Non opiods Flashcards Preview

Pharmacology > Non opiods > Flashcards

Flashcards in Non opiods Deck (50):
1

Endorphins, enkephalins

provide a natural amount of pain relief

2

Norepinephrine, serotonin

play an inhibitory role in the descending tract, explains why antidepressants can be used for pain control

3

glutamate, GABA

several receptor provide many targets for combo therapy for pain control

4

Somatic pain

constant, well localized, aching, throbbing; analgesic, nerve block

5

Visceral pain

diffuse, deep, dull, cramping, squeezing, referred, analgesic, neurological procedures

6

neuropathic pain

altered sensations, stabbing, burned, constant or intermittent, sharp, shooting, antidepressant, anticonvulsants, neurological procedures, not opioids

7

types of chronic pain

pain that persists beyond expected healing time, related to chronic disease, w/out an identifiable cause, , chronic+acute associated with CA

8

Tolerance

reduced effect w/ same dose, need to increase dose to get same effect, not addiction

9

Pseudotolerance

a need to increase the dose, but only because of disease progression, new source of pain, drug interaction

10

Physical dependance

described as the occurence of withdrawal symptoms when the opioid is stopped all at once or without proper tapering

11

Addiction

a psychologically dependent state, they exhibit drug seeking behavior, compulsive use for their psychic effects

12

Pseudoaddiction

can present as addiction, but is a function of poorly controlled pain, once adequately controlled, their drug seeding tendencies disappear

13

Non-pharmacological approaches to pain pain control

remove source, psychotherapy, weight reduction, surgery, behavioral modification, rest/exercise, nerve block, massage therapy, acupuncture, hypnosis, heat, ice, pt

14

NSAIDs MOA

inhibition of the enzyme COX which prevents prostaglandin synthesis

15

Do NSAIDs produce tolerance

they do not tolerance, physical dependence, or psychological dependence

16

Ceiling effects of NSAIDs

analgesia has ceiling effect, less of ceiling effect to anti-inflammatory response, increased doses will still provide additional results

17

Popular NSAIDs

Diclofenac ER (Voltaren), Ibuprofen (Motrin, Advil), Naproxin (Naprosyn), Noproxen Sodium (Aleve, Anaprox), Meloxicam (Mobic), Indomethacin (Indocin), Ketorolac (Toradol)

18

Less popular NSAIDs

Etodolac (Lodine), Sulindac (Clinoril), Tometin (Tolectin), Oxaprozin (Daypro), Ketoprofen (Orudis), Piroxicam (Feldene), Nabumetone (Relafen)

19

NSAID characteristics that distinguish them from narcotics

antipyretic, anti-inflammatory, ceiling effect to analgesia, do NOT cause tolerance, do NOT cause physical or psychological dependence, potentcy, time of onset, duration of action

20

NSAID clinical uses

acute pain of skeletal muscle or dental pain, pain and inflammation associated with osteoarthritis and RA, chronic malignaant pain as an addititve affect to narcotic analgestics, pain related to bone metastases

21

ADRs of NSAIDs

Renal dysfunction (can be reversed), fluid retention, increase BP, avoid in CHF, GI are most concerning, bleeding risk

22

Ibuprofen (Motrin, Advil)

initial choice by many for acute pain due to cost and safety, available OTC, prescription and IV, safe in peds as suspension

23

IV ibuprofen

used for infants with patent ductus arteriosis, Caldolar is new product used for management of acute pain and fever

24

Ketorolac (Toradol)

First parenteral available in US, quick onset, use limited to

25

IV Ketorolac (Toradol)

considered by many to be equally efficacious to opiods for severe acute piain, due to GI adrs cannot get that level of relief with oral ketorolac, caution with post op

26

Naproxen (Aleve, Anaprox, Naprosyn)

BID dosing, OTC, PO, inc GI bleed?

27

Meloxicam (Mobic)

daily dosing, more selective for COX, better for long term, prescription only, $$

28

COX 2 inhibitors MOA

selectively inhibit COX2, no more efficacious, less GI irritation, less anti-platelt effects, all other ADRs similar to NSAIDs, well tolerated

29

2 drugs pulled from the market

Valdecoxib (Bextra), Rofecoxib (Vioxx) pulled for cardiovascular disease

30

Celecoxib (Celebrex)

the only one left, used for low cardio risk who require long term NSAIDs and at risk for GI toxicity, not for acute pain, not PRN

31

Acetaminophen

APAP, no one really knows for sure how it works, analgesic and antipyretic effects, no anti-inflammatory effects, max dose 3 grams, combo

32

APAP uses and ADRs

recommended as 1st line therapy for ostoeoarthritis, fever, mild pain, aches; hepatic necrosis at high doses for prolonged periods of time or with a toxic doses, decreases opioid requirements

33

Apap available as

tablets, caplet, liquid, suppository, and IV, safe in peds

34

APAP IV

Ofirmev, very controversial

35

APAP overdoses

caused by exhaustion of glutathione stores which function to neurtralize toxic metabolites for removal, monitor w/ APAP levels in relation to time of ingestion, can be a medical ER in most severe cases

36

Treatment of APAP overdose

fluids, gastric lavage, activated charcoal, acetylcysteine (Mucomyst) given IV to replenish glutathione, need to treat within 8 hours

37

APAP physical findings

usually asymptomatic for first 24 hours, then nausea, vomiting, jaundice, abd pain, renal injury, coagulopathy, hepatic encephalopathy, cerebral edema, hypotension

38

Acetylcysteine indications

meets criteria on the Rumack-Matthew nomogram, single ingestion of >150 mg, unknown time of ingestion and a serum aceta > 10 mcg, history of ingestion and any evidence of liver injury, Pt with delayed presentation have less success

39

Aspirin

oldest analgesics and prototype of non-opioids, not used for pain but antiplatelet

40

Aspirin mechanism

irreversibly inhibits COX which dec prostaglandin synthesis, inhibits COX prevents formation of thromboxane A2

41

ADRs of aspirin

gastric disturbances and bleeding, tinnitus, rhinitis, asthma, nasal polyps, edema, hypotension, shock, Reye's syndrome

42

Aspirin clearance

contingent on urine pH, pH becomes more acidic, renal excretion increases because aspirin is in ionized form

43

Other non-opioid approaches to pain

muscle relaxants, bisphosphonates, steroids, Clonidine, ketamine

44

Conditions associated with neuropathic pain

diabetic neuropathies, post herpetic neuralgia, back pain, trigeminal neuralgia, HIV, CA, HA, spinal cord injury, phantom limb

45

General approach to neuropathic pain

initiate one drug at a time, use more favorable ADR profiles, start dosing low, slowly increase, always investigate alternative agents in setting of therapeutic failures, drugs have a longer onset

46

Antidepressant options

specifically focusing on agent that have activity with regards to norepinephrine and serotonin, TCAs, SSRIs, Duloxetine (Cymbalta)

47

Anticonvulsant options

Gabapentin (Neurontin) never used as anticonvulsant anymore, for chronic use, should titrate up, very sedating, Pregabalin (Lyrica), Carbamazepine, topiramate

48

Capsaicin Cream

substance P inhibitor, available OTC for chronic management, not PRN, not as monotherapy

49

Lidocaine options

patches-DOC for post herpetic neuralgia, apply x12 hours, then remove 12 hours, can be cut!, apply up to 3 patches, injections also but rare

50

Treatment of Fibromyalgia

antidepressants, cyclobenzaprine (Fleceril), Duloxetine (Cymbalta), venlafaxine (Effexor), Tramadol (Ultram), exercise, cognitive behavioral therapy