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Clin Med 2 > 2. Pain Control > Flashcards

2. Pain Control Flashcards

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1
Q

any substance, whether endogenous or synthetic, that produces morphine-like effects that are blocked by the morphine antagonist naloxone

A

Opioid definition

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2
Q

exist in plants

derived from the resin of the opium poppy
morphine or codeine

A

Opiates

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3
Q

Opioid Peptides

A

produced in the human body

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4
Q

Codeine
Hydrocodone
Vicodin - (hydro + acetaminophen)
Morphine (MS Contin)
Oxycodone (Oxycontin)
Percocet (oxy + acetaminophen)
Fentanyl (Duragesic)
Hydromorphone (Dilaudid)
Meperidine (Demerol)

A

Opioids to know

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5
Q

analgesia, antitussive (codeine), some are used in treating addiction to transition off of stronger opioids

A

Opioid Indications

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6
Q

bind opioid receptors in the CNS to inhibit ascending pathways

A

Opioid MOA

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7
Q

PO, rectal, IM, IV, topical, subcut infusion, epidural, intrathecal, intranasal, transmucosal

A

Opioid Route

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8
Q

opioids available in

A

immediate or sustained release products

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9
Q

Opioid CNS AE’s

A

*Sedation
*Nausea
Respiratory Depression
Cough Suppression
Miosis (pupil) (no tolerance developed)
Truncal Rigidity

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10
Q

Opioid Peripheral Effects

A

*Constipation (no tolerance)
Urinary Retention
Bronchospasm
Reduced GI motility
Pruritus

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11
Q

OAE: Respiratory depression even at usual doses -

A

contributes to risk of accidental overdose

avoid if baseline resp disease or in combo with other CNS depressants or benzodiazepines, especially in elderly

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12
Q

OAE: Cognitive impairment

A

worst in first few hours after dose and first few days of use; consider when to time the med around PT

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13
Q

OAE: Cough Suppression

A

negative in older patients post-surgery (atelectasis)

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14
Q

OAE: Truncal Rigidity

A

in pt with baseline spasticity may decrease function and further impair ventilation

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15
Q

OAE: Delayed Gastric Emptying

A

impacts absorption of other drugs

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16
Q

3 Main Opioid Receptors

A

MU (µ)
Delta
Kappa

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17
Q

Euphoria
Bradycardia
Emesis
Pruritus
High abuse / dependence potential
—
Respiratory depression (d)
—
Analgesia
Slowed GI Motility

A

µ - side effects

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18
Q

Lower abuse potential (k)
Respiratory depression (m)
—
Analgesia
Slowed GI Motility

A

Delta - side effects

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19
Q

Lower abuse potential (d)
—
Analgesia, spinal
Slowed GI Motility

A

Kappa - side effects

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20
Q

Codeine
Fentanyl
Heroin
Hydrocodone
Hydromorphone
Morphine
Oxycodone

indication: severe pain

A

Full Agonist
(all are strong µ agonists)

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21
Q

Buprenorphine
Butorphanol
Tramadol (p)

A

Partial / Mixed Agonist

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22
Q

Naloxone is a __

A

antagonist

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23
Q

Strong µ agonists

A
  • all of the full agonist list

Watch out for active metabolites
- morphine: can accumulate after extended dosing even if normal renal function (have naloxone on hand)

Oxycodone - often combined with acetaminophen or aspirin for additive effect - decrease opioid effect

Fentanyl - do NOT use for chronic pain management if opioid naive; activity/heat on the patch increases drug delivery, properly dispose of patch

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24
Q

Codeine

A

Mild-Moderate µ Agonist
(weak opioid)

Indication: moderate pain

Prodrug - must convert to morphine to get the effect, can get lingering metabolites

Antitussive effects so used in cough syrup (abuse - purple drank, sizzurp)

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25
Tramadol
Weak µ and k-agonist AND inhibits reuptake of NE and serotonin (NTs in descending inhibitory pain pathway) indication: moderate pain relief Believed to have less risk of dependence but is still possible Increases risk of seizures so avoid if personal history or in combo with other drugs that could increase risk (ex: some antidepressants)
26
Controlled Substances
all of the previous are C-II except tramadol is C-IV C-II = medical, high abuse potential C-IV = medial, low abuse potential
27
tolerance and physical dependence
are not equivalent to addiction and psychological dependence
28
over time decreases some AE's but also decreases analgesic effect treat by increasing dose or changing opioids
Tolerance
29
after long term use experience withdrawal symptoms after missed dose anxiety, irritability, chills, hot flashes, body aches, runny nose, diarrhea, shivering, insomnia, N/V
Physical Dependence
30
deliberately seeking out drug due to compulsive cravings
Addiction
31
addiction treatment
- methadone or buprenorphine - induction therapy (impatient) to titrate until cravings are minimized - maintenance therapy (outpatient) may require observed therapy - end goal" medically supervised withdrawal
32
Naloxone (Narcan)
Competitive antagonist at µ, k, and ∂ receptors highest affinity for the µ-receptor = rapidly reversing respiratory depression and euphoria with less impact on analgesia Route: IV, IM, subcut, intranasal. For acute opioid overdose or resp depression with therapeutic opioid doses Note: naltrexone is also antagonist bu its used for maintenance of abstinence, not acute OD
33
Opioid Anagonist CDC Supports
standing orders at pharmacies through local community-based organizations access and use by law enforcement officials training for basic emergency medical service staff on how to administer drug
34
Who should have naloxone?
Those with legitimate prescriptions for high doses of opioids, especially if also taking benzodiazepines, using alcohol or with some concomitant disease states Those illegally abusing opioids Family and friends of the above
35
Opioid Therapeutic concerns
AEs: drowsy, dulled cognition, constipation, miosis Schedule therapy for max pain relief Increased fall risk Patches - avoid heat, pressure, and exercise be aware of drug seeking behaviors
36
Patient-Controlled Analgesia (PCA)
self-administration: as needed and programmed. ONLT THE PATIENT CAN HIT BUTTON
37
PCS Options
Options: - small worn pump - implant - larger pump on pole Catheters: IC, intrathecal, epidural
38
PCA: Types of Anesthetics
Opioids: morphine, fentanyl, hydroporphone Local: epidural
39
PCS enables _____ pain control
Continuous lowers incidence of side effects more steady-state
40
PCA Dosing Strategies
Loading dose Demand dose Lockout interval 1 and 4 hr limits Background Infusion Rate Successful vs. Total demand
41
Loading Dose
Initial amount given by physician to quickly reduce pain
42
Demand Dose
amount administered when the pt hits the button
43
PCA Pharmacologic Side Effects
adverse reactions to medication
44
Problems with PCA delivery
Programming errors Kinking of tubing Catheter migration Catheter pressing on nerve tissue
45
PCA Benefits for PT
May enable earlier participation in post-op rehab. Patients may be more alert and experience fewer side effects. Patient my be more mobile
46
PCA Disadvantages for PT
Medication may make patient drowsy. - watch for signs of respiratory depression, excessive sedation Be aware of potential pump malfunction/problems - pump may not deliver adequate pain control
47
Cannabinoids
- Endogenous in the body - Exogenous in marijuana - mediate effects via CB1, receptors found in basal ganglia, limbic system, hippocampus, brainstem, cerebellum, and both ascending and descending pain pathways
48
The primary psychoactive compound in marijuana
THC
49
THC causes
euphoria, disinhibition, relaxation, changes in mood and preception
50
a non-psychoactive component of marijuana
CBD
51
CBD is currently marketed in products used for
relief of pain, anxiety, and insomnia
52
MMJ is legalized in ___ states and ___ terriitories
38, 4
53
Federally controlled schedule III substance
proposed change from schedule I to III gives MMJ recognition, accepted medical use allows lawful prescriptions enables research
54
conclusive evidence for CBD effectiveness in
Relieving chronic pain Antiemetic Reduced spasticity with MS
55
CBD: Can educate pt on
different routes of administration and effect time
56
CBD: encourage patient to monitor their pain levels in response to self-administration products to determine effectiveness by...
complete pain journals or scales to track product effectiveness
57
CBD: be aware of signs of abuse
refer to diagnostic criteria for Cannabis Use Disorder
58
Anesthesia Categories
1. General: IV, Inhaled 2. Regional: intrathecal epidural 3. Local: injection, topical
59
4 phases of general anesthesia
1. analgesia/induction 2. delirium/disinhibition 3. surgical anesthesia 4. medullary paralysis
60
Goal of general anesthesia
loss of consciousness, analgesia, amnesia, skeletal muscle relaxation, inhibition of sensory and autonomic reflexes
61
GenA goals achieved by
Balanced anesthesia: combo of IV and inhaled anesthetics, analgesics and neuromuscular blocking agents
62
GenA Categories
Inhaled: - gas (nitrous oxide) - volatile liquids Intravenous: - barbiturates (thiopental) - dissociative (ketamine) - miscellaneous (propofol) - opioids (fentanyl) - benzodiazepines
63
Inhaled GenA's
includes: NO, halothane, etc.. exact MOA unknown adipose creates later hangover effect as drug redistributes
64
IV GenA's
may be used in combo with inhaled anesthetic quick onset, quick recovery often preferred for induction (barbiturates, dissociative, miscellaneous, opioids, benzos)
65
Regional Anesthesia Route:
topical, infiltration anesthesia, peripheral nerve block, IV regional block, epidural or spinal administration.
66
RegA med
lidocaine
67
RegA Categories
Central neuraxial block - epidural or intrathecal space Peripheral nerve block: - near a nerve or plexus innervating the area of surgery Field block: - adjoining tissues so the drug will diffuse to the surgical area for minor hand or foot procedures
68
RegA blocks can be used in combo with GenA to
reduce general anesthesia doses
69
Local Anesthetic MOA
reversibly bind a receptor site within the pore of the Na+ channels in nerves -> block ion movement through the pore -> blocks ap for nerve conduction, especially at small myelinated axons that carry nociceptive input
70
LocA med
lidocaine (patch)
71
LocA advantages
quick recovery, low systemic toxicity, action mostly confined to nerve available OTC
72
LocA disadvantages
incomplete analgesia, longer time to anesthesia
73
LocA AE's
rare but possible, especially if drug enters systemic circulation - CNS stimulation (tremors, confusion, seizures) progressing to CNS depression - CV: arrhythmia, bradycardia, hypotension, cardiac arrest - Respiratory Depression
74
Anesthesia neuromuscular weakness
pt may have prolonged drowsiness potential fall risk - guard carefully regional blocks may not have worn off, especially post-op joint replacement
75
Anesthesia Impaired airway clearance
anesthetics depress mucocilliary clearance encourage pt to cough and deep breathe (incentive spirometer) expel anesthetic gases and pooled secretions
75
GenA Immune function
surgery and anesthesia can supress T and B cell function up to 1 month post-op
76
GenA Older Adults
pulmonary complications during anesthesia and post-op greatly increased reduced cough reflex = increased risk for pneumonia and post-op atelectasis
77
Drug Names
Codeine Hydrocodone Vicodin (h+acetaminophen) Morphine (MS contin) Oxycodone (oxycontin) Fentanyl (duragesic) Hydromorphone (dilaudid) Buprenorphine Naloxone Tramadol Propofol Lidocaine

Clin Med 2 (6 decks)

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