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Clinical Pharmacology Year V NIŠ > Pain > Flashcards

Pain Flashcards

(52 cards)

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1
Q

Why is it beneficial to switch one opioid to another?

A

Increasing dose becomes ineffective
Adverse effects and treatment better balance
Prevent analgesic tolerance

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2
Q

What are the contraindications of acetaminophen?

A

Allergic reactions
Severe liver failure

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3
Q

What are the adverse effects of aspirin?

A

GIT- direct corrosive effects = inhibition of PG synthesis
Hypersensitive- potential cross reaction with other NSAIDs
Risk of bleeding (48 hours)

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4
Q

What is the mechanism of action of beta blockers?

A

Modulation of adrenergic and seratoninergic neurotransmission
In cortical and subcortical pathways
Increases migraine attack threshold

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5
Q

What are the goals of prophylaxis in Migraine management?

A

Decrease frequency and severity of attacks as well as debilitating symptoms
Decrease use of small efficacy drugs
Improve quality of life

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6
Q

Aspirin is a ……… inhibitor

A

Aspirin is a irreversible COX inhibitor

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7
Q

What is the first line drug for mild-moderate pain?

A
  • Naproxen (propionic acid derivative)
    Long half life
    More potent analgesic
    Safest in high risk CVD patients
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8
Q

What drugs are COX-2 coxib inhibitors?

A

Celecoxib
Etoricoxib

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9
Q

When are opioids used for migraines?

A

Rarely used
Possible rebound headache and addiction
If other drug managements are contraindicated
Moderate to severe attacks

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10
Q

When is prophylaxis indicated for Migraines?

A

> 2 attacks/month
Presence of severe or debilitating symptoms
Patients wants to decrease number of attacks
Exaggerated use of abortive therapy drugs

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11
Q

Define pain

A

Unpleasant and subjective experience
Net effect of ascending and descending neurons
Including biochemical, physiological, psychological and neocortical processes

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12
Q

What are the adverse effects of acetaminophen?

A

Liver necrosis- toxic doses, chronic alcoholism and hepatitis
Methemoglobinemia & Hemolytic anaemia in G6PD

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13
Q

What is the function of aspirin?

A

Analgesic
Anti-pyretic
Anti-inflammatory
Decreases nociceptive sensitization and increases pain threshold

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14
Q

What are the types of pain?

A

Neuropathic
Functional
Nociceptive (preventative)
Inflammatory (preventative)

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15
Q

How are migraines managed using non-opioids?

A

Non opioid + Metclopromide
Mild to moderate pain
Most commonly used
Less GIT adverse effects
As effective as sumatriptan and more effective than DHE (Dihydroergotamine)

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16
Q

What is the function of Meloxicam?

A

Oxicam drug class
Selective COX-2 inhibitor
Lower ulcerogenic potential
Long lasting analgesic and anti-inflammatory effects

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17
Q

What are some antiepileptics used in migraine management?

A

Valproic acid and Divalproex - contraindicated in pregnancy and chronic liver disease
Topiramate

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18
Q

What are the adverse effects of Triptans?

A

Drowsiness
Dizziness
Paraesthesia
Sensation of warmth
Chest fullness
Nausea

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19
Q

How do you assess pain?

A

SOCRATES
Number scale 1-10
Patient expectations
Associated Symptoms
Acute or Chronic
Impact of pain on functionality, mental status and behaviour

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20
Q

What is the mechanism of action of antidepressants in migraines?

A

Downregulates 5-HT2 receptors
Increases NA in synapses
Increased effects of endogenous opioids

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21
Q

When can combination therapy be used with opioids?

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A

Opioid + Non-opioid
Moderate to severe pain
Enhances analgesia and at lower dose of each
Short acting therapy, therefore not indicated for chronic pain

22
Q

How are dihydroergotamines (DHE) used for migraine management?

Study These Flashcards
A

Early treatment, during the beginning of attacks
Oral administration
Caffeine combination tablets increase absorption and potentiates analgesic effect

23
Q

What is the function of acetaminophen?

Study These Flashcards
A

Analgesic and anti-pyretic
Central analgesic with low potency
Used for mild to moderate pain
Can be used in combination with weak opioids

24
Q

The choice of drug and route of administration for opioids use depends on?

Study These Flashcards
A

Comorbidities
Body mass and age
Intensity and perception of pain
Tolerance to opioids

25
Why convert from one dosage to another in opioids?
Ineffective pain control Side effects emerge Change in patient status Formulatory restrictions
26
Why do DHE's have limited use?
Maximum only 2 day use due to risk of fibrosing pleura, pericardium, heart valves and peritoneum
27
What is the plan for migraine prophylaxis?
Start with small doses, increase until maximal tolerance or expected efficacy is reached Change drug if adverse effects emerge or if not efficient Follow up efficiency every 2-3 months : Migraine Diary
28
What are the adverse effects of opioids?
Nausea, constipation, vomiting Sedation and hallucinations Respiratory depression- alhtough tolerance develops to this Constipation tolerance does not develop- laxative must be prescribed in combination e.g. bisacodyl or senna
29
Why are 2nd generation triptans better than 1st generation (Sumatriptan)?
E.g. Eletriptan, Frovatriptan, Almotriptan, Naratriptan Longer half life Better pharmacokinetics- higher bioavailability Depending on drug- less adverse effects, more analgesic effect and lower frequency of repeated attacks
30
What type of pain are NSAID's best suited for?
Mild to moderate Pain mediated by PGs e.g. Rhematoid A, Menstrual cramps and post-surgical pain Minimal use in neuropathic pain
31
What are the contraindications of coxib COX-2 inhibitors?
Pregnancy and breastfeeding Hypersensitivity Liver and kidney dysfunction GIT active bleeding, peptic ulcer and IBD <16 yrs Cerebrovascular disease, Peripheral vascular disease etc
32
What are the 3 drug groups used for migraine prophylaxis?
Antidepressant, Antiepileptics and Beta Blockers used Proved efficacy- Metoprolol and valproic acid Probably efficient- Atenolol and amitriptyline Possibly efficient- Carbamazepine and pindolol
33
What opioids are used for mild to moderate pain?
Codeine Oxycodone Hydrocodone Meperidine
34
What types of antidepressants can be used for migraines?
SSRI SNRI TCA
35
What is the WHO analgesic ladder for pain management
Mild (1-3): non-opioid analgesic Moderate (4-6): combine acetaminophen/NSAID with moderately potent analgesic Severe (7-10): high potentcy opioids
36
What is the mechanism of action of Triptans?
Strong vasoconstrictor of dilated intracranial arteries Peripheral neural inhibition Inhibition of neurotransmission of trigeminal-cervical complex
37
What is opiophobia?
Exaggerated concern over opioid use Risk > Benefit , therefore not prescribed Although patients are indicated
38
What are the side effects of DHE's?
Chronic headache conversion from chronic use MI Ergotism Nausea & vomiting Abdominal pain Diarrhea Muscle pain and weakness
39
When can combination therapy be used with opioids?
Opioid + Non-opioid Moderate to severe pain Enhances analgesia and at lower dose of each Short acting therapy, therefore not indicated for chronic pain
40
When are DHE's contraindicated?
Liver and kidney failure Cerebral or peripheral vascular disease Coronary artery disease Pregnancy Lactation Sepsis
41
What is the mechanism of action of antiepileptics in migraines?
Increased GABA inhibitory effects Modulation of glutamate excitatory neurotransmission Na and Ca channel inhibition
42
How are headaches classified?
Primary- migraines, cluster headaches, tension-type headaches and trigeminal autonomic headaches etc. Secondary- head or neck trauma, infection, vascular or non-vascular intracranial disorders etc
43
What are NSAIDs adverse effects?
GIT irritation- dyspepsia, peptic ulcers & bleeding Nephrotoxicity- hypoperfusion of kidneys Antiplatelet effect, Na retention, Liver Dysfunction & CNS dysfunction Increased risk of CVS events
44
What are the contraindications of Triptans?
Pregnancy Lactation PAD CAD MAO inhibitors (including use in previous 2 weeks) Caution with SSRI or SNRI due to Seretonin Syndrome
45
What is the first line drug for pain?
- Acetaminophen
46
What is the mechanism of action of DHE?
Strong arterial vasoconstrictor
47
What are the contraindications of aspirin?
III trimester of pregnancy Risk of bleeding Allergy Peptic ulcer Liver or Kidney dysfunction Co-medication with methotrexate Children < 16 yrs Severe decompensated heart failure
48
What are the contraindications of coxib COX-2 inhibitors?
Pregnancy and breastfeeding Hypersensitivity Liver and kidney dysfunction GIT active bleeding, peptic ulcer and IBD <16 yrs Cerebrovascular disease, Peripheral vascular disease etc
49
When are triptans indicated for migraine management?
Severe or debilitating attacks Non-specific therapy is ineffective
50
What drugs are acetic acid derivatives?
Diclofenac Ketorolac
51
What opioids are used for moderate to severe pain?
Morphine Oxymorphone Hydromorphone Methadone Fentanyl
52
What are the first, second and third line drugs for neuropathic pain?
First line: Gabapentin Lidocaine transdermal TCA e.g. SSRI or SNRI Second line: Opioids e.g. tramadol Third line: SSRI Anti-epileptic e.g. carbamezapine, lamotrigine, valproic acid NMDA anatagonists e.g. Ketamine

Clinical Pharmacology Year V NIŠ (9 decks)

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