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pharmacology > Opioid Analgesics and Non Opioids > Flashcards

Opioid Analgesics and Non Opioids Flashcards

1
Q

2 types of pain

A
  • duration: acute (sudden) or chronic (3+ months)
  • origin
  • somatic: skin, bone, soft tissues - burning, throbbing, localized
  • visceral: abd/thorasic - dull, aching, hard to locate (loss of consciousness, N/V)
  • neuropathic: nerves - shooting, stabbing
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2
Q

Categories for pain management (3)

A
  • opiates: morphine (pain 7-10)
  • non-opiates: acetaminiphen, salicylates (ASA), NSAIDs (pain 1-3)
  • adjuvant (in addition to others): benzodiazepines, TCA, corticosteroids; treating anxiety, hypnotic, anti-nausea to help comfort
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3
Q

pathway to pain receptors

A
  • injury to cell produces aracadonic acid - cyclooxygenase - prostaglandin release (pain response - vasodilation, increased vascular perm, edema)
  • injury to cell also produced bradykinin (pain receptors)
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4
Q

ADE opiates

A
  • serious: decrease respiration (if RR
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5
Q

route of administration: opiates

A

PO, IM, IV(can titrate), patch, PCA

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6
Q

common clinical uses: opiates

A
  • relief of moderate to severe pain
  • acute pulmonary edema
  • severe non productive cough (codeine)
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7
Q

infrequent uses: opiates

A
  • invasive diagnostic tests
  • pre-op sedation
  • labor and delivery
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8
Q

use opiates cautiously when…

A
  • respiratory depression (CNS depressant)
  • chronic lung disease (CNS depressant)
  • kidney/liver disease (met/exc)
  • increased ICP (watch consciousness)
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9
Q

opiate antagonists

A
  • will counteract opiate/block receptors, NOT stimulants
  • naloxone (narcan)
  • works for 2 hours, fast acting, may need repeat dose
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10
Q

opiate abuse/withdrawal

A
  • tx with methadone (still addictive, but can fx)
  • tolerance and cross tolerance fast
  • babies can die from withdrawal
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11
Q

non-opiates (examples/fx)

A

ASA, acetaminophe, NSAIDs

- work to block cyclooxygenase 1 and 2

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12
Q

pathway for non-opiates

A

stimuli to cell -> arachidonic acid -> non-opioid will stop process to cox1 and 2

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13
Q

cyclooxygenase 1

A

(physiologic/protective prostaglandins)

  • GI: protects stomach
  • renal: maintain blood flow
  • regulates smooth muscle (vessels, lungs)
  • regulates blood clotting (keeps regular)
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14
Q

cyclooxygenase 2

A

(pathologic prostaglandins - ADE)

  • inflammation (vasodilatation, increased perm)
  • edema
  • leukocytosis (increase WBC to injury)
  • cytokine release (play part in pain)
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15
Q

ASA - Acetylsalicyclic Acid: therapeutic effects

A

(aspirin)
- mild analgesic: pain 1-3
- anti-inflammatory
- antipyrectic: effects hypothalamus - sweat
- anti thrombotic: bind irreversibly to inhibit platelet aggregation “slippery”

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16
Q

ASA: ADE

A
  • tinnitus, reversible hearing loss
  • n/v (common), GI bleeding (serious)
  • bleeding: nose, vomit, cough, urine, bruise
  • pregnancy: still born, hemorrhage, long just/labor (class D)
17
Q

salisilate poisoning (s&s and tx)

A
  • S&S: confusion, restlessness, sweating, thirst, hyperventilation (get rid of CO2 from met. acidosis
  • tx: general, gastric levage (1-2h), IV fluids, resp support
18
Q

NSAID: clinical uses

A

(ibuprofen/advil)

  • mild analgesic
  • anti-inflammatory
  • antipyretic
  • anti-thrombotic: binds reversibly only for the time NSAID is in circulation, will come off as platelets are metabolized
19
Q

NSAID: ADE

A
  • drowsiness, tinnitus (CNS)
  • blurred vision
  • n/v, bleeding ulcers (serious), hepatotoxicity
  • kidney necrosis (serious)
  • cat D for pregnancy
20
Q

NSAID drug interactions

A
  • steroids: ulcers
  • oral anticoagulants: bleeding
  • lithium: lithium toxicity
  • oral hypoglycemics: low blood sugars
  • alcohol: GI irritation
  • heparin: bleeding
21
Q

Acetaminophen: uses

A 
(tylenol)
- mild analgesic: pain 1-3
- antipyretic
*NO anti-inflammatory
*WEAK effect on platelets
(used on children or those who cannot tolerate aspirin)
22
Q

Acetaminophen: ADE

A
  • serious: hepatotoxicity (in large doses or with alcohol), renal toxicity, contraindicated for those with liver/renal disease
  • common: rash, urticaria, nausea
23
Q

Acetaminophen-induced hepatotoxicity

A

1-24h: flu-like (n/v, diaphoresis, malaise)
12-24h: decreased urine, pain in RUQ of abd (liver)
2-6d: ecchymosis, jaundice, renal failure
- tx: acetylcysteine within 24h (prevents reactive metabolites from binding with protein mols in liver)

24
Q

cox2 inhibitors

A

(celecoxib) : blocks pathologic prostaglandins
- mild analgesic
- anti-inflammatory
* * BLACK BOX warning: MI and CVA due to increase platelet activity

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