Pain and Inflammation Medications

Question 1

Which receptors do opioids bind to?

Answer 1

MU receptors
Kappa Receptors
Delta Receptors

Question 2

Examples of Opioid Strong Agonists

Answer 2

• Morphine Sulfate
  Fentanyl
  Merperidine (Demerol)
  Hydromorphone (Dilaudid)
  Methadone

Question 3

Opioid Moderate to Strong Agonist Examples

Answer 3

• Codeine
  Oxycodone
  Tramadol (Ultram)

Question 4

Opioid Agonist-Antagonist Examples

Answer 4

• Butorphanol
  Nalbuphine (Nubain)

Question 5

What do MU Receptors cause?

Answer 5

Analgesia
Respiratory Depression
Euphoria
Miosis
Reduced GI motility

Question 6

What do Kappa Receptors cause?

Answer 6

Analgesia
Sedation
Respiratory Depression
Dysphoria
Miosis

Question 7

What do Delta receptors cause?

Answer 7

Analgesia

Question 8

Which neuropeptides are part of the endogenous analgesia system?

Answer 8

Endorphins
Enkephalins
Dynorphins

Question 9

Endorphins

Answer 9

Inhibit Pain Signal Transmission
Induce Euphoria

Question 10

Enkephalins

Answer 10

Inhibit substance P release
Modulate Pain Perception

Question 11

Dynorphins

Answer 11

Produce analgesia

Question 12

Morphine Sulfate

Answer 12

They bind to opioid receptors in brain, spinal cord, and peripheral tissues and activate endogenous analgesia system.

Moderate to servere pain

Question 13

Adverse Effects of Morphine Sulfate

Answer 13

Respiratory depression
CNS depression
Nausea and Vomiting
Orthostatic hypotension
Sedation
Urinary Retention
Pupil Constriction
Itching

Question 14

Black Box Warning for Morphine Sulfate

Answer 14

Regarding combined use of morphine and other opioid analgesics with benzodiazepines and other CNS depressants. All opioid analgesics – respiratory depression, coma, death, drug abuse and dependence.

Question 15

CNS Depressants

Answer 15

Alcohol, antidepressants, antipsychotic, barbiturates, benzodiazepines, and sedatives

Question 16

Meperidine (Demerol)

Answer 16

• Produces neurotoxic metabolite (normeperidine) which accumulates with chronic use, large doses or renal failure.
• CNS Stimulation – Agitation, hallucinations, seizures
• Normeperidine not reversible with sopioid antagonist drugs

Not frequently used

Question 17

Methadone

Answer 17

• Longer Duration of action
• Therapueutic uses: Servere pain and detoxification and maintenance treatment of opioid use disorder
• Adverse Effects: Lead to fatal dysrhythmias (Torsades de pointes)

Question 18

Examples of Potent Opioids

Answer 18

Fentanyl and hydromorphone (Dilaudid)

Question 19

Examples of milder opioids

Answer 19

Oxycodone and Codeine

Black Box Warning: Children who are ultra rapid metabolizers of codeine

Question 20

Signs of Opioid Toxicity

Answer 20

Classic Triad: Coma, Respiratory Depression, Pinpoint Pupils

Question 21

Equianalgesic Dosing

Answer 21

An equianalgesic dosing chart is a conversion chart that lists equivalent doses of analgesics

Question 22

Patient-controlled Analgesia (PCA)

Answer 22

• Patient self-administers
• Preset bolus
• Basal amount
• Lockout period
• Education

Question 23

Tramadol (Ultram)

Answer 23

MOA: Binds to mu opioid receptors and inhibits norepinephrine and serotonin reuptake
Therapeutic uses:
* Moderate to severe pain
* Older adults
* Fibromyalgia, neuropathic pain
* Chronic pain

Question 24

Tramadol (Ultram) adverse effects

Answer 24

• Serotonin syndrome
• Respiratory depression
• GI effects
• Hypotension
• Seizures
• Suicidal ideation

Drug interactions: CNS depressants and SSRIs

Question 25

Opioid Nursing Considerations

Answer 25

* Opioid tolerant vs. Opioid naive * Pain Assessment * Sedation Assessment * Respiratory Assessment * Orders * Treatment goals

Question 26

Opioid Agonist/Antagonist Examples

Answer 26

* Butorphanol * Nalbuphine (Nubain) * Buprenorphine

Question 27

Butorphanol

Answer 27

* Similar to morphine in analgesic effects and respiratory depression risk * Can induce withdrawal in opioid dependence * MOA: Act on same pain receptors as other opioid agonists. Agonists at some receptors and produce antagonist activity at others. | For moderate to severe pain

Question 28

Adverse Effects of Butorphanol

Answer 28

Black Box Warning: Potentially fatal respiratory depression, coma, death, drug dependence and abuse potential Vertigo Nausea and Vomiting Possible withdrawal in opioid-tolerant

Question 29

Signs and Symptoms of Opioid Withdrawal

Answer 29

* Perspiration * Chills * N/V/D * Anxiety, restlessness, insomnia * Pupil dilation * Anorexia * Increased body temperature, RR, BP * Dehydration * Muscle cramps

Question 30

Opioid Antagonist Example

Answer 30

Naloxone (Narcan)

Question 31

Naloxone (Narcan)

Answer 31

* Antidote for CNS and respiratory depression caused by opioids. Also reverses analgesia * MOA: Competes with opioids at receptor sites and prevents binding or displaces bound opioids. * Therapeutic use: Reverse respiratory and CNS depression caused by opioid overdose | Adverse Effect: Withdrawal Shorter duration of action than opioids.

Question 32

Nonnarcotic Analgesic Antipyretic Example

Answer 32

Acetaminophen (Tylenol)

Question 33

Acetaminophen (Tylenol)

Answer 33

MOA: Mechanism of action for pain response is largely unknown. Acts on hypothalamus to reduce fever. Does not block prostaglandin synthesis in the periphery, pain relief action suspected to be via CNS. Therapeutic uses: Analgesic, antipyretic | Does not have anti-inflammatory properties

Question 34

Adverse effects of Acetaminophen (Tylenol)

Answer 34

Hepatotoxicity - Max dose 4 grams/24 hours - Use in caution with liver or renal impairment Nephrotoxic in overdose Overdose - In multiple combination drugs - Acetylcysteine (Mucomyst)

Question 35

Antiprostaglandins/ Cyclooxygenase Inhibitors Examples

Answer 35

Salicylate NSAIDS (1st and 2nd Generations)

Question 36

What are the roles of prostaglandins?

Answer 36

* Participate in Inflammatory response * Formed in response to cellular injury * Sensitize pain along with other chemical mediators * Protect GI tract adn kidneys * Regulate platelet function * Regulate vascular tone

Question 37

Aspirin (Acetylsalicylic acid)

Answer 37

MOA: Nonselective inhibitor of cyclooxygenase, suppresses platelet aggregation. Acts centrally and peripherally. Blocks pain response.