Pain Deck 2

Question 1

Peripheral
Sensitization
Drugs

Answer 1

Local Anesthetics
Topical Analgesics
Anticonvulsants
Tricyclic Antidepressants
Opioids

Question 2

Descending Modulation

Drugs

Answer 2

Anticonvulsants
Opioids
Tricyclic/SNRI Antidepressants

Question 3

Central Sensitization

Drugs

Answer 3

Anticonvulsants
Opioids
NMDA-Receptor Antagonists
Tricyclic/SNRI Antidepressants

Question 4

NSAID examples

Answer 4

† Aspirin
† Nonselective Cox 1and 2 inhibitors (ibuprofen,
naproxyn)
† Selective cox-2 inhibitors (celebrex)
† Ketorolac (Toradol)

Question 5

NSAID MOA

Answer 5

Block prostaglandin synthesis

† Analgesia, antipyretic, anti-inflammatory actions

Question 6

Toradol is used on an outpatient bases for

Answer 6

migraine

Question 7

prostaglandins do what

Answer 7

reduce pain and fever
reduce inflmation

they also protect the stomach and promting clotting. So anything that works against these will cause GI upset and bleedign

Question 8

ASA is an

Answer 8

antiplatelet

Question 9

IBU can be taken every __ versus naproxin which is ___

Answer 9

6 to 8

12

Question 10

NSAID pharmacokinetics

Answer 10

† Biotransformed in the liver

† Small amount excreted renally

Question 11

NSAID side effects

Answer 11

… Side effects: GI, renal, CV ( BP or HF)

Question 12

Risk factors for NSAID ADR

Answer 12

… Alcohol intake
… Age > 60 years
… Female gender
… Duration of treatment
… Type of NSAID use
… Multiple NSAID use
… Corticosteroid use
… Duration of treatment … History of PUD
… Increased dosage
… History of PUD
… Comorbid CV
condition

Question 13

NSAIDs Contraindications

Answer 13

† PUD, GI or other bleeding disorders, Hyperuricemia,
Impaired renal or hepatic function, Vitamin D
deficiency, Cancer, Pregnancy and lactation

† Asthma-ASA-Nasal polyps triad

Question 14

NSAID Lab considerations

Answer 14

† LFTs, salicylate level, hct, PT and INR

† False – urine glucose tests (Clinitest, Tes-Tape)

Question 15

HF and Hypertension can be worsened by

Answer 15

NSAID

Question 16

Acetaminophen MOA

Answer 16

† Prostaglandin and Cox inhibition in CNS, no peripheral
action
† Mild Analgesia, antipyretic, no anti-inflammatory

Question 17

Acetaminophen PHarmacokinetics

Answer 17

† Metabolized liver

Question 18

Acetaminophen SE

Answer 18

† Nephropathy , liver injury

† Limit 3-4G per day*

Question 19

The following opioids are available as combination

Answer 19

products with acetaminophen, aspirin, or ibuprofen

† Codeine; hydrocodone; oxycodone; propoxyphene

Question 20

acetaminophen has a direct

Answer 20

effect on hypothalmus

Question 21

opioid combination are typically used for

Answer 21

† Moderate episodic (PRN) pain

† Breakthrough pain in addition to a long-acting opioid

Question 22

opioids never use more than

Answer 22

one combination product at any one time

Question 23

hydrocodone and oxycodone are more potent
than ____ , which is more potent than
_____, which some studies suggest is
equipotent to aspirin

Answer 23

codeine

propoxphene

Question 24

there is little difference between hydrocodone

products and

Answer 24

oxycodone products in terms of

potency

Question 25

Adjuvants

Answer 25

``` … Non-pharmacologic … Topicals … Tylenol … NSAIDS, Celecoxib, steroids … Anticonvulsants … Antidepressants … Antiarrhythmics ```

Question 26

Tramadol - Indications

Answer 26

mild to moderate pain

Question 27

Tramadol MOA

Answer 27

entrally acting synthetic pain reliever † Action similar to morphine † Max dose 300mg/d † Not recommended for acute use for >5d

Question 28

Tramadol SE

Answer 28

Side Effects † Increased falls in the elderly? † May be habit forming

Question 29

Tramadol dont

Answer 29

Don’t stop abruptly, taper off

Question 30

Agents to treat acute pain - Adjuncts

Answer 30

``` † Preemptive analgesia † NMDA receptor agonists † Alpha-2 adrenerg g ic a onists † Local anesthetics † Anticonvulsants ```

Question 31

Agents to treat chronic pain - Adjuncts

Answer 31

† Anticonvulsants | † Antidepressants

Question 32

Preemptive Analgesia

Answer 32

After tissue injury or surgery: † Damage causes peripheral sensitization and central sensitization … Treatment started before and is operational during a surgical procedure … Antinociceptive treatment that reduces altered sensory input Research † preemptive analgesia decreases peripheral sensitization † Decrease in central sensitization controversial

Question 33

… Agents Shown to be of Pre-Emptive Benefit

Answer 33

†Ketamine 0.25-1 mg/kg †Cox-2 I hibi * 2 Inhibitors* †Neurontin 300 mg †Local Anesthetics

Question 34

Ketamine MOA

Answer 34

binds to phencyclidine site on the NMDA | receptor

Question 35

Ketamine Use at

Answer 35

subanesthetic dose

Question 36

Ketamine Current literature

Answer 36

† Administer pre-incision and throughout the | perioperative period

Question 37

Ketamine Other effects

Answer 37

† Less PONV than control, no adverse psychic effects or | sedation

Question 38

Local Anesthetics MOA

Answer 38

reversibly block impulse conduction along nerve axons and other excitable membranes that utilize sodium channels as the primary means of action potential generation

Question 39

Local Anestheits causes

Answer 39

reversible local anesthesia and a loss of | nociception

Question 40

Esters

Answer 40

… Tetracaine (Pontocaine) … Benzocaine … Cocaine … Procaine (Novacaine)

Question 41

Amides

Answer 41

``` … Lidocaine … Mepivicaine … Bupivicaine (Marcaine) … Etidocaine(Duranest) … Prilocaine ```

Question 42

classification of local anesthetics

Answer 42

Esthers | Amides

Question 43

Topical types

Answer 43

Topical † Emla † Tracheal lidocaine

Question 44

Topicsal MOA

Answer 44

… Peripheral nerve endings and major nerve trunks | † Axillary, ankle blocks etc.

Question 45

Topical administration

Answer 45

Epidural or subarachnoid

Question 46

Alpha-2 Adrenergic Agonists examples

Answer 46

clonidine | dextemetomidine

Question 47

Alpha 2 can be gven as an

Answer 47

infusion

Question 48

Clinidine

Answer 48

† Antihyptensive amd analgesic adjunct | † No respiratory depression

Question 49

Dextemetomidine (Precedex)

Answer 49

``` † Central and peripheral effects „ More alpha-2 selective „ No respiratory depression „ May reduce HR and BP „ Potentiates effects of opioids, sedatives, anesthetics ```

Question 50

Gabapentin (Neurontin) - in animal studies it

Answer 50

In animal studies it helps to prevent allodynia

Question 51

Gabapentin (Neurontin) 0 used

Answer 51

Used preemptively, reduces anxiety in

Question 52

Gabapentin (Neurontin) MOA

Answer 52

… U k MOA Unknown MOA † Studies have suggested that it helps preemptively by reducing wind up pain

Question 53

Gabapentin (Neurontin) Dosine condierations

Answer 53

Dosing considerations: Renal dosing

Question 54

Gabapentin (Neurontin) SE

Answer 54

dizziness, somnolence, edema

Question 55

Pregabalin (Lyrica) is like

Answer 55

``` “Neurontin on steroids” † Has greater analgesic effect on neuropathic pain in animal models † Titrate up, taper down † Reduces Opioid induced hyperalgesia ```

Question 56

Pregabalin SE

Answer 56

† Be careful with elderly „ Can cause ataxia, drowsiness, depression, suicidal † Weight gain, peripheral edema,