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Pharmacology > Pain > Flashcards

Pain Flashcards

(53 cards)

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1
Q

General Anesthetics

A

Use for major surgery
Induce a reversible state of unconsciousness
Provide amnesia

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2
Q

Anesthesia stage 1

A

Analgesia,

Still conscious
Somewhat aware
Loss of sensation

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3
Q

Anesthesia stage 2

A

Excitement,

Unconscious
Amnesiac
Appears agitated and restless

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4
Q

Anesthesia stage 3

A

Surgical anesthesia,

Ideal level for surgery
Regular, deep respirations

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5
Q

Anesthesia stage 4

A

Medullary paralysis,

Should be avoided
Cessation of spontaneous respirations
Cardiovascular collapse

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6
Q

Inhalation of anesthesia

A

Gases or volatile liquids
Longer onset to stage III
Easier to adjust dose and maintain anesthesia

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7
Q

Intravenous route of anesthesia

A

Several categories of CNS depressants
Rapid onset to stage III
Risk of over medication

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8
Q

Barbiturates in association to anesthetics

A

Induction of anesthesia
Fast onset
Relatively safe

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9
Q

Opioid analgesics in association to anesthetics

A

Induction and maintenance of anesthesia

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10
Q

Benzodiazepines in association to anesthetics

A

Induction and maintenance of anesthesia

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11
Q

Ketamine

A

Dissociative anesthesia
Patient appears detached from surroundings
Awake but sedated and unable to recall events
Useful for short procedures

less cardiac and respiratory adverse effects

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12
Q

Propofol

A

Short acting hypnotic
Rapid onset
Induction and maintenance
Rapid recovery

Continuous infusion: sedation of mechanically ventilated patients

Rare adverse effect: Propofol related infusion syndrome (PRIS)

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13
Q

Etomidate

A

Hypnotic-like drug

Rapid onset anesthetic

Short duration

Quick recovery

Minimal cardiopulmonary side effects

can cause muscle twitching

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14
Q

Dexmedetomidine

A

Alpha-2 agonist

No respiratory depression

Adjunct during surgery

Short-term sedation for mechanically ventilated patients

Hypotension
Bradycardia

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15
Q

Mechanism of Action – Anesthetics

A

Inhibit neuronal activity in the CNS (sedation, hypnosis, amnesia)

Inhibit neuronal function in spinal cord (immobility, inhibiting motor response to painful stimuli)

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16
Q

Neuromuscular Blockers

A

Succinylcholine, Rocuronium, Cisatracurium (Nimbex)

Adjunct to general anesthesia, Skeletal muscle paralysis, blocks nerve impulses.

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17
Q

Neuromuscular Blockers advere effects

A

Tachycardia
Increased histamine release
Residual muscle pain and weakness

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18
Q

Local Anesthetics (LA)

A

Loss of sensation in a specific area
Used prior to minor surgical procedures
Rapid recovery with minimal side effects

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19
Q

Local anesthetics MOA

A

Inhibit opening of sodium channels on nerve membranes

Blocks action potential along neuronal axons

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20
Q

Transdermal – Lidocaine patches

A

For MSK pain, neuropathic pain

Must have 12 hour “lidocaine free” period each day

Do not apply heat on or near patch (can speed up release and result in toxcitity)
Apply to clean, dry, intact skin

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21
Q

Infiltration Anesthesia

A

Injection directly into selected
Used for performing surgical repair

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22
Q

Peripheral Nerve Block

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A

Injected close to nerve trunk
Interrupt transmission along the nerve
Used in dental procedures

Minor nerve block
-Single peripheral nerve

Major nerve block
-Several nerves or nerve plexus

23
Q

Central Neural Blockade

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A

Injected in spaces surrounding the spinal cord

epidural nerve blockade, caudal blockade, spinal nerve blockade

24
Q

Sympathetic Blockade

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A

Selective interruption of sympathetic efferent discharge
Used for complex regional pain syndrome (CRPS)

Goal is decreased sympathetic outflow, not analgesia

25
Differential Nerve Block
Local anesthetics block specific nerve fiber groups depending on their size & myelination
26
Local anesthetic systemic toxicity (LAST)
Early symptoms Ringing in the ears, agitation, restlessness, decreased sensation in the tongue, around the mouth, and areas of the skin CNS effects Somnolence, confusion, agitation, excitation, seizures, impaired respiratory function Cardiac effects Decreased cardiac excitation, heart rate, and forced of contraction
27
Excessive prostaglandins results in...
Inflammation Pain Fever Dysmenorrhea Thrombus formation
28
NSAID Mechanism of Action
cox inhibitors
29
COX-1
Synthesizes beneficial prostaglandins Maintains cellular hemostasis Inhibition may cause stomach and kidney issues
30
COX-2
Produces prostaglandins in response to injury Selective NSAIDs inhibit only COX-2 Less GI adverse effects Risk of hypertension, heart failure and infarction
31
Aspirin
Nonselective cox inhibitor, Low dose for CV disease prevention Anti-inflammatory effects require higher dosing than analgesia effects
32
Ibuprofen (Advil, Motrin)
nonselective COX inhibition, Anti-inflammatory effects require higher dosing than analgesia effects
33
NSAID Adverse Effects
GI Damage Cardiovascular Problems Kidney Damage / Hepatotoxicity Hypersensitivity Reye Syndrome Bleeding risk
34
Acetaminophen (Tylenol / Paracetamol / APAP) side effects
Analgesic and antipyretic effects Lacks anti-inflammatory or anticoagulant effects Not associated with GI irritation
35
Acetaminophen (Tylenol / Paracetamol / APAP) MOA
Inhibition of cyclooxygenase in the CNS
36
Acetaminophen dosing
Liver dysfunction Max dose 2 g/ 24 hours Normal liver function Max dose 4 g/ 24 hours
37
Goals of treatment for RA
Decrease joint inflammation Arrest progression of the disease
38
DMARDs
Slow or halt the progression of RA Used with NSAIDs and glucocorticoids Highly effective Significant adverse effects
39
Antimalarials (Hydroxychloroquine)
Use in combination with newer DMARDs or patients who cannot tolerate newer agents Adverse effects High doses - irreversible retinal damage Headache GI distress
40
Immunosuppressant (Azathioprine)
Use to treat severe cases not responding to other agents Adverse effects Fever, chills Sore throat Fatigue Nausea, vomiting Loss of appetite
41
Leflunomide (Arava®)
Decreases pain, inflammation, and joint effusion Slows formation of bone erosions Works early ~ 1 month
42
Leflunomide (Arava®) adverse effects
GI distress Allergic reactions (skin rashes) Pneumonitis
43
Methotrexate
Antimetabolite used in cancer treatment Decreases synovitis and bone erosion Less narrowing of joint space Used alone or in combination with biological agents Rapid onset ~ 2-3 weeks
44
Methotrexate adverse effects
Long term: pulmonary problems, hematological disorders, liver dysfunction
45
Tumor Necrosis Factor (TNF) Inhibitors (Adalimumab (Humira®), etanercept (Enbrel®), infliximab (Remicade®))
Slow progression of inflammatory joint disease Improve symptoms and quality of life Onset of action: months
46
TNF inhibitors adverse effects
Infections, malignancy, liver disease, heart failure, lupus-like disease, demyelinating disorders
47
Rituximab (Rituxan)
Depletes B lymphocytes Beneficial in select patients
48
Tocilizumab (Actemra)
Blocks the interleukin-6 receptor Alternative for select patients
49
Abatacept (Orencia)
Inhibits T cell activation Used second line
50
Goals of treatment for OA
Manage pain Maintain an active lifestyle
51
Viscosupplementation
Uses hyaluronan to restore lubricating properties of synovial fluid -Reduces pain and improves function Temporarily attenuates progression Responders may benefit for 6-12 months May delay need for invasive treatment Well tolerated, pain, swelling, stiffness ~24hr post injection
52
Glucosamine and Chondroitin Sulfate
Proposed benefit of decreased pain and improved function Well tolerated Onset of action: weeks to months
53
Glucocorticoids for RA adverse effects
Increased bone loss Muscle wasting, weakness Hypertension Aggravation of DM, glaucoma, cataracts Increased risk of infection Skin break down

Pharmacology (10 decks)

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