioid Agonists Product name
Butorphanol Buprenorphine Nalbuphine Pentazocine
61
Opioid Antagonists Product name
Naloxone Naltrexone Pure antagonist
62
Opioid Antagonists a) Advantage b) Disadvantage
a) Affinity for all opioid receptors Can reverse a drug overdose b) Sever withdrawal reaction Short duration
63
Opioid Antagonists a) route b) uses
a) IV, IM, Sub Q Nasal spray b) Rapidly reverse respiratory depression Treatment of opioid induce pruritis
64
Central Analgesics product name
Tramadol Tapentadol Bonds to mu opioid receptors
65
Central Analgesics a) advantage b) disadvantage
a) Less respiratory depression than natural opioids b) Addicting C-IV controlled substance
66
67
Naloxone Dosage form Vial +syringe
1ML/repeat in 2 minutes if necessary IM 3mL
68
Naloxone Prefilled Syringe + Needle
1ML/repeat in 2 minutes if necessary
69
Naloxone Prefilled Syringe + MAD
1ML/repeat in 2 minutes if necessary
70
Naloxone Nasal Spray
4mg repeat in 2 minutes if necessary
71
Naloxone prescription Standing Orders
Pharmacists can dispense naloxone without a prescription under the physician’s authority No Dr visits require
72
Naloxone prescription Third-Party Prescribing
The person receiving naloxone does not have to be the person at risk for overdose
73
Naloxone prescription Liability Protection
Persons who prescribe/dispense/administer naloxone are protected from liability
74
Opioid Related ADRs What is the most common ADRs?
Constipation (90-95%) Tolerance does not develop Differs by agent
75
Opioid-Related ADRs How to treat the most common ADRs?
1st Laxatives – Stool softeners – Osmotic Then Naldemedine and Naloxegol GI upsets headaches
76
Opioid-Related ADRs What is the most serious ADRs?
Respiratory Depression Occurs if respiratory rate falls below 8 breaths/min
77
Opioid-Related ADRs a) CNS system related b) parenteral administration related
a) Drowsiness and Sedation b) Itching and pruritus with parenteral administration
78
Opioid-Related ADRs N/V
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
Opioid Drug Interactions CNS depressants
Inc respiratory depression and sedation Antihistamines Sedatives Anti-anxiety
80
Opioid Drug Interactions Anticholinergic drugs
Inc constipation and urinary retention Antipsychotics Antidepressants
81
Opioid Drug Interactions Hypotensive agents
Increased hypotension
82
Neuropathic Pain a) cause? b) pain felt like?
a) Pain from nerve injury Diabetic peripheral neuropathy HIV and Antiretroviral therapy b) Burning, tingling “pins and needles”
83
Neuropathic Pain Tricyclic Antidepressants/name
Amitriptyline
84
Neuropathic Pain Anticonvulsants/name
Gabapentin Pregabalin
85
Neuropathic Pain SSNRI/name
Duloxetine FDA approved
86
Analgesic Treatment Failure
Inappropriate diagnosis or unknown etiology Misunderstanding of pharmacology or pharmacokinetics Adverse effects Fear of addiction Unrealistic goals for therapy Patient barriers
87
Muscle Spasms what is the mechanism?
Involuntary contractions of a muscle or group of muscles. Muscles become tightened and fixed – Can cause intense pain
88
Muscle Spasms Causes?
-Inadequate blood supply * Intermittent claudication – Dehydration * Cramps – Pregnancy – Muscle Injury or Overuse – Neurodegenerative Disease * Multiple sclerosis * Myasthenia gravis * Stroke/Spinal cord injury
89
Muscle Spasms Meds name?
Baclofen Cyclobenzaprine Dantrolene Tizanidine
90
Dantrolene a) action b) Uses
a) Interferes with the release of calcium ions in skeletal muscle – Calcium release required for contraction *b) Muscle spasms Malignant hyperthermia
91
Dantrolene ADRs
– Liver toxicity/failure – CNS * Confusion, speech and visual disturbances, seizures, severe sedation – Pleural effusion Muscle spasms
92
Baclofen a) action b) Uses
a) – May involve GABA inhibition – Appears to affect monosynaptic reflexes b) – Muscle spasms – Alcoholism
93
Baclofen ADRs
CNS * Sedation, dizziness, weakness, fatigue Anticholinergic Withdrawal Syndrome(worse long time use) Visual and auditory hallucinations * Delusions * Agitation * Seizures Muscle spasms
94
Cyclobenzaprine a) action
Works in the CNS to dec muscle spasm activity No direct effect on muscle function
95
Cyclobenzaprine ADRs
Muscle spasms Seizures Arrhythmias Anticholinergic effects CNS depression Sedation
96
Tizanidine a) action b) Uses C) ADRs
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
Opioid potency Most to least
Fentanyl---- Heroin---- Morphine---- methadone----codeine----propoxyphene
98
The most potent a drug is?
less amount that is required to produce an effect Easily to get overdose

Pharmacology (34 decks)

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