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ATTH 5100 > Drugs For Treating Pain > Flashcards

Drugs For Treating Pain Flashcards

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
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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
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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.
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4
Q

Describe analgesics:

A
  • drugs used to alleviate (reduce or eliminate) pain
  • does not cause loss of consciousness
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5
Q

Describe opiates:

A
  • drugs that are obtained from the opium poppy
  • naturally occurring drug
  • main form: morphine
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6
Q

Describe opioids:

A
  • broader term referring to drugs with similar effects as opiates
  • can be synthetic and semi-synthetic
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7
Q

Describe narcotics:

A
  • any controlled substance in legal context
  • primary categories: schedule 1 and 2. Illegal to produce, distribute, or administer.
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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
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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
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10
Q

Outside of North America, Acetaminophen is called….

A

Paracetamol

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11
Q

Describe the potential therapeutic effects of acetaminophen.

A
  • analgesic and antipyretic
  • not anti-inflammatory or anti-platelet
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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
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13
Q

Acetaminophen is available in what forms?

A
  • tablets, capsules
  • chewable tablets
  • suppositories
  • elixirs, suspensions
  • IV
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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
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15
Q

When would you use suppositories?

A

If someone is vomiting a lot

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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.
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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.
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18
Q

Indications for acetaminophen:

A
  • mild to moderate pain
  • fever
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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
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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.

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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)
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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
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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
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24
Q

2 types of opioids:

A
  • endogenous (body produces its own): endorphins
  • exogenous (produced outside of the body)
25
Q

Name the opioid receptors found primarily in CNS, PNS, and GI tract.

A
  • 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
Q

If a medication goes through the first pass effect, they need to take a ______ dose if taking oral form vs parenteral form.

A

Larger

27
Q

Describe pharmacodynamics and pharmacokinetics of opioids.

A
  • 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
Q

Indications for opioids:

A
  • moderate to severe pain
  • cough suppression (cough syrup with codeine - because of depression of respiratory system)
  • diarrhea (opioids associated with constipation)
29
Q

Adverse effects of opioids

A
  • respiratory depression
  • constipation
  • sedation/drowsiness
  • orthostatic hypotension
  • miosis (pin point pupils)
  • urinary retention
  • nausea and vomiting
  • tolerance
  • dependence
  • addiction
30
Q

What is the difference between tolerance, dependence, and addiction?

A
  • 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
Q

Abrupt withdrawal of opioids causes:

A
  • abstinence syndrome
  • early presentation of tremors, sweating, irritability etc.
32
Q

Drug interactions with opioids:

A
  • CNS depressants (since opioids are also a depressant, causes excessive CNS depression and respiratory depression): ex. benzodiazepines, alcohol, cannabis.
  • caffeine (stimulant)
33
Q

Routes of administration for opioids:

A
  • oral
  • parenteral (non GI forms. Primarily injection - IV, subcutaneous, intranasal, intraspinal, intramuscular)
34
Q

Describe the indications for morphine:

A
  • moderate to severe pain
  • constant, dull pain relieved at lower doses than sharp, intermittent pain
  • decrease anxiety and distress
  • causes drowsiness
35
Q

Describe codeine and what it is used for.

A
  • 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
Q

What are the 4 types of prescription Tylenol?

A

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
Q

Describe meperidine.

A
  • aka Demerol
  • opioid
  • shorter duration
  • adverse effects: tremor, muscle twitching, seizures
  • do not use with monoamine oxidase inhibitors (used to treat depression)
38
Q

Describe oxycodone.

A
  • 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
Q

Percocet is made up of _____ + ______.

A
  • oxycodone
  • acetaminophen
40
Q

Vicodin is made up of _______ + ______.

A
  • hydrocodone
  • acetaminophen
41
Q

Describe methadone.

A
  • longer duration of action
  • good oral absorption
  • used as analgesic
  • opioid, but used to prevent withdrawal syndrome in heroin addicts during treatment
42
Q

Describe fentanyl

A
  • 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
Q

What is car-fentanyl?

A
  • 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
Q

What is a opioid antagonist?

A

Naloxone

45
Q

Describe tramadol

A
  • 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
Q

How can opioid analgesics be used appropriately?

A
  • 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
Q

Describe topical analgesics.

A
  • 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
Q

What are salicylates?

A
  • aspirin (do not use with those with aspirin sensitivity)
  • some anti-inflammatory component
49
Q

Name a natural topical analgesic:

A
  • 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
Q

Describe topical anesthetics:

A
  • 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
Q

What are the different ways to apply topical anesthetics?

A
  • solutions
  • sprays
  • gels
  • ointments
52
Q

Uses for topical anesthetics:

A
  • 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
Q

Adverse effects of topical anesthetics:

A
  • skin irritation
  • burning
  • dermatitis
54
Q

Most topical anesthetics end in ____.

A

_____caine (ex. Lidocaine, benzocaine)

55
Q

How does local anesthetics work?

A
  • 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
Q

Uses for local anesthetics:

A
  • dental procedures
  • minor Sx
  • diagnostic procedures: injecting nerve or joint to see what is causing pain
57
Q

Local anesthetics can be used in conjunction with _______ to make it last longer.

A

Vasoconstrictors

58
Q

Adverse effects of local anesthetics:

A
  • 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
Q

What can ATs do in terms of pain medications?

A
  • 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

ATTH 5100 (13 decks)

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