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Pharmaco For Pod > wk 2- analegesic, anesthetic, sedatives > Flashcards

wk 2- analegesic, anesthetic, sedatives Flashcards

1
Q

types of pain/ classification of pain

A
  1. acute- less than 30 days, pathology clear, treatment typically analegics
    can be
    nocieptive
    inflammatory
    neuropathic
  2. chronic- constant 3months or longer in the past 6 months, pathology unclear
    can be
    central pain
    non neuropathic
    neuropathic
    psychogenic
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2
Q

treatment of nociceptive pain vs neuropathic

A

nociceptive- sharp, dull, aching pain that can radiate
-NSAIDS and OPIODS

neuopathic- tingly, burning, shooting pain
-Resistant to NSAIDs
-TCAs, anticonvulsants, sodium channel blockers

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3
Q

impacts of pain

A
  • inability to work
  • quality of life
  • loss of worth and self esteem
  • sleep disturbance
  • mood, depression, suicidal
  • health status reduced
  • unable to exercise
  • fatigued
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4
Q

types of analgesics podoatrist can prescribe

A
  1. non opioid analgesics
    - aspirin
    -paracetamol
  2. opoiod
    - codeine
    -oxycodone (surgeon)
  3. NSAIDS
    -celecoxib
    -diclofenac
    -ibuprofen
    -indometacin
    -meloxicam
    -naproxen
    -sulindac
    -ketorlac (surgeon)
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5
Q

acute pain - treatment options and how to treat different severities of pain

A
  1. NSAIDS with or without paracetamol
  2. opioids

mild- non opioid (paracetamol, NSAIDS, aspirin) with or without adjuvant

mod- weak opioid added like codeine

severe- strong opioid instead of weak like oxycodine

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6
Q

paracetamol indications, contrindications, overdose levels

A

analgesic, anti pyretic, mild anti inflammatory

indications- mild to mod pain in isolation or combined

contraindicated in-
infants less than 1 month
hepatic/renal impairment
allergy

3x500mg every 4-6 hours max
which is max 4g daily- build up of toxic metabolites

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7
Q

NSAIDs MOA, indications, contraindications

A

Analgesic, anti inflammatory and antipyretic

MOA- inhibit COX enzyme, reduce prostaglandins

indicated in- pain with inflammation, arthritis/MSK conditions

contraindication in-
peptic ulcers/GI bleeding
asthma
renal/hepatic impairment
hypertension/fluid retention
chronic congestive heart failure
large amount of drugs
alcohol, anticoagulants, antacids, antihypertensives, diuretics, lithium, MTX, NSAIDS, sulfonylureas, cyclosporin
infection/inflammatory response
triple whammy (ACE, NSAID, DUIETRIC)

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8
Q

COX 1 ENZYME

A

stomach lining

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9
Q

cox 2 enzyme

A

inflammatory process and platelet aggregation

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10
Q

NSAIDs can be

A

cox2 selective or non selective (1/2)

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11
Q

what do cox2 selective NSAIDS do

A

also are anti inflammatory/fever and pain relivers but cause fewer stomach and intestinal problems (bleeding, ulcers, sodium retention, renal function) by not inhibiting cox1 responsible for lining the stomach

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12
Q

example of cox2 selecetive NSAIDS (coxib)

A
  • ibuprofen
  • diclofenac- topical
  • naproxen
  • mefenamic
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13
Q

adverse effects of NSAIDS

A

GI bleeding
renal and hepatic disturbances
CVD risk
asthma worsened
rash- topical

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14
Q

triple whammy

A

ACE
DIURETIC
NSAID
renal failure

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15
Q

what NSAIDS are first choice for inflammatory joint disease and why

A

ibuprofen, fenbrufen, naproxen less side effects

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16
Q

a drug that combines paracetamol/ibuprofen

A

maxigesic

17
Q

opioids MOA, indications, contraindications

A

moa- mimick natural ligands for opioid receptors in brain and spinal cord, Mu receptor mostly for analgesia (endorphin, enkephalin)

indications- mod-severe pain

contraindicated in- addiction/dependence

18
Q

adverse effects of opioids

A

with long term use:
tolerance
dependence/addiciton
opioid induced hyperalgesia
endocrine disorders

constipation
nauesea
pruritius (itching)

19
Q

what are adjuvant analgesics?

A

antidepressants and anticonvulsants

most effective in nociplastic nerve pain (neuropathic pain)/ sleep depletion due to pain

20
Q

adverse effects of antidepressents

A

sedation, dry mouth, blurred vision, constipation, weight gain, arrhythmias, orthostatic hypotension

21
Q

adverse effects of anticonvulsants (antiepiletic drugs)

A

drowsiness
nausea
falls/blurry vision
weight gain
cognitive dysfunction
suicidal
convulsions

22
Q

local anaesthesia MOA

A

reversible loss of sensation in an area of the body

block sodium ion channels so that sodium cannot flow into neurons inhibiting the transmission of APs along individual neurons

23
Q

what nerves are more susceptible to LA

A

small fibres and myelinated neurons

24
Q

differences between esters and amides LA

A

esters
short-long duration
metabolised rapidly by enzyme in blood/skin
possiblity of allergic reaction
photo/temperature labile
slower onset
pka- weak base

amides
longer duration
metabolised slower by liver
mod-fast onset
pka- closer to neutral

amide more preferred because of its rapid onset and stable compound, less likely to cause reaction

25
Q

order nerves are blocked by LA

A

smaller myelinated fibres blocked first because more sensitive

autonomic (B)
sensory (A)
motor fibres (C)

26
Q

components of LA molecule and what they do

A

aromatic ring- confers lipid solubility

intermediate linkage- dictates mode of metabolism (ester/amide)

terminal amine- charged or uncharged for water solubility

27
Q

what are LAs pH and why is it important

A

weak bases, they exist in both ionised and unionised forms but only the unionised form can reach its site of action then it needs to become ionised to bind to sodium ion channels

28
Q

amide LA

A

bupivacaine
lidocaine
ropivicaine
etidocaine

29
Q

ester LA

A

cocaine
chloroprocaine
tetracaine
procaine

30
Q

important clinical properties of LA

A

onset
potency
duration of action

31
Q

potency means

A

concentration of rug required to produce effect

32
Q

onset means

A

length of time it takes for medicine to work

33
Q

complications of LA

A

-broken needles
-wrong solution
-injection into blood vessel
-infection
-neuralgic pain
-nerve palsy

34
Q

allergies to LA

A

allergy to LA is rare

allergies are usually related to
psychogenic
presevatives / latex
cardiovascular response to adrenaline

35
Q

allergies are more common in

A

esters

36
Q

sedatives/hypnotics podiatrist can prescribe

A

diazepam
lorazepam

37
Q

benzos (sedatives/hypnotics) MOA

A

increase effectiveness of endogenous inhibitory neurotransmitter GABA

38
Q
A

Pharmaco For Pod (10 decks)

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