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Lecture 2 Flashcards

Pain Treatment and Pain Research

1
Q

What is trephination?

A

The idea that a disease was created by bad spirits inhabiting your skull. They would cut your skull open and take out a chunk of it.

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2
Q

What is theriac?

A

A mixture of many natural ingredients (one of which is the opium poppy)

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3
Q

What were the two biggest pain treatments in 1500 A.D.?

A

Willow bark and opium poppies

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4
Q

What was the name of the first pharmaceutical company? When and where was it founded? What was its purpose?

A

Merck. It was founded in Darmstadt in 1688. Its purpose was to create and sell a standard dose of morphine.

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5
Q

Where and when was the first public demonstration of surgical anesthetic performed? What kind of anesthetic was used?

A

Massachusetts Hospital in Cambridge in 1846. The anesthetic was inhaled ether.

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6
Q

What are the differences between opioids and opiates?

A

Opiates are things that are like opium. Opioids are a broader category which includes things in your body like endorphins. All opiates are opioids, and all opiates are loosely based on the structure of opium.

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7
Q

What are the most common routes of drug administration?

A

Subcutaneous, intravenous, intramuscular, transdermal, and implantation.

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8
Q

What are pharmacodynamics?

A

What the drug does to the body.

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9
Q

What are pharmacokinetics?

A

What the body does to the drug.

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10
Q

What do pharmacokinetics break down into?

A

ADME
Absorption (how much of the drug is actually absorbed into the bloodstream),
Distribution (How the drug gets distributed throughout the body),
Metabolism (the body metabolizes the drug into metabolites),
Elimination (the metabolites get eliminated through one of three ways: breathe it out, poop it out, or pee it out)

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11
Q

What is metabolism?

A

The liver’s breaking down of complicated molecules into simpler molecules.

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12
Q

What is patient-controlled analgesia (PCA)?

A

The idea that a patient can press a button to dose themselves with a certain drug. You will get timed out if you press too many times, and the machine will not allow you to give yourself enough to overdose.

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13
Q

What is the most prevalent side effect of opiates?

A

Constipation (up to 80%)

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14
Q

What are side effects?

A

When the drug is not only going to the place that you want, it is also binding to other receptors all around the body, leading to effects that we don’t want.

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15
Q

What are some common side effects of opiates?

A

Constipation (up to 80%)
Nausea (15-30%)
Sedation (20-60%)
Respiratory depression
Dry mouth
Pruritus (itching)
Serious libido problems

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16
Q

What does NSAID stand for?

A

Non-steroidal anti-inflammatory drugs

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17
Q

What are common NSAIDs?

A

Aspirin, ibuprofen, and naproxen sodium.

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18
Q

What does it mean when cancer goes metastatic?

A

The tumor cells get into your bloodstream and end up in your bones. This is extremely painful.

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19
Q

What is the WHO analgesic ladder?

A

A diagram telling physicians how to manage cancer pain. Starts at the bottom with non-opioid, and increases until level 3 with opioid for moderate to severe pain

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20
Q

What is the first analgesic category of drugs?

A

NSAIDs
There are 24 types of NSAIDs on the market

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21
Q

What is the second analgesic category of drugs?

A

Opiates
There are 19 types of opiates on the market

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22
Q

What is the third analgesic category of drugs?

A

Local anesthetics
There are 10 local anesthetics on the market

23
Q

What is the fourth analgesic category of drugs?

A

Migraine drugs
There are 9 types of migraine drugs on the market

24
Q

What is the difference between an ‘-ectomy’ and an ‘-otomy’

A

An ‘-ectomy’ is a cut, and an ‘-otomy’ is the removal of something

25
What is allopathy?
Medicine informed by the rules of science and the scientific method.
26
What is the best analgesic?
Distraction.
27
What was the name of the baby who received open-heart surgery without any anesthetics?
Jeffrey Lawson
28
What are the best ways to calm down a baby that is in pain?
Sucrose, suckling, and kangaroo care.
29
Who is regarded as the father of pain medicine? Why?
John Bonica. He published the first textbook on pain 'The Management of Pain', and founded the first multidisciplinary pain clinic
30
What is curative treatment?
Treatment with the intent to cure
31
What is palliative treatment?
Treatment with the intent to make comfortable. Used if curative treatment did not work.
32
Why was there pushback against pain as the fifth vital sign?
Pain is subjective. The other vital signs can be measured the same way by everyone, but pain is sorely based on how the patient feels and/or describes it.
33
What is the evidence-based medicine pyramid?
As you go up the pyramid, the evidence becomes better. 1. Personal opinion 2. Expert opinion 3. Case reports 4. Case series 5. Case control studies 6. Cohort studies 7. Randomized controlled double-blind studies 8. Systematic reviews and meta-analyses
34
What is the Cochrane Collaboration?
A collaboration of many people who do meta-analyses for a living. The 'top-of-the-line' meta-analyses will be found here.
35
What is an RCT?
An RCT is a randomized controlled trial.
36
What are common exclusion criteria for RCTs?
Having another condition that could mess with results, having a pain score that is too low or too high, not having pain for a long enough time, age, if you are already on analgesics, etc.
37
What is allocation?
The random assignment of participants to either a control group or treated group.
38
What is a parallel design?
A type of RCT design where everyone gets one of two or three treatments.
39
What is a crossover design?
An RTC design where everyone gets both treatments. You are randomized to which treatment you get first and which you get second.
40
What are some advantages of a crossover design?
It allows you to compare the two treatments within the same person, which gives you more statistical power. You need fewer people for it. People tend to prefer this method.
41
What is the disadvantage of a crossover design?
The carry-over effects.
42
What is an enriched design?
An RTC design where you give the drug to all of your sample and increase the dose until people either leave due to adverse effects or the drug's lack of efficiency. All those who the drug worked on are now the sample and those will be randomized to either stay on the dose that previously worked for them (control group) or to have the dose increased unbeknownst to them (active group).
43
What is the most common way of showing clinical trial results?
Having the y-axis be a measurement of pain and the x-axis be a measure of time.
44
What are the two less common ways to show results of a clinical trial?
You could show the statistics of how many people preferred your pain treatment to the alternative placebo treatment. You could also show that people tended to stay in the trial and use your pain treatment longer than the alternative placebo treatment.
45
What is the primary outcome measure?
The drug company has to decide before the study is run which measure they will use to identify if their drug works or not.
46
What is an odds ratio and how do you calculate it?
An odds ratio is also called relative risk and comes from the cancer field. In the numerator you multiply the two factors that are in support of the relationship, and in the denominator, you multiply the two factors that go against the hypothesis. You then divide the numerator by the denominator.
47
What is a forest plot?
A way to plot all the odds ratios of all the RTCs on a topic. The box is the estimate (the bigger the box, the bigger the study was and the more weight it hold), and the lines from either side are the confidence intervals on the left and right. The diamond on the bottom is the net average (median) of all the results. If the median is negative, it favours the active group. If the median is positive, it favours the placebo.
48
What are L'Abbe plots?
L'Abbe plots are a way to plot all the RTCs on a topic. You plot the percentage of patients with a certain outcome of the active treatment on one axis and the percentage of patients with a certain outcome of the placebo treatment on the other axis. There is a diagonal line through the graph: the side of the diagonal that the most dots are on is the favoured treatment.
49
What is NNT and how do you calculate it?
Number-Needed-to-Treat. 1/(number of patients given the active treatment that achieved the target/total number of patients given the active treatment) - (number of patients given the control treatment that achieved the target/total number of patients given the control treatment). What this means is that the NNT is 4, the number of patients that will benefit from the drug/treatment is 1 in 4.
50
What does the acronym GRADE stand for? What is it?
Grading of Recommendations, Assessment Development, and Evaluation. It is when the most eminent doctors in a certain field meet, comb through the evidence that each drug presents, and eventually come up with a recommendation of which drugs should be called first line, second line, or third line.
51
What are some of the things used to decide GRADE Recommendations?
Quality, effect size (NNT), tolerability and safety (NNH), preferences, cost and resource allocation, the strength of the recommendation, etc.
52
Are first, second, or third line drugs the most strongly recommended?
First line drugs are the most strongly recommended and third line drugs are the third-most strongly recommended.
53
What is the IASP?
The International Association for the Study of Pain. They are multidisciplinary, involve over 126 countries, and publish journals about pain.

PSYC 302 (7 decks)

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