pain management Flashcards by Hanna Consoldane

what are the 3 distinct families of endogenous opioid peptides

endorphins
enkephalins
dynorphins

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what are common side effects of Mu receptor activation

sedation and respiratory depression

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antagonists don’t produce ____

analgesia

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antagonists are primarily used to treat….

opioid overdoses
addiction

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what is the primary agent used to treat opioid overdose

naloxone

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strong agonists are used to treat…

severe pain

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morphine is an example of

strong agonist

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mild-to-moderate agonists are used to treat….

moderate pain

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codeine, hydrocodone and oxycodone are what type of agonsit

mild-to-moderate

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mixed agonist-antagonists strength

less risk of side effects with Mu receptors

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mixed agonist-antagonist weaknesses

may produce psychotropic effects
maximal analgesic effect may not be as strong

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spinal effects/mechanism of opioids

inhibits both presynaptic and postsynaptic membranes of pain-mediating synapses by “trapping” neurotransmitters

(basically is able to stop neurons from communicating to each other that there is pain)

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opioid receptors are linked via _________ to signaling pathways

G proteins

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supraspinal effects/mechanism of opioids

opioids bind to the midbrain’s gray matter (PAG) and sends signals down a pathway to the pain sight to slow the pain signals

(basically decreases pain by stopping the pain signals to the brain)

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increased activity of descending pathways travel through the ventromedial medulla (VMM) to reach the ______

dorsal horn of the spinal cord

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neurons in descending pathways release _____ and _____ onto _______ to inhibit pain impulses to the brain

serotonin
norepinephrine
dorsal horn synapses

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orthostatic hypotension

when you get up too fast and get dizzy

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2 mechanisms of opioid tolerance

receptor down-regulation
loss of communication between opioid receptors and G proteins

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when do withdrawal symptoms become evident, when is the peak, and how long do they last for?

evident: 6-10 hours
peak: day 2-3
last for: 5 days

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some symptoms of physical dependence to pain medicine include

body aches
diarrhea
fever
insomnia
irritability
stomach cramps
vomiting/nausea

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opioid-induced hyperalgesia

failure to respond to opioids
could increase pain sensitivity

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methadone function

offers milder withdrawal symptoms

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peripheral effects/mechanism of opioids

the exogenous opioids assist the endogenous peptides in stopping the transmission of pain

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2 types of corticosteroids

glucocorticoids (cortisol)
mineralocorticoids (aldosterone)

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what corticosteroid affects carbohydrate and protein metabolism

glucocorticoids (cortisol)

what corticosteroid regulates electrolyte and water metabolism

mineralocorticoids (aldosterone)

glucocorticoids __(increase/decrease)___ blood glucose and liver glycogen

increase

glucocorticoids act on macrophages, lymphocytes, and endothelial cells to inhibit the expression of __________

inflammatory proteins (cytokines)

how do glucocorticoids reduce inflammation

1. inhibits inflammatory proteins (cytokines) 2. reduces lymphocytes and eosinophils 3. inhibits adhesion molecules so leukocytes can't promote inflammation 4. reduces vascular permeability by suppressing histamine and kinins

in order to reduce vascular permeability, ____ and ___ must be produced (think endogenous)

histamine and kinins

what are the main functions of glucocorticoid medications

decrease inflammation immunosuppression replacement for adrenal insufficiency

the main adverse symptom of prolonged corticosteroids in the ENDOCRINE system

hyperglycemia

the main adverse symptom of prolonged corticosteroids in the CARDIOVASCULAR system

fluid retention/edema

the main adverse symptoms of prolonged corticosteroids in the IMMUNE system

increase risk of infections activates latent viruses masks infection

the main adverse symptoms of prolonged corticosteroids in the MUSCULOSKELETAL system

osteoporosis bone fractures

the main adverse symptoms of prolonged corticosteroids in the GASTROINTESTINAL system

peptic ulcers GI bleeding gastritis nausea

the main adverse symptoms of prolonged corticosteroids in the NERVOUS system

insomnia mood changes

-prazole

proton pump inhibitor helps with gastric ulcers

-idine

histamine H2-receptor blockers helps with gastric ulcers

-amide

oral antidiabetics (sulfonylurea group) helps with type 2 diabetes (antidiabetics)

-dronate

bisphosphonates helps with osteoporosis

what is the first step of the eicosanoid biosynthesis and then what are the 2 pathway options

arachidonic acid is released then either goes the LOX or COX pathway

prostaglandin

a group of lipid-like compounds that are produced by all living cells (except RBCs)

leukotriene

pro-inflammatory and mediates airway inflammation

increased PGE2 causes

inflammation

how do eicosanoids promote fever

altering thermo-regulatory set-point

dysmenorrhea

painful cramps that accompany menstruation

eicosanoids cause

pain fever dysmenorrhea thrombus formation inflammation

how do eicosanoids cause thrombus formation

TXA2 causes platelet aggregations that result in the blood clot formations

what do aspirin and other NSAIDs inhibit

Cyclooxygenase (COX)

what does it mean to say that aspirin is a nonselective inhibitor? Why is this a bad thing?

it means that aspirin inhibits COX1 and COX2 This is bad because COX1 helps platelet function and gastric protection

COX1 function

gastric protection platelet function

COX2 function

pain fever bone formation

what is aspirin good at preventing

pain/inflammation fever vascular disorders cancer prevention

what is the primary NSAID used in treating fever in adults

aspirin

2 main adverse effects of aspirin-like drugs

1. gastrointestinal problems 2. cardiovascular problems

aspirin is linked to causing _______ in children

reye syndrome

benefit of COX-2 selective drugs

because COX1 is untouched, the chance of gastric irritation is much lower

what does NSAID stand for

Nonsteroidal anti-inflammatory drugs

which COX drug (1 or 2) may increase the risk of serious cardiovascular events like heart attack/stroke

COX-2

is acetaminophen an NSAID drug? why or why not?

no because it lacks anti-inflammatory and anti-coagulant properties

what is the main contraindication to taking acetaminophen

people who have pre-existing liver disease (or are alcohol abusers) acetaminophen is filtered through the liver and can be especially toxic in these individuals

pain management Flashcards

(62 cards)