Flashcards in pain management Deck (45)
what are the 5 classes of drugs used in pain management
2. alpha- 2 agonists
3.non steroidal anti-inflammatory drug
4. NMDA antagonists
5. infiltrative and local anesthetics
what are opioid drugs commonly used for
what are advantages of opioids?
1. rapid onset of action
3.reversible (with a reversal drug)
4. potent analgesia
what are the 3 opioid receptors
mu, delta, kappa
what is an agonist?
drugs with high level of affinity and efficacy that causes a physiological activity
what is an antagonist?
drugs that block another drug from combining with a receptor
what are the 4 classes of opioids?
1. pure agonists
2. partial agonists
what is a pure agonist?
they bind on receptors and produce the desired therapeutic effect
what is a partial agonist?
binds on receptors but are unable to elicit the maximal response of the receptor system. still have some analgesic effect)
what is a agonist-antagonist
mixed effect. able to bind on one type of receptor while blocking another type of receptor
what is an antagonist?
binds on receptor but produces no effect, mainly function as a competitor to block other opioids from attaching to the receptors
what are the major side effects of opioids?
1. respiratory depression (at a high dose)
3.histamine release (can be prevented by slow injection)
5. urine retention
how are opioids metabolized? and caution in which patients?
- metabolized by the liver and excreted via kidneys
-caution in patients with renal or hepatic disease
what are alpha 2 agonists?
they bind to alpha 2 receptors - they inhibit release of norepinephrine activation -> of antinociceptive system (dampen pain)
what are the analgesic effects of alpha 2 agonists?
1. good visceral pain
2. dose dependent (20 min to 2 hrs)
3. rapid onset (5 to 15 min)
how long does the sedative effect last for with alpha 2 agonists?
30 to 90 min
what are 3 commonly used alpha 2 agonists?
xyazine, medetomidine, dexmedetomidine
what are some negative side effects of alpha 2 agonists
cardiovascular effects, vomiting, transient hyperglycemia
what does NSAID stand for?
non-steroidal anti-inflammatory drug
what patients do you not use alpha 2 agonists in
geriatric, cardiac, increased intracranial pressure patients
pros of NSAIDS
-easy to give
-long duration of action
list 5 common NSAIDs in North America
Meloxicam, Carprofen, Deracoxib, Ketoprofen, Robenacxib
what do NSAID act as inhibitors to
Cyclooxygenase enzymes (COX)
which inflammatory mediators are produced upon production/activation of COX
prostaglandins, prostacyclin, thromboxane
how many types are there of cyclooxygenase enzymes
2, COX-1 and COX-2
what is a COX-1 enzyme, what does it produce
it is a constitutive enzyme, produces prostaglandins that deal with normal physiologic functions
-secretion of protective gastric mucus
-perfusion of gastric mucosa
-maintenance of renal blood flow
-maintenance of platelet function
what is a COX-2 enzyme, what does it produce
it is an inducible enzyme, prostaglandins that deal with clinical signs of inflammation
-amplify transmission of pain
list side effects of tramadol
-may decrease seizure threshold in high dose
- use a lower dose for patients with hepatic and renal deficiencies
when should be cautioned with tramadol
patients with seizures and increased intracranial pressure