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BNPH700 > Analgesics > Flashcards

Analgesics Flashcards

1
Q

What different analgesic medications are there?

A
  • Paracetamol
  • NSAID
  • Opioids Agonist
  • Opioid Antagonist
  • Synthetic Opioid
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2
Q

What are the 4 steps of the pain pathway?

A
  • Transduction
    • Inflammatory mediaters are released and activate
      the first neuron , sends message for pain
  • Transmission
    • Neurons are firing (A delta fast, C slow)
  • Perception of pain
  • Modulation
    • Alters a pain signal as it is transmitted along the pain pathway
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3
Q

How many opioid receptors are there and what are they called?

A

Mu
Kappa
Delta

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4
Q

What is an example of an opioid agonist?

A

Morphine
Loperamide
Codeine

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5
Q

What is the indication of use for opioid medications, specifically Morphine?

A

Typically, Opioids are prescribed for the short-term treatment of moderately severe or severe pain, such as pain experienced following surgery or an injury. They can be prescribed for palliative care and chronic pain.

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6
Q

What is the MOA for opioid medications?

A

Spinal level: stimulates opioid receptor and inhibits substance p release from the dorsal horn neurons.

Supraspinal: closes dorsal horn gate inhibiting afferent transmission to cortex. Alter pain perception and response.

Stimulates mu receptors

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7
Q

What are some adverse drug reactions associated with Opioid medications?

A

Respiratory depression, Excessive sedation, Dysphoria, Constipation, Nausea & vomiting, Tolerance and Dependence, (histamine release) itch, bronchoconstriction, urinary retention, Euphoria

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8
Q

What patient education would you provide to someone who is on opioid medications?

A
  • Do not drink alcohol
  • This medication may be addictive with prolonged use, talk to Dr. if you feel it isn’t working for you anymore
  • Has sedation effects and may make you more sleepy than normal
  • This medication can make you constipated
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9
Q

What are some cautions/contraindications associated with opioids?

A

Interacts with alcohol, Monoamine oxidase inhibitor. Opioid antagonist. Avoid in head injury

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10
Q

What are the KEY monitoring requirement associated with opioids?

A

Bowels
Resp rate
Sedation
Nausea/Vomiting (input/output)

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11
Q

What slow releasing types of morphine are available?

A

m-Elson capsules, LA Morph tablets

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12
Q

What are some immediate releasing type of morphine which are available?

A

Severdol tablets or RA Morph solution

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13
Q

What must be available for IV morphine administration?

A

Naloxone and oxygen

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14
Q

How do morphine infusions occur? and what monitoring requirements are required?

A

Through a pump. Monitoring of respiratory rate as well as sedation recorded hourly throughout the infusion as can cause respiratory depression and sedation.

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15
Q

What is the indication of use for Loperamide?

A

Acute and chronic diarrhoea

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16
Q

What is the MOA for Loperamide?

A

Loperamide is synthetic opioid that binds to the opiate receptor in the gut wall. Consequently, it inhibits the release of acetylcholine and prostaglandins, thereby reducing propulsive peristalsis, and increasing intestinal transit time. Loperamide increases the tone of the anal sphincter, thereby reducing incontinence and urgency. Slows down the movement of the gut

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17
Q

What are some adverse drug reactions associated with Loperamide?

A

Nausea, abdominal cramps, dizziness, drowsiness, urticaria (a raised, itchy rash that appears on the skin)

18
Q

What are some contraindications/cautions associated with Loperamide?

A

Conditions where inhibition of peristalsis should be avoided; where abdominal distension develops or in conditions such as active ulcerative colitis or antibiotic-associated colitis. Ensure appropriate use of fluid and electrolyte replacement; in acute diarrhoea only use for short-term symptomatic management

19
Q

What patient education would you provide to someone on Loperamide?

A
  • Loperamide can be taken before or after food.
  • If you forget to take a dose, just take a dose after the next time you go to the toilet with diarrhoea. Do not take two doses together to make up for a missed dose.
  • Make sure you drink plenty of water or electrolyte replacement drinks because diarrhoea can make you dehydrated.
20
Q

What opioid antagonist can reverse opioid overdose?

A

Naloxone

21
Q

What is the MOA for Naloxone?

A

Attach to opioid receptor within the nervous system but not stimulate them = prevention of opioid effects.

22
Q

What are some adverse drug reactions associated with Naloxone?

A

Nausea, vomiting, hypotension, hypertension, tachycardia, headache, dizziness, dry mouth

23
Q

What is an example of a Synthetic Opioid?

A

Tramadol

24
Q

What is the indication of use for Tramadol?

A

Moderate to severe pain; post-operative pain

25
Q

What is the MOA for Tramadol?

A

Tramadol is a synthetic opioid agonist resulting in inhibition of ascending pain pathways in the brain and spinal cord, altering the perception and response to pain. Tramadol also inhibits re-uptake of noradrenaline and serotonin which may contribute to its analgesic activity. Stimulates mu receptors

26
Q

What are some adverse drug reactions associated with Tramadol?

A

Nausea, vomiting, constipation, dry mouth, dyspepsia, biliary spasm, bradycardia, tachycardia, palpitation, oedema, postural hypotension, mood changes, dizziness, confusion, drowsiness, sleep disturbances. Risk of serotonin toxicity

Less risk of respiratory depression, euphoria, or addiction. Reduced seizure threshold

27
Q

What are some contraindications/precautions associated with Tramadol?

A

reduced seizure threshold, risk of serotonin toxicity (contraindicated when on MAOis or history of seizures). Avoid if creatinine clearance within renal function less than 10 mL/minute

28
Q

What is a example of a Non-Steroidal anti-inflammatory drugs (NSAIDs)

A

Ibuprofen

29
Q

What is the indicator of use for NSAIDS (Ibuprofen)?

A

Analgesic for mild to moderate pain, fever, anti-platelet, anti-inflammatory and anti-pyretic

30
Q

What is the MOA for NSAIDs?

A

Inhibit cyclo-oxygenase (COX) enzyme and therefore inhibits production of prostaglandins, Prostaglandin have several psychological actions including the mediation of pain, inflammation and increasing body temperature.

31
Q

What are some contraindications for NSAIDs?

A
  • Renal impairment
  • Asthma
  • Known AKI or peptic ulcers
32
Q

What are some adverse drug reactions associated with NSAIDs?

A

Gastric irritation due to COX 1 decreasing mucus production, peptic ulceration/bleeding, Reduction in GFR leading to fluid retention, Prolonged bleeding time, increased risk of MI & Asthma attacks

33
Q

What patient education would you provide to someone on NSAIDs?

A
  • Advise patients to take ibuprofen with a full glass of water and with food, and to remain in an upright position for 15– 30 min after administration.
  • Educate patient that taking higher than recommended doses does not provide increased pain relief but may increase incidence of side effects. Use lowest effective dose for shortest period of time, especially in the elderly. Avoid the concurrent use of alcohol, aspirin, paracetamol as these can alter the effect of the drug.
  • Inform patients ADRs. Inform Health care professional if rash, itching, tinnitus, weight gain/oedema, epigastric pain, dyspepsia, black stools, hematemesis, persistent headache.
  • Paediatrics: Advise parents or caregivers not to administer ibuprofen to children who may be dehydrated (can occur with vomiting, diarrhoea, or poor fluid intake); dehydration increases risk of renal dysfunction.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected.
34
Q

What is the indicator of use for paracetamol (acetaminophen)?

A

Fever, migraine, tension headache, pain (non-inflammatory origin), osteoarthritis
* Weak anti-inflammatory effect

35
Q

What is the MOA for paracetamol?

A

unclear, has both local action (COX inhibition) and central action (inhibition of prostaglandin synthesis in the CNS)

36
Q

What are some adverse drug reactions associated with paracetamol?

A

ADR’s are RARE: liver impairments, cause malaise, overdose can cause hepatic necrosis

37
Q

What is an adjuvant analgesic and can paracetamol be one?

A

Yes it can. Adjuvant analgesic are medication that is not primarily designed to control pain but can be used for this purpose. (Antidepressants, Anticonvulsants, Antihistamines, Corticosteroids)

38
Q

What patient education would you provide to someone who is taking paracetamol?

A

Lots of other Over The Counter medications contain Paracetamol in them, e.g., cold n flu medications. – caution with exceeding daily dose (4g for an adult).

39
Q

How do you reverse Acute Hepatotoxicity for a paracetamol-induced overdose?

A

hepatotoxicity can be reversed with acetylcysteine (parvalax), this drug works by preventing the hepatotoxic metabolites of Paracetamol from working.

40
Q

What is the WHO analgesic ladder? Explain each step

A

PAIN: Assess, pain evaluation, individual parameters (age, concurrent conditions, drug history, etc.)

!! First step. Mild pain (1-3 pain): non-opioid analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen with or without adjuvants

!! Second step. Moderate pain (4-6 pain): weak opioids (hydrocodone, codeine, tramadol) with or without non-opioid analgesics and with or without adjuvants

!! Third step. Severe and persistent pain (7-10 pain): potent opioids (morphine, methadone, fentanyl, oxycodone, buprenorphine, tapentadol, hydromorphone, oxymorphone) with or without non-opioid analgesics, and with or without adjuvants
* Monitor to prevent ADR’s (constipation, Nausea and
vomiting, sedation, Respiratory depression)

41
Q

What is the difference between COX 1 and COX 2 enzyme?

A

COX 1 is focused on platelets and homeostasis
COX 2 is focused on inflammation

BNPH700 (8 decks)

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