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Flashcards in Chapter 10 pharm 343 Deck (57):
1

*Acetaminophen (tylenol)

nonopioid analgesic. (APAP) management of pai especially pain with inflammation. avoid from alcoholics or who have hepatic disease. oral, rectal,and IV form. hydrocodone (vicodin) and oxycodone (percocet)

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*Morphine Sulfate

naturally occuring alkaloid from opium poppy. schedule 11 drug. indicated for severe pain and has a high abuse potential. oral, injectable, and rectal forms. hydromorphone is 8 times more potent than morphine.

3

*Naloxone hydrochloride (narcan)

pure opioid antagonist. no agonist morphine-like properties and works as a blocking drug for opioids. does not cause anasthesia and resp depression. only injectable forms.

3

Agonist

a substance that bind to a receptor and causes a response.
mild- codeine, hydrocodone.
Severe- morphine, hydromorphine, levorphanol, oxycodone, oxymorphone, meperidine, fentanyl, and methadone.

4

Acute pain

pain that is sudden in onset, usually subsides when treated, and typically occurs over less than a 6-week period.
It is determined by its onset and duration, associated with disease or conditions and the way they treat.

4

Agonists-antagonists

substances that bind to a receptor and cause a partial response that is not as strong as that caused by an agonist.
(pentazocine and nalbuphine)

5

Addiction

A chronic, neurobiologic disease whose development is influenced by genetic,psycosocial, and environmental factors.

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analgesic ceiling effect

what occurs when a given pain drug no longer effectively controls a patient's pain despite the administration of the highest safety dose.

6

Adjuvant analgesics drugs

drugs that are added for combined therapy with a primary drug and may have additive or independent analgesic properties, or both.
drugs from other chemical categories are added to opioid regimen.
NSAIDS, antidepressants, antiepileptic drugs, and corticosteroids.
reduces some of the adverse effects that are seen with higher dosages of opioids, such as respiratory depression, constipation, and urinary retention.

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analgesics

medications that relieve pain without causing loss of consciousness. (painkillers)

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antagonist

a drug that binds to receptor and prevents a response.
it functions as a competitive antagonists bcuz it competes with and reverse the effects of agonist and agonist-antagonist drugs at the receptor sites.
Opioid antagonists-naloxone and naltrexone and bind to receptor sites. when treating overdose or toxicity, withdrawal may occur. severe resp depression, naloxone is given (shortlived and lasts abt 1hr.).

8

breakthrough pain

pain that occurs between between doses of pain meds.
it is becuz the analgesic effects wear off as the drug is metabolized and eliminated from body.

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central pain

pain resulting from any disorder that causes central nervous system damage.
.

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chronic pain

persistant or recurring pain that is often difficult to treat. pain lasting longer than 3-6months, longer than 1month after healing of an acute injury, or pain that accompanies a nonhealing tissue injury.

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deep pain

pain that occurs in tissue below skin level.

12

gate theory

the most well-described theory of pain transmission and pain relief. it uses a gate model to explain how impulses from damaged tissues are sensed in the brain.
the tissue injury causes the release of several substances from injured cells, such as bradykinin, histamine, potassium, prostaglandins, and serotonin.
some pain meds work by altering the actions and levels of these substances.
the release if these initiates action potentials.

13

cancer pain

pain resulting from any of a variety of causes related to cancer and/or metastasis of cancer.
tumor mass against nerves, organs, or tissues.
include hypoxia from blockage of blood supply, metastasis, pathologic fractures, muscle spasms, and adverse effects of radiation and surgery and chemo.

13

narcotics

originally applied to drugs that produce insensibility or stupor, especially the opioids. currently used to refer to any medically used controlled substances and in legal setting to refer to any illicit or "street" drug.

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neuropathic pain

pain that results from a disturbance of function or pathologic change in a nerve. could also be idiopathic (unexplained).

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nociception

processing of pain signals in the brain that gives rise of the feeling of pain.

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norciceptors

a subclass of sensory nerves that transmit pain signals to the central nervous system from other body parts. A&C fibers.
the nerve impulses are conducted along sensory nerve fibers and activate pain receptors in the dorsal horn of the spinal cord. the so-called gates are located.
the gates regulate the flow of sensory nerve impulses.
if impulses are stopped by gate, no impulses are transmitted to the higher centers of the brain.
if the gates permit sufficient number of action potentials to be conducted from the spine to the cerebral cortex, the pain is felt.
A fiber close gates. C fiber opens gates.

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nonopioid analgesics

analgesics that are not classified as opioids.

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nonsteroidal antiinflammatory drugs (NSAIDS)

a large chemically diverse group of drugs that are analgesics and also possess antiinflammatory and antipyretic activity but are not corticosteroids.

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opioid analgesics

synthetic drugs that bind to opiate receptors to relieve pain. from the opium poppy plant. opium means juice.
morphine, codeine, (pain relievers) and papaverine.(muscle relaxants)
chemical classes: morphine-like, meperidine-like, and methadone-like drugs.
strong drugs- fentanyl, sufentanil, and alfentanil are commonly used in combination with anesthetics during surgery. for balance of anesthesia.
also suppress the medullary cough center which results in cough suppression (codeine is used).
constipation occurs becuz of decrease gi motility it occurs bcuz drugs bind to intestinal opioid receptors.
contraindications- allergy and asthma. resp insufficiency, elevated intracranial pressure, sleep apnea, paralytic ileus, and preggo.
produce marked euphoria.
cause histamine release.-unwanted adverse effects bcuz of it. causes dilation which leads to flushing and orthostatic hypotension.
CNS depression which may lead to resp depression.
urinary retention caused by increasing bladder tone.

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opioid naive

describes pts who are recieving opioid analgesics for the first time and who therefore are not accustomed to their effects.

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opioid tolerance

a normal psych condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms

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opioid tolerant

the opposite of opioid naive; describes pts who have been recieving opioid analgesics for a period of time and who are at gr8er risk of opioid withdrawal syndrome upon sudden discontinuation.
differnt with CYP450 enzymes can cause different pts whether addicted or not to respond more or less effectively to a given drug.

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opioid withdrawal

the s/s associated with abstinence from or withdrawal of an opioid analgesic when the body has become physically dependent on the substance.
cancer pt usually go through withdrawal symptoms.
if opioid doses are abruptly reduced however actual or psychological dependence in such pt is unusual.
symptoms are directly related to half-life of drug being used.

24

pain threshold

the level of a stimulus that results in the sensation of pain.

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partial agonist

a drug that binds to a receptor and causes a response that is less than that caused by a full agonist

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psyochologic dependence

a pattern of compulsive use of opioids or any other addictive substance charaterized by a continuous craving for the substance and the need to use it for effects other than pain relief.

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referred pain

pain occuring in an area away from the organ of origin

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somatic pain

pain that originates from skeletal muscles, ligaments, or joints.

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pain

an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Pain involves physical, psychological, and even cultural factors.

29

special pain situations

the general term for pain control situations that are complex and whose treatment typically involves multiple meds, various health care personnel, and nonpharm therapeutic modalities.

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superficial pain

pain that originates from the skin or mucous membranes opposite of deep pain.

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pain tolerance

the amt of pain a pt can endure without its interfering with normal function.
Can be from pt personality, attitude, environment, culture, and ethnic background.

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synergistic effects

drug interactions in which the effect of a combination of 2 or more drugs with similar actions is gr8er than the sum of individual effects of the same drug given alone.

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tolerence

the general term for a state in which repetitive exposure to a given drug over time, induces changes in drug receptors that reduce the drug's effects.

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phantom pain

pain experienced in the area of a body part that has been surgically or traumatically removed.
burning, itching, tingling, or stabbing descriptions, occur in paralyzed limbs following spinal cord injury.

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vascular pain

pain that results from pathology of the vascular or perivascular tissues.

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physical dependence

a condition in which a pt takes a drug over a period of time and unpleasant physical symptoms occur if the drug is stopped abruptly or smaller doses are given. the physical adaptation of the body to the presence of an opioid.

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visceral pain

pain that originates from organs or smooth muscles.

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World Health Organization

an international body of health care professionals, including clinicians and epidemiologists among many others, that studies and responds to health needs and trends worldwide.
Step 1- the use of nonopioids once pain has been identified.
Step 2- the use of opioids with or without nonopioids and with or without adjuvants.
Step 3- use of opioids administered with or without nonopioids or adjuvants.

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three pain receptors believed to be involved in pain

mu receptors in the dorsal horn of the spinal cord to appear to play the most crucial role.
kappa and delta receptors involved in less pain sensations.
pain is percieved by the number of mu receptors. gene controled by mu opioid gene.
the number of recpetors is high, pain diminishes.
receptors reduced, pain occurs.

37

endogenous Neurotransmitters

enkephalins and endorphins
produced within body to fight pain and are considered painkillers. both are capable of bonding with opioid receptors and inhibiting the transmission of pain impulses by closing the spine gates. endorphin=endogenous morphine.

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massaging pain

pain massaging often reduces pain. when an area is rubbed, large sensory A nerve fibers from peripheral receptors carry pain-modulating impulses to the spine. A fibers close gate to reduce pain.

39

PCA

patients are able to self-medicate by pressing a button on a PCA infusion pump.
morphine and hydromorphine are commonly given PCA form.
ONLY PATIENT CAN USE. -PCA by proxy.

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placebos

inert dosage forms that actually lack meds.
psychological thearpeutic effect that occurs even in the absence of actual meds.

41

equianalgesia

refers to the ability to provide equivalent pain relief by calculating dosages of different drugs and/or routes of administration that provide comparable analgesia.

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interactons of opioids

alcohol, antihistamines, barbs, benzos, phenothiazine, and other CNS depressants can result in additive resp depressants effects.

43

lab tests interations of opioids

increase serum levels of amylase, alanine aminotransferase, alkaline phosphatase, bilirubin, lipase, creatinine kinase, and lactate dehydrogenase.

44

Capsaicin

works by interfering with substance P, a pain signal in the brain. muscle pain, joint pain, and nerve pain.

45

mechanism of action acetaminiphen

it is similar to salicylates. it blocks peripheral pain impulses by inhibition of prostaglandin synthesis. lowers fever body temp by acting on the hypothalamus.

46

indications for acetiminophen

it is appropriate substitute for aspirin bcuz of its analgesic and antipyretic properties. it is also an antifever drug for children with flu symptoms bcuz of the reye's syndrome.

47

overdose of acetiminophen

potential lethal drug for overdose.
can cause hepatic necrosis and hepatic toxicity (can be reversed by acetylcysteine). for healthy dose 4000, alcoholics 2000. maximum daily dose 3000.

48

interactions of acetiminophen

alcohol is potentially the most dangerous. maybe at risk for liver toxicity. other hepatic drugs should be avoided. (phenytoin, barbs, warfarin, isoniazid, rifampin, beta blockers, and anticholinergic drugs.