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Pharm 2 Exam 2 > Non-Opioids and Opiods > Flashcards

Non-Opioids and Opiods Flashcards

1
Q

How does the WHO define pain?

A

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage”

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2
Q

Further Defining pain

Physical Well-Being:

A 
Stamina/strength
Appetite
Sleep
Elimination
functional capacity
comfort
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3
Q

Further Defining Pain

Psychologica Well-being:

A 
Coping
Control
Concentration
Enjoyment/happiness
Sense of usefulness
Anxiety/depression/fear
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4
Q

Further Defining Pain

Social Well-being:

A 
Social support/family
sexuality/affection
employment
finances
appearances
roles and relationships
Isolation/dependence/burden
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5
Q

Further Defining Pain

Spiritual well-being:

A 
Religion
Sense of purpose/meaning
Hopefulness
Uncertainty
Suffering
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6
Q

Pain Pathway:

What is Transduction?

A

A physiological process whereby a noxious mechanical, chemical or thermal stimulus is transduced via specialed receptors on primary afferents into an electrical impulse up to the brain.

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7
Q

Pain Pathway

What is transmission?

A

Once transduced and generated, nerve impulses are conducted to the central nervous system using specific sodium channels. - Opioids try to prevent transmission to the brain.

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8
Q

Pain Pathway

What is perception?

A

The process by which a noxious event is recognized as pain by a conscious person

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9
Q

Pain Pathway

What is descending modulation?

A

Inhibition of nociceptive impulses. Descending input from the brainstem influences central nociceptive transmission in the spinal cord. Neurons from the brain stem release 5 HT and NE.
EX: Tricyclic antidepressants enhance normal modulation by interfering with reuptake of 5 HT and NE. In turn, decreases the perception of pain.

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10
Q

Categorizing Pain

What is Visceral Pain? + example

A

Visceral pain is referred, colicky, diffuse in organs such as gallbladder, liver, intestines
*squeezing, cramping, bloating

EX: US, cholecystitis, peptic ulcer

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11
Q

Categorizing Pain:

What is somatic pain?

A

Somatic pain is well-localized pain caused by tissue damage to skin, soft tissue, muscle or bone.
*Stabbing, aching, sharp

Ex: trauma and arthritis

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12
Q

Categorizing Pain:

What is Neuropathic pain?

A

Neuropathic pain is injury or inflammation of nerves. Often coexists with somatic and or visceral pain.
*Radicular, stocking-like, burning numb, electric, tingling.
Ex: phantom limb syndrome, diabetic neuropathy, postherpetic neuralgia.

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13
Q

What is Acute Pain?

A
  • Less than 3 months

- Changes in vital signs, brief duration, subsides with healing, treated with PRN medications

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14
Q

What is Chronic pain?

A
  • Greater than 3 months

- Vital sign within normal limits, continuous duration, treated with around-the-clock medications

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15
Q

Pediatric pain

When is the nociceptor system functional by?

A

24 weeks gestation

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16
Q

Pediatric Pain

What are pediatric indicators of pain:

A

vocalizations, social withdrawal, changes in sleep pattern, poor feeding, increased HR and RR

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17
Q

Pediatric Pain

What can be used for pediatric pain control?

A 
Sucrose
Acetaminophen
Aspirin
NSAIDS
Opioids
Topical analgesia/local analgesia
Psychotropic medications
Nonpharmacologic measures
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18
Q

Pediatric Pain: Sucrose

When is used as an effective pain medication?
When should it be given?

A

Most effective under 1 month of age, but some up to 6 months.

Should be given 2 minutes before painful procedure

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19
Q

Aging and Pain:

What should you take into consideration with the elderly?

A
  • Increase in pain threshold (skin thickness changes, peripheral neuropathies
  • Reduced pain tolerance
  • changes in the metabolism of drugs
  • comorbidities causing pain
  • comorbidities impacting the pharmacokinetics of prescribing
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20
Q

What is the structured pain protocol?

A
  1. Complete pain assessment (OLDCART)
  2. Match appropriate durg to pain type
  3. Consider potential side effects and risks
  4. Assess safest route of delivery. Provide clear instructions
  5. Determine financial burden and access
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21
Q

WHO Pain ladder:

What is Step 1 of the ladder?

A

Mild to moderate pain:

treat with non-opioid +/- adjuvant

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22
Q

WHO Pain ladder:

What is Step 2 of the ladder?

A

Moderate to severe pain or fail Step 1:

  • use oral opioid + non-opioid
  • +/- adjuvant
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23
Q

WHO Pain ladder:

What is Step 3 of the ladder?

A

Severe pain or fail Step 2:
-Treat with opioid for severe pain with or without non-opioid
-Practice around-the-clock dosing
Adjuvant medications

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24
Q

Acetaminophen:

Use and MOA

A

Mild pain treatment; for moderate pain would combine with oxy or hydro
Believed to inhibit the synthesis of prostaglandins in teh central nervous system and work peripherally to block pain impulse generation

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25
Acetaminophen: Dosage
Max: 4g in 24 with monitoring. 3 g in 24 with no monitoring Pediatric: 10-15 mg/kg/ dose every 4-6 hours
26
Acetaminophen: Safe In: Pregnancy? Lactation? Elderly?
Yes to all 3
27
Acetaminophen: Side Effects
Skin rash Increased ALT Increased bilirubin
28
Acetaminophen: Monitoring
LFT
29
Acetaminophen: Contraindications
Liver impairment
30
NSAIDS: Use and MOA
Mild pain treatment; for moderate pain would combine with oxy or hydro MOA: reversibly inhibits COX 1 and COX 2 enzymes, which results in decreased formation of prostaglandin precursors.
31
NSAIDS: Dose
Max: 3,200 mg /day Naproxin is 1,250 mg/day KIDS: 2,400 mg/day Pediatric: 5-10 mg/kg/dose every 4-6 hours
32
NSAIDS: Side Effects
Edema skin rash epigastric heartburn
33
NSAIDS: Monitoring parameters
Renal panel CBC GI disturbances
34
NSAIDS: Caution in what patients
Hypertension - Ace and Arbs Renal Disease - Blood disorder - affects plts Avoid in pregnancy- preterm labor
35
Local Anesthetics: What is EMLA?
Topical eutectic mixture of lidocaine and prilocaine
36
Local Anesthetics: When should EMLA be placed on infants and children?
Infants: 1 hour before | Older children: Up to 4 hours
37
Local Anesthetics: SE of EMLA?
Neonates: Methemoglobinemia Redness and blistering with circumcision
38
Local Anesthetics: Indication for EMLA?
anesthetizes skin before painful procedures
39
Local Anesthetics: What is Voltaren Gel?
NSAID gel
40
Local Anesthetics: Indication for Voltaren Gel?
Acute pain related to sprains, strains | Osteoarthritis
41
Local Anesthetics: How often can Voltaren gel be used?
4 times per day
42
List adjuvant medications
Antidepressants - Cymbalta and Effexor, Amitriptyline | Anticonvulsants - Gabapentin, Pregabalin
43
Serotonin and NE reuptake inhibitors (SNRI's) | MOA:
MOA of SNRI's: Cymbalta and Effexor Potent inhibitor of neuronal serotonin and NE reuptake and a weak inhibitor of dopamine reuptake
44
Serotonin and NE reuptake inhibitors (SNRI's) | Side Effects:
Nausea HA Drowsiness Xerostomia - dry mouth
45
Serotonin and NE reuptake inhibitors (SNRI's) | Clinical Indication:
Neuropathic pain | Chronic MS pain
46
``` Tricyclic antidepressants (TCA's): Amitriptyline MOA ```
MOA of TCA's: Amitriptyline | Central inhibition of NE and serotonin reuptake
47
``` Tricyclic antidepressants (TCA's): Amitriptyline Side Effects ```
``` Sedation Anticholinergic effects Postural Hypotension Cognitive impairment **Avoid in Elderly: check EKG for conduction ABN prior to initiation ```
48
``` Tricyclic antidepressants (TCA's): Amitriptyline Monitoring parameters: ```
Mental status Suicidal ideation HR BP
49
``` Tricyclic antidepressants (TCA's): Amitriptyline Clinical Indication ```
Neuropathic pain | Chronic pain
50
Anticonvulsants: Gabapentin | MOA
Anticonvulsants: Gabapentin MOA: high affinity-binding sites are located throughout the brain; sites correspond to the presence of voltage-gated calcium channels which may modulate the release of excitatory neurotransmitters which participate in norcicption
51
Anticonvulsants: Gabapentin | Side effects
``` Dizziness Drowsiness ATaxia - muscle coordination fatigue peripheral edema ```
52
Anticonvulsants: Gabapentin | Monitoring parameters
Sedation Renal function Suicidality
53
Anticonvulsants: Gabapentin | Clinical indications
Neuropathic pain
54
Anticonvulsants: Pregabalin | MOA
Anticonvulsants: Pregabalin MOA: exerts antinociceptive and anticonvulsant activity; may also affect descending noradrenergic and serotonergic pain transmission pathways from the brainstem to the spinal cord
55
Anticonvulsants: Pregabalin | Side Effects
``` Peripheral edema Dizziness drowsiness HA Fatigue ```
56
Anticonvulsants: Pregabalin | Monitoring parameters
Sedation Weight gain Suicidality
57
Anticonvulsants: Pregabalin | Clinical indication:
Neuropathic pain
58
Tramadol Use
Moderate pain option that is a non-opioid that works on the opioid receptor
59
Tramadol MOA
Tramadol and its active metabolite M1 binds to mu-opioid receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain: also inhibits the reuptake of NE and serotonin, which are neurotransmitters involved in the descending inhibitory pain pathway responsible for pain relief.
60
Tramadol Side Effects
``` Can lower seizure threshold Flushing Dizziness HA Nause Constipation ```
61
Tramadol Monitoring parameters:
Sedation | Suicidal ideation
62
Tramadol Cautions
Risk for serotonin syndrome when combined with TCA's, SSRIs, SNRIs, triptans **Needs to be tapered if will be discontinued after chronic use
63
Opioid MOA
Binds to opioid receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of an response to pain; produces generalized CNS depression
64
Opioid Major receptor subtypes:
mu, kappa, mu is primary receptor
65
Opioid Side Effects
``` Sedation respiratory depression nausea vomiting constipation urinary retention pruritus confusion hypotension ```
66
Opioid Special considerations
Morphine, Dilaudid, and codeine have active metabolites can accumulate in renal impairment Fentanyl is NOT to be used in opioid-naive patients.
67
Naloxone MOA
Pure opioid antagonist that competes and displaces opioid at opioid receptor sites
68
Naloxone Dose
Naloxone 0.4-2 mg may need to repeat doses every 2-3 minutes
69
Naloxone side effects
Flushing Hypertension Tachycardia agitation
70
Naloxone monitoring parameters:
``` RR HR BP Temp LOC ABG's or SpO2 ```
71
Naloxone Caution
patients with CV disease
72
What is Incomplete Cross-Tolerance
A patient who is tolerant to the effects and side effects of one opioid may not be equally tolerant to the effects and side effects of another opioid Decrease equianalgesic dose by 1/3 to 1/2 because of incomplete cross-tolerance.
73
What types of meds should be used for constipation caused by opioids? Give Examples
Prophylactic motility-focused laxatives for patients on opioid therapy Like: Senna Dulcolax Miralax
74
What types of meds for constipation should be avoided by opioid users? Give Examples
Bulk-forming laxatives including Metamucil, Citrucel
75
Define addiction:
Psychological dependence on the drug. Using drug for psychic effects Often associated with drug-seeking behaviors Drug use continues despite negative legal, social and economic effects.
76
Define Tolerance:
Tolerance: Expected effect of chronic opioid use Presents as decreased duration of analgesia Need of more frequent dosing and or higher doses to maintain analgesia
77
Define: Physical dependence:
- Expected effect of chronic use - Not a sign of addiction. - Withdrawal symptoms; when opioid dose is markedly decreased or stopped abruptly. - Symptoms: increased pain, anxiety, lacrimation, rhinorrhea, nausea or diarrhea.
78
What are some Alternative Treatments for pain?
``` RICE massage Heat application Physical therapy TENS therapy (Transcutaneous Electrical Nerve Stimulator) Acupuncture Reiki Distraction/relaxation/music therapy/medication Yoga ```

Pharm 2 Exam 2 (9 decks)

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