Drugs For Treating Pain Flashcards
(59 cards)
1
Q
Pain: a unpleasant _____ and _____ experience associated with or resembling that associated with actual or potential ______ damage or described in terms of such damage.
A
- sensory
- emotional
- tissue
2
Q
What is the difference between acute and chronic pain?
A
- acute: up to 6 months? 6 weeks with acute injury
- chronic: 3-6+ months
3
Q
Describe the 3 types of pain:
A
- nociceptive: pain that we can link to somatic or visceral stimulation.
- inflammatory: can stimulate pain receptors
- pathological: pain that is not from a injury source. Can be emotional or psychological component or issues in processing sensation.
4
Q
Describe analgesics:
A
- drugs used to alleviate (reduce or eliminate) pain
- does not cause loss of consciousness
5
Q
Describe opiates:
A
- drugs that are obtained from the opium poppy
- naturally occurring drug
- main form: morphine
6
Q
Describe opioids:
A
- broader term referring to drugs with similar effects as opiates
- can be synthetic and semi-synthetic
7
Q
Describe narcotics:
A
- any controlled substance in legal context
- primary categories: schedule 1 and 2. Illegal to produce, distribute, or administer.
8
Q
Describe narcotic analgesic:
A
- another term referring to opioids
- relieves pain and produces a state of drowsiness or sleep. Can affect consciousness.
- pain relievers that have an abuse potential
9
Q
Give examples of types of drugs for treating pain:
A
- NSAIDs and corticosteroids
- Acetaminophen (non opioid analgesics)
- opioids
- topical analgesics
- topical and local anesthetics
- caffeine
- anti-depressants and anti-convulsants
10
Q
Outside of North America, Acetaminophen is called….
A
Paracetamol
11
Q
Describe the potential therapeutic effects of acetaminophen.
A
- analgesic and antipyretic
- not anti-inflammatory or anti-platelet
12
Q
Acetaminophen does not affect what organs/structures?
A
- does not cause stomach irritation or ulcers
- does not affect platelet function
- does not affect kidney function
13
Q
Acetaminophen is available in what forms?
A
- tablets, capsules
- chewable tablets
- suppositories
- elixirs, suspensions
- IV
14
Q
What is the difference between tablets, capsules, and caplets?
A
- capsule can be broken open, has gelatin outer component with powder or liquid inside of it.
- tablet = round
- caplet = oval or rectangle
15
Q
When would you use suppositories?
A
If someone is vomiting a lot
16
Q
What is the difference between elixirs and suspensions?
A
- elixirs: liquid form (syrup), contains sugar to make it more palatable.
- suspensions: liquid that has beads in it that contain the medication. Usually administered to infants.
17
Q
Describe the pharmacokinetics of acetaminophen.
A
- generally taken orally = goes through first pass
- readily and completely absorbed from GI tract
- half-life around 2 hours. Usually taken every 4-6 hours.
- metabolized by liver and metabolites are excreted in urine.
18
Q
Indications for acetaminophen:
A
- mild to moderate pain
- fever
19
Q
Describe the dosing of acetaminophen.
A
- typically 325 - 500 mg.
- Tylenol arthritis has 650 mg in a extended/controlled release form. Has different dosing schedule, usually every 12 hours.
- 4000 mg max daily dose
- 1000 mg max dose at 1 time in adults.
- ceiling effect
20
Q
What is the ceiling effect?
A
If you take more than the recommended amount, there is no additional benefit seen and you are more at risk of adverse effects.
21
Q
Describe the biggest adverse effect from acetaminophen.
A
- hepatotoxicity (liver toxicity)
- amount of acetaminophen exceeds the ability of the liver to metabolize it completely
- toxic metabolite accumulates and reacts with components of the liver cells
- symptoms: nausea, vomiting, drowsiness, abdominal pain
- evidence of hepatotoxicity is evident 2-4 days after overdose
- people often unknowingly take products that have acetaminophen in them (combination products)
22
Q
Describe drug interactions with acetaminophen.
A
- alcohol: increases production of toxic metabolite of acetaminophen. Chronic alcohol consumption compromises liver.
- warfarin (anti-coagulant): even though acetaminophen is not an anti-platelet drug, it can inhibit warfarin medication and increase bleeding time
23
Q
Medications often mixed with acetaminophen:
A
- caffeine: assumed to be utilized because it speeds up metabolism of acetaminophen so that it works faster. Migraine meds have this. Caffeine itself may also have an effect on decreasing pain.
- codeine
24
Q
2 types of opioids:
A
- endogenous (body produces its own): endorphins
- exogenous (produced outside of the body)
25
Name the opioid receptors found primarily in CNS, PNS, and GI tract.
- Mu (Mu opioid receptors - MOR): associated with analgesics and euphoria. Respiratory depression is a risk.
- Kappa: associated with analgesics, sedative and dysphoria (not as good as Mu)
- Delta: associated with sedative
26
If a medication goes through the first pass effect, they need to take a ______ dose if taking oral form vs parenteral form.
Larger
27
Describe pharmacodynamics and pharmacokinetics of opioids.
- absorption: most opioids absorbed well. Oral needs larger dose.
- distribution: opioid molecules bind to plasma that circulates. Reaches brain, liver, lungs, kidney.
- frequently administer prescriptions accumulates in adipose and muscle tissue.
- metabolism: extensive first-pass in liver
- excretion: primarily through urine
28
Indications for opioids:
- moderate to severe pain
- cough suppression (cough syrup with codeine - because of depression of respiratory system)
- diarrhea (opioids associated with constipation)
29
Adverse effects of opioids
- respiratory depression
- constipation
- sedation/drowsiness
- orthostatic hypotension
- miosis (pin point pupils)
- urinary retention
- nausea and vomiting
- tolerance
- dependence
- addiction
30
What is the difference between tolerance, dependence, and addiction?
- tolerance: as you take it, you develop tolerance and require more to get the same effect.
- dependence: physical response. Withdrawal.
- addiction: broad term that includes psychological response
31
Abrupt withdrawal of opioids causes:
- abstinence syndrome
- early presentation of tremors, sweating, irritability etc.
32
Drug interactions with opioids:
- CNS depressants (since opioids are also a depressant, causes excessive CNS depression and respiratory depression): ex. benzodiazepines, alcohol, cannabis.
- caffeine (stimulant)
33
Routes of administration for opioids:
- oral
- parenteral (non GI forms. Primarily injection - IV, subcutaneous, intranasal, intraspinal, intramuscular)
34
Describe the indications for morphine:
- moderate to severe pain
- constant, dull pain relieved at lower doses than sharp, intermittent pain
- decrease anxiety and distress
- causes drowsiness
35
Describe codeine and what it is used for.
- codeine = opiate and opioid
- biotransformed, activated into morphine
- less potent than morphine
- mild to moderate pain
- antitussive (aka cough suppressant)
- often used in combination
36
What are the 4 types of prescription Tylenol?
Tylenol 1: acetaminophen (300 mg) + codeine (8 mg) + caffeine (15 mg)
Tylenol 2: acetaminophen (300 mg) + codeine (15 mg) + caffeine (15 mg)
Tylenol 3: acetaminophen (300 mg) + codeine (30 mg) + caffeine (15 mg)
Tylenol 4: acetaminophen (300 mg) + codeine (60 mg)
37
Describe meperidine.
- aka Demerol
- opioid
- shorter duration
- adverse effects: tremor, muscle twitching, seizures
- do not use with monoamine oxidase inhibitors (used to treat depression)
38
Describe oxycodone.
- available in controlled-release form (OxyContin), larger dose
- generally suggested to take oxycodone. Only prescribed OxyContin if it is long term chronic pain but should not be the first line of defence.
- those that are addicted often seek out OxyContin and crush the drug to get the high dose faster.
39
Percocet is made up of _____ + ______.
- oxycodone
- acetaminophen
40
Vicodin is made up of _______ + ______.
- hydrocodone
- acetaminophen
41
Describe methadone.
- longer duration of action
- good oral absorption
- used as analgesic
- opioid, but used to prevent withdrawal syndrome in heroin addicts during treatment
42
Describe fentanyl
- 100x more potent than morphine
- available parenterally as an adjunct to anesthesia (used in medicine with Sx for sedation and pain)
- available as a transdermal patch for chronic, severe pain in opioid tolerant patients.
- Is manufactured on the street and cut into other drugs because it is cheap and highly addictive
43
What is car-fentanyl?
- not supposed to be used in humans
- used as a tranquilizer for large animals
- 100x more potent than fentanyl
- some drugs are being laced with car-fentanyl
44
What is a opioid antagonist?
Naloxone
45
Describe tramadol
- was initially considered an opioid but with lower risk of respiratory depression, physical dependence, and addiction.
- with further research, it is now considered a opioid and is a schedule 1 controlled substance.
46
How can opioid analgesics be used appropriately?
- should not be the first routine therapy for chronic pain
- measurable goals of pain and function should be set
- discuss the benefits/risks and nonopioid options
- prescribe only immediate release opioids for acute pain
- start low and go slow. Prescribe no more than needed
- do not prescribe extended-release or long-acting opioids for acute pain
- follow up and reevaluate risk of harm. Reduce dose or taper and discontinue if needed.
47
Describe topical analgesics.
- salicylates and/or menthol, camphor, capsaicin
- counterirritants (stimulates something other than what is injured - similar to gate control theory)
- rubefacient effect - localized vasodilation resulting in redness and warmth
- adverse effects: skin reactions or burns if wrapping on top
48
What are salicylates?
- aspirin (do not use with those with aspirin sensitivity)
- some anti-inflammatory component
49
Name a natural topical analgesic:
- mustard powder
- natural form of a counter irritant that creates warmth
- some people use mustard powder with water to heat an area, but can get too warm
50
Describe topical anesthetics:
- decrease sensation (including pain, has numbing effect)
- lasts a max of 30 min
- short term relief at the site on the surface of skin or mucous membranes
- some absorption into bloodstream
51
What are the different ways to apply topical anesthetics?
- solutions
- sprays
- gels
- ointments
52
Uses for topical anesthetics:
- sunburn
- minor burns
- insect bites (calamine lotion)
- poison ivy
- hemorrhoids
- sore throat
- dental/oral irritation (oragel)
- minor sport injuries
- emla = topical cream before dermatology procedures
53
Adverse effects of topical anesthetics:
- skin irritation
- burning
- dermatitis
54
Most topical anesthetics end in ____.
_____caine (ex. Lidocaine, benzocaine)
55
How does local anesthetics work?
- locally inhibits nerve impulse transmission
- also cause diminished perception of hot, cold, and touch
- acts quickly, can last up to 4 hours
- typically through injection
- affects only the localized area
56
Uses for local anesthetics:
- dental procedures
- minor Sx
- diagnostic procedures: injecting nerve or joint to see what is causing pain
57
Local anesthetics can be used in conjunction with _______ to make it last longer.
Vasoconstrictors
58
Adverse effects of local anesthetics:
- few adverse effects
- high blood concentration can cause heart block and cardiac arrest
- rarely allergic reactions
- local anaesthetic toxicity: if someone has too much of it, it can result in a spike in activity in CNS, then a sudden drop.
59
What can ATs do in terms of pain medications?
- understand analgesics
- prioritize non pharmacological and non opioid pharmacological therapy
- start slow with OTC before prescription
- incorporate patient rated outcomes
- monitor athletes, know warning signs of abuse, misuse and dependence
- make sure opioids are used under the direction of a physician
- know how to use naloxone
