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Flashcards in pain management Deck (45)
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1

what are the 5 classes of drugs used in pain management

1. opioids
2. alpha- 2 agonists
3.non steroidal anti-inflammatory drug
4. NMDA antagonists
5. infiltrative and local anesthetics

2

what are opioid drugs commonly used for

1.analgesia
2.sedation
3. restraint
4.anesthetics
5.antitussive

3

what are advantages of opioids?

1. rapid onset of action
2. safe
3.reversible (with a reversal drug)
4. potent analgesia

4

what are the 3 opioid receptors

mu, delta, kappa

5

what is an agonist?

drugs with high level of affinity and efficacy that causes a physiological activity

6

what is an antagonist?

drugs that block another drug from combining with a receptor

7

what are the 4 classes of opioids?

1. pure agonists
2. partial agonists
3. agonist-antagonist
4. antagonist

8

what is a pure agonist?

they bind on receptors and produce the desired therapeutic effect

9

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)

10

what is a agonist-antagonist

mixed effect. able to bind on one type of receptor while blocking another type of receptor

11

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

12

what are the major side effects of opioids?

1. respiratory depression (at a high dose)
2.bradycardia
3.histamine release (can be prevented by slow injection)
4.vomiting
5. urine retention
6.constipation
7. patients

13

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

14

what are alpha 2 agonists?

they bind to alpha 2 receptors - they inhibit release of norepinephrine activation -> of antinociceptive system (dampen pain)

15

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)

16

how long does the sedative effect last for with alpha 2 agonists?

30 to 90 min

17

what are 3 commonly used alpha 2 agonists?

xyazine, medetomidine, dexmedetomidine

18

what are some negative side effects of alpha 2 agonists

cardiovascular effects, vomiting, transient hyperglycemia

19

what does NSAID stand for?

non-steroidal anti-inflammatory drug

20

what patients do you not use alpha 2 agonists in

geriatric, cardiac, increased intracranial pressure patients

21

pros of NSAIDS

-readily available
-easy to give
-long duration of action
-inexpensive

22

list 5 common NSAIDs in North America

Meloxicam, Carprofen, Deracoxib, Ketoprofen, Robenacxib

23

what do NSAID act as inhibitors to

Cyclooxygenase enzymes (COX)

24

which inflammatory mediators are produced upon production/activation of COX

prostaglandins, prostacyclin, thromboxane

25

how many types are there of cyclooxygenase enzymes

2, COX-1 and COX-2

26

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

27

what is a COX-2 enzyme, what does it produce

it is an inducible enzyme, prostaglandins that deal with clinical signs of inflammation
-vasodilation
-amplify nociception
-amplify transmission of pain

28

list side effects of tramadol

-may decrease seizure threshold in high dose
- use a lower dose for patients with hepatic and renal deficiencies

29

when should be cautioned with tramadol

patients with seizures and increased intracranial pressure

30

what is tramadol

a synthetic product that provides mild to moderate analgesia