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Pharmacology 2 > Modern Arsenal of Pain Control > Flashcards

Flashcards in Modern Arsenal of Pain Control Deck (44):
1

What do norepinephrine and serotonin do?

Inhibit pain signals from reaching the higher levels of brain

2

How do tricyclic antidepressants (TCAs) work?

Increases serotonin and or norepinephrine in the synapse by inhibiting reuptake
May have anticholinergic effects

3

How long does it take for TCAs to begin working?

1-3 weeks for pain control so used for chronic pain

4

What are some examples of TCAs?

Notriptyline and Amitriptyline

5

What are TCAs more effective for treatment of?

Diabetic neuropathy, moreso than other antidepressants

6

How do selective serotonin reuptake inhibitors (SSRIs) work?

Specific inhibitors of serotonin reuptake

7

What are some examples of SSRIs?

Paroxetine (Paxil), Fluoxetine (Prozac), Sertraline (Zoloft)

8

What are some side effects of SSRIs?

Suicidality, impaired platelet aggregation, CNS depression, QT prolongation, serotonin syndrome, hyponatremia, sexual dysfunction

9

How do serotonin and norepinephrine reuptake inhibitors (SNRIs) work?

Potent inhibitor of neuronal serotonin and norepinephrine reuptake and weak dopamine reuptake

10

What are some side effects of SNRIs?

Suicidality, serotonin syndrome, rest are same as SSRIs

11

What are some examples of SNRIs?

Venlafaxine (effexor), duloxetine (cymbalta)

12

What is venlafaxine used for?

Neuropathic pain, diabetic neuropathy
Onset 1-2 weeks, max 6 weeks

13

What are some adverse reactions from venlafaxine?

Nausea, dizziness, drowsiness, hyperhidrosis, hypertension

14

What is duloxetine used for?

Diabetic neuropathy, fibromyalgia, chronic MSK pain
60-120 mg daily

15

What are some adverse reactions of duloxetine?

Sedation, nausea, constipation, ataxia, dry mouth

16

How do alpha adrenergic agonist work?

Stimulates alpha adrenoreceptors in the brainstem, activating inhibitory neuron, reducing the sympathetic outflow of CNS (prevents pain signal transmission)

17

What are some examples of alpha adrenergic agonists?

Clonidine (last line of treatment)
Tizanidine

18

What is clonidine used for?

Neuropathic pain that is not responding to other treatment
Unlabelled: Heroin or nicotine withdrawal, dysmenorrhea, menopausal vasomotor symptoms, migraine prophylaxis

19

What are some adverse effects of clonidine?

Bradycardia, CNS and respiratory depression, hypotension

20

What is tizanidine used for?

Tension-type headache, back pain, neuropathic pain and myofascial pains
Less likely to cause hypotension than clonidine

21

What is peripheral sensitivity?

Neuropathic pain triggered by spontaneous peripheral nerve activity mediated by sodium channels caused by local tissue injury, ischemia releasing inflammatory factors, increasing Na channels

22

What medications are used for peripheral sensitivity?

Carbamazepine, tricyclic antidepressants, topiramate, lidocaine

23

What does carbamazepine do?

An anticonvulsant that limits the influx of sodium ions across the cell membrane

24

What is carbamazepine used for?

Trigeminal or glossopharyngeal neuralgia and neuropathic pain
Monitor drug levels (reach a steady state in 2-5 days)

25

What does topiramate do?

An anticonvulsant that limits the influx of sodium ions and antagonizes glutamate receptors

26

What are some adverse reactions of topiramate?

Dizziness, ataxia, somnolence, psychomotor slowing, paresthesia, weight loss

27

What should be monitored while on topiramate?

Electrolytes and kidney function

28

How does lidocaine work?

Topical application reduces discharge of small afferent nerve fibres by blocking voltage-gated sodium channels (decrease membrane permeability)
Gel or patch (will only work in area applied, max 3 patches to area every 24 hours)

29

What is lidocaine used for?

Post-herpetic neuralgia or peripheral neuropathies or other etiologies

30

What are some side effects of lidocaine?

Arrythmias, seizures, coma, respiratory depression or death
Patch: Erythema, swelling, burning or discomfort of the application site

31

How does central sensitivity occur (GABA, Ca)?

Occurs in dorsal horn of the spinal cord with the release of excitatory neurotransmitters (glutamate, substance P) and increased calcium transport (spontaneous impulses)

32

Which medications decrease calcium channel activity?

Gabapentin and Pregablin

33

How do gabapentin and pregablin work?

Modulate voltage gated Ca channels by binding alpha2-delta subunit of presynaptic neurons to regulate excitatory neurotransmitters

34

What is gabapentin used for?

Diabetic neuropathy and neuropathic pain

35

What are the adverse reactions of gabapentin and pregablin?

Somnolence, dizziness, peripheral edema

36

What is pregablin used for?

Neuropathic pain/diabetic neuropathy, spinal cord injury neuropathic pain

37

Which medications are NMDA antagonists (decrease nerve impulse)?

Ketamine, dextromethorphan, methadone

38

How does ketamine work?

Decreases central sensitization and modulation by lowering the threshold for nerve transduction and reduces the effects of substance P
Also is a dissociative agent that targets the opioid receptor, Na and K channels to reduce pain

39

What are some adverse reactions to ketamine?

Local skin reactions

40

How does dextromethorphan work?

Low affinity uncompetitive NMDA antagonist (high doses needed), also binds opioid receptors
Very short half-life

41

What some side effects of dexomethorphan?

Serotonin syndrome (if in combination with other antidepressants), rash, nausea, drowsiness, constipation/diarrhea, confusion, nervousness, closed-eye hallucinations

42

How does methadone work?

Mu and delta opioid agonist that also blocks the NMDA receptor and inhibits the reuptake of norepinephrine

43

What makes methadone better than morphine?

1 mg=10 mg morphine
Less need for opioid escalation, no active metabolites (less side effects), highly lipophilic (high bioavailability)

44

What are some side effects of methadone?

CNS and respiratory depression, QT prolongation, constipation, nausea and vomiting, dizziness and disorientation