Analgesics Flashcards by Alice Caporn

Q

Parasthesis is painful feelings…

A

With no apparent stimulus (eg. Pins and needles)

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Q

Allodynia is pain from

A

A stimulus that doesn’t usually cause pain

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Q

Short term pain, with an easily identifiable cause. A warning of present tissue damage or disease which respond well to medication is known as

A

Acute/nociceptive pain

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Q

Pain which persists, is constant or intermittent and has outlived its purpose since it no longer helps the body to prevent further injury is known as

A

Chronic/neuropathic pain

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Q

Which is easier to treat using analgesia nociceptive or neuropathic pain?

A

Nociceptive

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Q

The pain pathways is linked to which tract?

A

Spinothalamic tract

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Q

What intensifies the sensation of pain and the pain pathway?

A

Inflammation

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Q

In the pain pathway inflammation intensifies the pain, which drugs could be given to control the inflammation and therefore dampen down the pain signals

A

NSAIDs and paracetamol

Anti inflammatory actions of steroids

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Q

Where in the brain is the ‘perception of pain’

A

Thalamus

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Q

Where in the brain is the pain localised?

A

Somatosensory cortex

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Q

Where in the brain is the behavioural and emotional side of pain

A

Hypothalamus limbic system

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Q

Where in the brain is the ‘alertness’ associated with pain interpreted

A

Reticular formation in the brain stem

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Q

True or false, we have our own endogenous pathways to responding to pain, drugs enhance these

A

True

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Q

Which analgesics modify the transmission of pain signals and the subjective perception of pain

A

Opioids

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Q

Which analgesics are effective for neuropathic pain which is resistant to opioids?

A

Antidepressants, anti epileptics

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Q

Which type of analgesics are effective for trigeminal neuralgia

A

Anti epileptics; carbamazepine

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Q

Which type of analgesic is particularly effective for severe intractable or crescendo neuropathic pain: emergency medicine

A

Local anaesthetics

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Q

Neuropathic pain is often resistant to anaesthetics, true or false

A

True

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Q

Which of the following chemicals may be classed as pain modulators;
Noradrenaline
Enkephalins
Histamine
Bradykinin

A

Enkephalins

Histamine

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Q

True or false, Mu-opioid receptors are responsible for relatively few side effects

A

False

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Q

Mu-opioid receptors may elicit sedation and dysphoria, true or false

A

False

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Q

True or false, opioids interact with cimetidine (drug for ulcer treatment)

A

True

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Q

True or false, acute pain is pain that has lasted for 6months or longer

A

False

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Q

True or false, chronic pain is constant or intermittent pain that does not help the body prevent injury

A

True

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Which analgesics work at spinal cord and CNS level, decreasing neurotransmitter release and blocking post-synaptic receptors, and activating inhibitory pathways

Opioid analgesics

What are some com in side effects of opioid analgesics

Nausea, vomiting, constipation, drowsiness, resp depression, hypotension, dependency

What are the cautions/contraindications of using opioids

Acute respiratory depression Acute alcoholism Head injury

Opioid analgesics interact with alcohol, what effects can be seen

Increased hypertensive and sedative effects

Opioids interact with MAOIs what effect can be seen

Increases CNS excitation/inhibition

Opioids interact with SSRI/TCAs what effect can be seen

Increased sedation

Opioids interact with the drug carbamazepine, what effect can be seen

Decrease in the plasma concentration of methadone

Opioids interact with the ulcer healing drug cimetidine, what happens

Inhibits opioid metabolism

What are the 3 types of opioid receptors

Mu, Kappa, delta

Most analgesic opioids are agonists of which opioid receptor

Mu

Which analgesics mimic our endogenous ligands (enkephalins)

Opioids

Which opioid receptors are found in the CNS and peripheral sensory neurons and don't have a major contribution to the pain pathways?

Delta

Which opioid receptors are found only in the CNS, spinal cord and peripheral sensory neurons

Kappa

Which opioid receptors are responsible for the sedation and dysphoria side effects seen with opioid analgesics

Kappa

Which opioid receptors are responsible for opioid dependence

Mu

Which opioid receptors are found in the CNS, spinal cord, peripheral sensory neurons and GI tract

Mu

Which opioid receptors are responsible for most of the side effects seen with opioid analgesics

Mu

Which opioid receptors are responsible for most of the analgesic effects

Mu

True or false, opioid antagonists have strong analgesic actions

False, opioid antagonists have no analgesic properties, they are used in the treatment of heroine/morphine overdose

The opioid analgesic morphine can be used for which pain A. Chronic B. Acute C. Both

Both

What is the half life of morphine

3-4 hours

How can morphine be administered

Oral IV Intrathecally Subcutaneously

True or false, diamorphine is more rapidly metabolised than morphine

True

How can diamorphine be Administered

Oral | IV

What are the side effects of morphine, diamorphine and fentanyl

Sedation. Tolerance Resp depression. Dependence Constipation. Euphoria N & V Itching

How is the opioid hydromorphine administered

Oral | IV

What is the half life of hydromorphine

2-4 hours

How many more times effective is hydromorphine than morphine

6 fold

Which opioid drug is only indicated for chronic pain?

Methadone

What is the half life of methadone

>24hours

How is methadone administered

Oral | IV

Which two opioids cannot be administered orally?

Buprenorphine and fentanyl

Which opioid analgesic is indicated for acute, intense pain

Pethidine

How can the opioid analgesic Pethidine be administered

Oral IV Intramuscular

Which two opioid analgesics are indicated for mild pain

Codeine | Dextropropoxyphene

Which opioid analgesic causes the side effects of mainly constipation and has no dependence liability

Codeine

Which opioid analgesic is a pro drug, metabolised to morphine once ingested

Codeine

Which opioid analgesic is indicated for acute & chronic pain, rheumatoid arthritis, restless leg syndrome, motor neurone disease and fibromyalgia

Tramadol

What is the half like of Tramadol

4-6 hours

Which analgesics work only upon endogenous inhibitory pathways

Antidepressants

Which type of antidepressants are highly effective for neuropathic pain

Serotonin and noradrenaline re uptake inhibitors

Venlafaxine and duloxetine are examples of what type of analgesic

Antidepressant - serotonin and noradrenaline reputable inhibtors

SSRI are not particularly effective analgesics but may be effective in some cases, such as what?

Diabetic or HIV-related neuropathy

Paroxetine and citalopram are examples of what kind of analgesics

Antidepressants, SSRIs

How do SNRI/SSRIs work as analgesics

Prevent the reputable of neurotransmitters, enhancing their signal which inhibits pain pathway in brain

The SNRI antidepressants duloxetine and Venlafaxine are prescribed as analgesics for pain associated with what?

Diabetic neuropathy

Which SNRI antidepressant causes the following side effects; Nausea, somnolence, insomnia, dizziness

Duloxetine

Which SNRI antidepressant causes the following side effects; | Nausea, sedation, headache and dizziness

Venlafaxine

Which drugs are contraindicated for the following? | Epilepsy, cardiac diseases, angle closure glaucoma, pregnancy/breast feeding

SNRIs duloxetine and Venlafaxine

Opioid analgesics interact with the SNRIs duloxetine and Venlafaxine increasing what?

The sedative effect

Tramadol interacts with the SNRIs duloxetine and Venlafaxine increasing what

Increasing CNS toxicity

NSAIDs/aspirin interact with the SNRIs duloxetine and Venlafaxine how?

Increase risk if bleeding

Which analgesics work by inhibiting ion channels, decreasing electrical activity suppressing the pain pathway

Anti epileptics

Which ion channels do anti epileptics inhibit which makes then effective analgesics

Inhibit voltage gated Na channels and Ca channels

True or false, anti epileptics inhibit glutamine, aminobutyric acid (GABA) and glycine receptors

False, they inhibit glutamate, GABA and glycine receptors

Which anti epileptic drug works well as an analgesic against the following pain; Glossopharyngeal neuralgia, post herpetic neuralgia, trigeminal neuralgia and diabetic neuropathies

Carbamazepine

Which anti epileptic drug works well as an analgesic for various neuropathic pain states; complex regional pain syndrome, deafferentiation neuropathy of the face, post herpetic neuralgia, sciatic type pain, neuropathy

Gabapentin

How do local anaesthetics work as analgesics

Inhibit Na channels, preventing nerve transmission

Lidocaine and ketamine are examples of what type of analgesic

Local anaesthetic

Which type of analgesic is particularly effective for severe intractable or crescendo neuropathic pain: emergency medicine

Local anaesthetics

Which patients is lidocaine not effective as an analgesic

Cancer patients

How is lidocaine administered as an analgesic

IV