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Pharm 584 > MCP: Analgesics > Flashcards

MCP: Analgesics Flashcards

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1
Q

Non-Pharmacologic Options for Pain Management

A
  • R.I.C.E
  • Heat
  • Physical Therapy
  • Exercise
  • Acupuncture
  • Massage
  • Hypnosis
  • Cognitive Behavioral Therapy
  • Visualization
  • Breathing Techniques

Using these may help save money, get full relief, not need to take as high of doses

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2
Q

What is Pain?

A
  • Sensation that causes discomfort
  • Types of Pain:
    • Nociceptive
    • Neuropathic
    • Migraine
  • Universal Pain Assessment Tool
    • Rank pain on a scale of 1-10
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3
Q

Nociceptive Pain

  • Definition
  • Classes of medications used
A
  • Definition: Pain caused by damage to body tissues
  • Classes of medications used:
    • Acetaminophen
    • NSAIDs
      • Nonselective
      • COX-2 selective inhibitors
    • Opioid analgesics
    • Other: tramadol
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4
Q

Indications for Acetaminophen

A
  • Mild-moderate pain
    • Sometimes severe pain
  • Fever
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5
Q

What major toxicity should you be concerned about with acetaminophen?

A
  • Hepatotoxicity
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6
Q

What is the maximum daily dose of acetaminophen you should recommend to a patient?

A
  • 3g according to package
  • 4g according to FDA
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7
Q

Acetaminophen: Pearls

A
  • Remember many OTC medications and opioid analgesic combinations contain acetaminophen
    • Make sure not taking over daily recommended maximum
  • Preferred analgedic in pregnant or breastfeeding women
  • Infant and children acetaminophen weight based dosing
    • Double check what concentration using
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8
Q

NSAID: Nonselective vs. Selective

A
  • Celebrex is brand only
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9
Q

NSAIDs: MOA

A
  • Inhibit enzymes that convert arachidonic acid into prostaglandins
  • COX-1
    • Expressed in almost all body tissues
    • Resonsible for “housekeeping” function (gastric mucosa, platelet aggregation, kidney function, etc.)
  • COX-2
    • Expressed in sites of inflammation
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10
Q

Nonselective NSAIDs: Uses

A
  • Mild to moderate pain (arthritis, dysmenorrhea, inflammation)
  • Acetaminophen NOT for inflammation
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11
Q

Nonselective NSAIDs: Onset of Action

A
  • ~30-60 min
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12
Q

Nonselective NSAIDs: Side Effects

A
  • Dizziness
  • GI upset
    • Nausea/Vomiting
    • Heartburn
    • Dyspepsia (Indigestion)
  • *Instruct patients to take with food or milk (carbohydrates)
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13
Q

Nonselective NSAIDs: Precautions/Warnings

A
  • Risk of gastrointestinal ulcers or bleeding
  • Risk of cardiovascular events including heart attack or stroke
  • *Associated with higher doses and longer periods of use*
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14
Q

Nonselective NSAIDs: Use with Caution In

A
  • Kidney dysfunction
  • Cardiovascular risk or disease
  • Older adults
    • Less GI mucosa protection
  • Avoid taking two NSAIDs concurrently
    • Saturates COX enzymes, not get anymore benefit, get more side effects
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15
Q

Nonselective NSAIDs: Contraindications

A
  • Allergy to aspirin or any NSAID
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16
Q

Selective NSAIDs: celecoxib (Celebrex®) Uses

A
  • Arthritis
  • Dysmenorrhea
  • Acute Pain
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17
Q

Celecoxib: Onset of Action

A
  • ~1 hour (acute pain)
  • 1-2 weeks (chronic pain)
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18
Q

Celecoxib: Side Effects

A
  • GI upset
    • Not as common as nonselective NSAID
      ​​

*May be taken with or without food*

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19
Q

Celecoxib: Precautions/Warnings

A
  • Similar to nonselective NSAIDs
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20
Q

Celecoxib: Contraindications

A
  • Allergy to aspirin or other NSAIDs
  • Allergy to sulfonamides
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21
Q

Opioid Analgesics

A
  • Actiq is brand only
    • Lolipop
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22
Q

Opioid Analgesics: MOA

A
  • Binds to µ-opiate receptors in the CNS to alter perception of pain
    • Brain and spinal cord
  • Spinal Column
    • Alters how pain is sent to brain
  • Brain
    • Alter brain’s processing and perception of pain
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23
Q

Opioid Analgesics: Uses

A
  • Moderate to severe pain
    • Post operative pain
    • Acute pain
    • Chronic pain
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24
Q

Opioid Analgesics: Time to Effect

Study These Flashcards
A
  • Varies
    • usually within 15-30 minutes; longer for ER formulations
25
Opioid Analgesics: Side effects
* Drowsiness/sedation * Take 1st dose at home to see how affects patient before driving * Nausea/vomiting * GI upset * Constipation * Common * Because smooth muscle processes slowed down
26
Opioid Analgesics: Contraindications
* Certain respiratory disorders * Severe asthma or respiratory depression
27
Opioid Analgesics: Administration Instructions
* Take with food or milk * If dose is a range, start with lower dose * Take 1 tab, if no relief, then take another at specified time interval
28
Opioid Analgesics: Precautions/Warnings
* Respiratory depression * Avoid alcohol * Respiratory depression * May cause CNS depression * Caution with driving * Habit-forming; potential for abuse/misuse * Not preferred for chronic pain * May cause euphoria in some patients, causing dependency * Combination products with acetaminophen; emphasize maximum daily dose of acetaminophen
29
Tramadol
30
Tramadol: MOA
* Binds to µ-opiate receptors in the CNS to alter perception of pain and alters concentrations of serotonin and norepinephrine in the brain
31
Tramadol: Uses
* Moderate to moderately-severe pain
32
Tramadol: Time to Effect
* ~1 hour
33
Tramadol: Side Effects
* Dizziness * Drowsiness * Constipation * Nausea/Vomiting Not cause GI upset
34
Tramadol: Administration Instructions
* Take with or without food
35
Tramadol: Precautions/Warnings
* May cause CNS depression * Take 1st dose at home * ​Caution with driving * Avoid alcohol * lowers threshold for seizures * ​Potential for abuse/misuse * May increase risk of seizures * Use with caution in those with seizure disorders or seizure risk * Ultracet®; emphasize maximum daily dose of acteminophen
36
Neuropathic Pain * Definition * Medications
* Definition: Pain originating from nerve damage * Diabetics * uncontrolled glucose levels lead to syrupy blood * Block capilaries, tissue death, nerve damage * ​Medications * GABA analouge * gabapentin * pregabalin
37
Gabapentin: Brand name
* Neurontin®
38
Gabapentin: MOA
* Unknown
39
Gabapentin: Uses
* Seizure disorders * Neuropathic pain (unlabeled use) * Other
40
Gabapentin: Time to Effect
* May take several days or a few weeks * counsel paitents on taking regularly to feel the full effect
41
Gabapentin: Side Effects
* Dizziness * Most common * Somnolence * Ataxia * Difficulty moving * Fatigue Start @ low dose and titrate up due to side effects
42
Gabapentin: Administration Instructions
* May take with or without food * No GI upset * Administer at least 2 hours after antacids * Alters absorption
43
Gabpentin: Precautions/Warnings
* CNS depression * Caution with driving * Avoid alcohol
44
Pregabalin
Brand only: Lyrica® * Schedule V: sometimes causes euphoria
45
Pregabalin: MOA
* Unknown
46
Pregabalin: Uses
* Seizure disorders * Neuropathic pain * Other
47
Pregabalin: Time to Effect
* As early as first week of therapy * Not prn, take regularly
48
​Pregabalin: Side Effects
* Dizziness * Somnolence * **Blurred vision or diptopia ** * Weight gain * **Peripheral edema **
49
Pregabalin: Administration Instructions
* May take with or without food
50
Pregabalin: Precautions/Warnings
* CNS effects * Caution with driving * Avoid alcohol * Caution in heart failure * Because of peripheral edema * May worsen * Caution in kidney dysfunction * also gabapentin * almost all renally cleared, may accumulate * Angioedema * Rare, but may be life-threatening * Notify healthcare provider of swelling of face or mouth * Can happen at anytime in treatment
51
Migraine: Definition
* Chronic neurological disorder * moderate to severe headache * Other symptoms * Unilateral, frontal or global * Gradual onset lasting 4-72 hours * Nausea, light/sound sensitivity * With or without aura (see spot/light)
52
Migraine: Medications
Serotonin (5-HT18, 10) receptor agonists
53
Serotonin Receptor Agonists: Medications
54
Serotonin Receptor Agonists: MOA
* Bind to serotonin receptors in cranial arteries, causing local vasoconstriction therby relieving migraines
55
Serotonin Receptor Agonists: Dosage Forms
* Rizatriptan: Oral tablet, oral disintegrating tablet * Sumatriptan: Oral tablet, nasal spray, subutaneous injection * Zolmitriptan: Oral tablet, oral disintegrating tablet, nasal spray
56
Serotonin Receptor Agonist: Time to Effect
* Rizatriptan: within 2 hours * Sumatriptan: oral ~30 min, nasal ~10-20 min, subcutaneous ~10 min * Zolmitriptan: oral ~60 min
57
Serotonin Receptor Agonist: Side Effects
* Nausea/Vomiting (nasal spray) * Dizziness * Weakness * Paresthesias (subcutaneous) * tingly in extremities ​
58
Serotonin Receptor Agonist: Administration Instructions
* Administer as soon as migraine symptoms appear; may need to be redosed within two hours if symptoms persist * Orally disintegrating tablet; place under tongue and allow to dissolve * Nasal spray; pre-loaded with one dose * Warn patient not to test dose
59
Serotonin Receptor Agonists
* Precautions/Warnings * Abortive, not preventative agents​ * @ onset of symptoms * Serotonin syndrome * Caution with pro-serotonergic drugs * Serotonin overload * ​​​Overuse may lead to rebound headaches (more than 10 dose/month) * detox from drug, if more headaches than 10/month, see doctor for preventative measures * ​​Use with caution in those with: * Seizure disorder * Coronary heart disease or cardiovascular risk factors

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