Intro + Pain Control Flashcards
PK/PD, Opioids, NSAIDs, Neuropathic pain, RA, SLE, and OA (118 cards)
1
Q
Pharmacokinetics definition
A
what the body does to a drug involves ADME
2
Q
Pharmacodynamics definition
A
how a drug affects a body
3
Q
what does ADME stand for?
A
absorption distribution metabolism excretion
4
Q
what are the 3 steps in the FDA drug approval process?
A
identify new drug need FDA IND Clinical trials
5
Q
what are the 4 phases of clinical trials?
A
- safety 2. efficacy 3. larger and longer RCT 4. post marketing surveillance
6
Q
how are controlled substances classified?
A
into 5 schedules, schedule 1 has the highest abuse and dependence level and no medical purpose
7
Q
what are the 2 ways drugs are absorbed?
A
via enteral (GI tract) or parenteral route
8
Q
what are 3 drug types that are absorbed via enteral route?
A
oral,
sublingual,
rectal
9
Q
what are 5 drug types that are absorbed via parenteral route?
A
inhalation, injection, topical, transdermal, implant
10
Q
define bioavailability
A
% of drug that makes it into systemic circulation
11
Q
What does volume of distribution tell us?
A
how extensively a drug is distributed to the rest of the body compared to the plasma
12
Q
what does a higher Vd mean?
A
there is more drug in tissue than the blood
13
Q
what is the difference between first-order and zero order elimination?
A
first-order has a constant half-life zero order has a constant elimination rate
14
Q
how many half-lives before a drug is considered “cleared”?
A
5
15
Q
how many half-lives does it take to reach “steady state”?
A
4-5
16
Q
define steady state as it pertains to dosing
A
amount of drug excreted in specific time frame = amount of drug administered often equal to time to reach therapeutic effect
17
Q
Schedule I substance
A
regarded as having the highest potential for abuse and addiction (THC, LSD, heroin, ecstasy)
18
Q
Schedule II substance
A
approved for specific uses but still have a high potential for addiction (opioids/narcotics)
19
Q
Schedule III substance
A
lower abuse potential but still might lead to dependence
20
Q
Schedule IV substance
A
still lower potential for abuse
21
Q
Schedule V substance
A
lowest relative abuse potential
22
Q
define specificity
A
drug binds to only one type of receptor
23
Q
define selectivity
A
can bind to a multiple subtypes of a receptor but it prefers one
24
Q
what is Emax?
A
maximal response receptors are saturated may cause toxicity
25
what is ED50?
effective dose to get 50% of expected response
26
how does ED50 relate to potency?
lower ED50 = more potent less drug required for effect
27
What is a quantal-dose response curve?
used to compare safety of a drug tracks % or # of population who has a particular reponse at a given dose
28
what can a quantal-dose response curve help us find?
the smallest effective dose among a population of people.
29
what is TD50?
dose that is toxic for 50% of people
30
What is the Therapeutic Index?
a ratio of TD50 to ED50
31
What is the Naranjo Scale/
a questionnaire that helps to determine if a pt is suffering from AE
32
what are the 3 types of pain?
nociceptive neuropathic psychogenic
33
What neural structures are involved with ascending pain pathways?
1. periphery sensory neurons
2. dorsal horn of spinal cord
3. brain stem
4. thalamus
5. somatosensory cortex
34
What does the descending pathway do?
modulate/suppression pain signals
35
where does the descending pathway originate?
periaqueductal gray matter of the mid-brain
36
Name some neurotransmitters in the nociceptive pathways
GABA, glutamate, serotonin, norepinephrine, adenosin
37
what is the MOA for opioids?
bind to opioid receptor in CNS to inhibit ascending pain pathways
38
What are the 3 main opioid receptors?
mu delta kappa
39
AE of opioids on CNS
sedation, nausea, respiratory depression, cough suppression, miosis (pinpoint pupil), truncal rigidity
40
AE peripheral effects of opioids
constipation urinary retention bronchospasm reduced GI motility Pruritus (itching)
41
what to notice for respiratory depression
labored breathing and decreased respiration rate
42
effects associated with Mu opioid receptors
analgesia, euphoria, respiratory depression, bradycardia, emesis, slowed GI motility, pruritis, high abuse/dependence potential
43
what is nociceptive pain?
produced by injury stabbing, aching, well-localized (exceptions)
44
when is nociceptive pain not localized?
when it originates from visera
45
what is neuropathic pain?
typically indicates nerve involvement burning, tingling sensation
46
what are the 2 primary nociceptive afferent neurons?
unmyelinated C fibers finely myelinated A delta fibers
47
in the dorsal horn, what neurotransmitters inhibit pain signal propagation?
1. NMDA blocker
2. substance P antagonists
3. inhibition of NO synthesis
48
what is the substantia gelatinosa?
a collection of gray cells (in dorsal horn) act like gate keeper to regulate pain signals from nociceptive fibers
49
what are the three subtypes of DMARDs?
1. Non-biologic
2. Biologic (TNF/Non-TNF inhibitor)
50
What is the basic MOA for DMARDs?
impacts mediators of inflammatory response
51
What 3 drugs are Non-biologic DMARDs?
1. Methotrexate
2. Sulfasalazine
3. Hydroxychloroquine
52
DMARD (biologic TNF Inh) common AE
1. headache
2. infection
3. antibody development
4. IV infusion reactions (fever, hypotension, urticaria)
53
DMARD (biologic TNF In) Boxed warnings
serious infections, secondary malignancies like lymphoma
54
What is the MOA of Methrotrexate?
unknown, but possibly impacts IL-1, TNF-alpha, leukotreine levels
55
methotrexate common AE
N/V/D, alopecia, malaise
56
methotrexate less common AE
1. increased liver function tests
2. heptatoxicity
3. nephrotoxicity
4. thrombocytopenia
5. bone marrow suppression
57
Methotrexate PT concerns
1. hydration
2. photo-sensitivity
3. caution: strengthening, stretching, deep tissue work, infection risk
58
hydroxychloroquine AE
1. dyspepsia
2. nausea
3. abdominal pain
4. rashes
5. nightmares and visual disturbances
59
What DMARDs are indicated for lupus?
1. methotrexate
2. hydroxychloroquine (Plaquenil - also indicated for malaria)
60
What drug is a Non-TNF inhibitor?
Rituximab
61
rituximab AE
1. injection/infusion reactions
2. increased LFTs
3. antibody development
62
What 2 drugs are TNF Inhibitors?
1. Adalimumab
2. Etanercept
63
AE TNF inhibitors
headache, antibody development, infection, IV reactions
64
which DMARDs have boxed warnings?
1. Adalimumab
2. Etanercept
65
Opioid drugs
1. Codeine
2. Hydrocodone
3. Hydrocodone w/acetaminophen
4. Morphine
5. Oxycodone
6. Oxycodone w/acetminophen
7. Fentanyl
8. Hydromorphone
9. Meperidine
10. Tramadol
11. Methadone
66
what opioid can be perscribed as an antitussive?
codeine
67
Opioid common routes
PO, rectal, IV, topical, subcutaneous, intrathecal, intranasal, transmucosa, epidural
68
Opioid MOA
bind to opioid receptors in the CNS to inhibit ascending pain pathways
69
Opioid AE CNS effects
sedation
nausea
respiratory depression
cough suppression
miosis
truncal rigidity
70
Opioid Peripheral AE
constipation
urinary retention
bronchospasms
reduced GI motility
pruitis
71
basic pathophysiology of cancer
uncontrolled cell growth
72
what is Nadir?
10-28 days when WBC is at it's lowest, no trx given here
73
primary treatment (cure) for cancer
1. surgery
2. radiation
3. chemotherapy
4. biotherapy
74
when is adjuvant therapy used?
after primary trx
75
when is neoadjuvant therapy used?
before primary trx
76
goals/stages of treatment
1. cure
2. control
3. palliative
77
what is palliative care?
decrease tumor burden, improve QOL, relieve pain
78
Types of cancer trx
1. radiation
2. surgery
3. pharmacotherapy,
79
what is used to treat almost every solid tumor?
radiation
80
Radiation trx AE
1. significant damage to all tissues
2. can result in fibrosis of lungs (location dependent)
3. fatigue
81
PT concerns for radiation
fatigue, location of tissue damage
82
Cancer trx used to maximize tumor eradication
surgery
83
PT considerations for surgery trx
wound complications, lymphedema, general post-op concerns
84
what are the 3 types of pharmacotherapy?
1. chemotherapy
2. targeted therapy
3. immunotherapy
85
what is chemotherapy
drugs that inhibit growth and replication of cancer cells
86
what is targeted therapy
blocks genes/proteins, specific genetic mutations
87
what is immunotherapy
hormones and drugs that use the immune system to trx cancer
88
majority of immunotherapy drugs utilize what?
1. antibodies that end in -mab
2. interferon
3. interleukins (non-specific immunotherapy)
89
what cancer AE should we be most concerned with?
1. thrombocytopena
2. neutropenia
3. peripheral neuropathy
4. pain
5. infection
6. mouth/throat
90
special precautions for oral chemotherapy
wear gloves when touching laundry or bodily fluids (specific to the oral med)
91
NSAID medications
Ibuprofen Naproxen Indomethacin Aspirin Celecoxib Meloxicam Diclofenac Trolamine salicylate
92
NSAID indications
analgesia antipyretic anti-inflammatory
93
Aspirin indications
analgesia antipyretic anti-inflammatory antithrombotic
94
NSAID MOA
reversibly inhibits COX-1 and COX-2 enzymes to decrease prostaglandin formation
95
how is Aspirin's MOA different from other NSAIDS?
it irreversibly binds to COX enzymes, other NSAIDs reversibly bind
96
general NSAID's AE
N/V, dyspepsia, ulcers, GI bleeding, increased BP, nephrotoxicity, CV risk
97
what NSAIDs are antithrombotic?
Aspirin
Celecoxib
Diclofenac
Trolamine Salicylate
Meloxicam
98
If you have GI risk which NSAID is the safest to take?
Ibuprofen (motrin, Advil)
99
If you are at CV risk what is the safest NSAID to take?
Naproxen
100
When should you avoid taking Celecoxib?
If you are at CV risk
101
If you hae CV risk what NSAID should you avoid?
Celexocib
102
T/F: someone with CHF shouldn't take NSAIDs because it will increase their fluid retention
TRUE
103
T/F: NSAIDs blunt the action of cardiovascular drugs?
TRUE
104
Gabapentin indication
neuropathic pain
105
Gabapentin drug class
GABA analog, anticonvulsant
106
Gabapentin MOA
bind to alpha 2-delta subunit of a calcium channel to block its effects
107
Gabapentin AE
dizziness, drowsiness
108
Azathioprine drug class
immunosuppresant
109
Azathioprine indication
1. SLE
2. off label trx for MS
110
Azathioprine MOA
decreases the immune response so the body doesn't attack itself
111
Azathioprine AE
N/V
112
Hyaluronate indication
OA
113
Hyaluronate MOA and AE
1. MOA - viscoelastic solution to provide joint lubrication
2. AE - injection site rxns, swelling, and rash
114
anesthetic drugs
1. lidocaine
2. propofol
115
anasthetic drugs indications
patient controlled analgesia
116
general anasthetic common routes
IV, inhalation
117
regional anasthetic common routes
intrathecal, epidural, inflitration anesthesia, peripheral nerve block, IV, regional block
118
local anasthetic common routes
injection, topical
