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Flashcards in Pain medications Deck (35):
1

What meds can act on peripheral nociceptors

TRANSDUCTION SITES:
Locas anesth.
NSAIDs, COX-1 and COX-2 inhibitors
Acetaminophen
Capsaicin

2

What meds can act on peripheral nerve

local anesth.
opioids

3

What meds can act on Dorsal horn

Local anesth.
Opioids
NSAIDs

4

What meds can act on descending modulation

OPIOIDS:
Serotonin drugs
Neuropeptides

5

What meds can act on the brain

Opioids
Glutamine/GABA (Ultram)
Antidepresants (5HT/NE)

6

What are possible side effects of COX-2 inhibitors

Interfers with renal function
Reduces prostaglandin mediated vasodilation--> heart attacks and strokes.

7

COX-1 and 2 inhibitors are

Analgesic
anti-inflammatory
anti-pyretic

8

Acetaminophen (Tylenol) properties

Non NSAID
Non COX-1 or 2 inhibitor
Might block COX-3 and/or block 5HT
Analgesic: dental, headache, muscle, bone pain
anti-pyretic (children); interaction with seratonin-->sedative
Stable in solution

9

What are examples of NSAIDs

non-selective COX-1 and 2 inhibitors
Salicylates
Ibuprofen-like
Selective COX-2 inhibitors (Celebrex)

10

What are the properties of Salicylates (Aspirin)

COX-1 and 2 inhibitor
Antipyretic; 300-600 mg
Analgesia; 600mg (plateau)
Anti-inflammatory; 1 gm
Duration; 4 hrs
Mild to mod somatic pain
Often combined w; acetaminophen, caffeine, opioids

11

What are side effects of salicylates

DO NOT USE ON CHILDREN up to 19yo; Reyes syndrome
GI irritation and erosion
Anti-clotting; damages platelets; two weeks to recover
Tinnitis at high doses
Acid; present in wart remover.

12

What are the properties of Ibuprofen-type NSAIDs

COX-2 and 1 inhibitor
Antipyretic; 400 mg
Analgesia; 400 mg
Anti-inflammatory; 800 mg
Duration; 4 hrs
Mild to mod pain relief ≥ aspirin

13

What are the side effects of Ibuprofen-like NSAIDs

GI ulcers

14

What are some Ibuprofen-type NSAIDs

Motrin
Advil
Naproxen (Alleve); longer-lasting but slower acting
Ketoprofen; Rx 50mg, more potent
Celebrex Rx; cox-2; no GI/anti-clotting action. poss CV effects.

15

What are other Rx NSAIDs

Indomethacin; non-selective, serious side effects.
Meloxican; Preferential cox-2 inh = less GI problems
Diflunisal (Dolobid); related to salycilates, bone pain

16

What are side effects of Acetaminophen

Liver toxin in high doses= 1 gm
Do not use on compromised liver patients

17

What are some NSAID anticoagulant contraindications

Cuomadin ( warfarin/pradaxa)
Joint replacement
Heart attack/stroke
Major surgery
Atrial fibrillation
Hemophiliac

18

What are some Ulcer NSAID contraindications

Ulcers;
Frequent upset stomach
Bleeding in stools
takes antacids
Takes H2 blockers (Tagamet)
Already taking high doses; Arthritis
History of allergies

19

What are therapeutic uses of Opioids

Analgesia; somatic/visceral--> mild to severe
Antitussive; interferes with cough reflex
antidiarrheal
Causes drug dependance/withdrawals after 1 month

20

Equipotent dosis

Fentanyl 0.1mg
Oxymorphone 1 mg
Hydromorphone 1.5 mg
Morphine 10 mg
Oxycodone (Oxycontin/Percodan) 20 mg
(Percoset) Oxycodone + acetaminophen
Hydrocodone + acetaminophen (lortab/vicodin) 30 mg (dentist most com)
Codeine 200 mg

21

What are other narcotic analgesics

Meperidine
Pentazocine; mod pain, mix ago/anta--> discourages abuse
Methadone/Buprenorphine; mod to strong, used to treat opioid addiction and as analgesic

22

What are opioid agonist side effects

Mostly mu receptors
Respiratory depression/dec pulmonary reflex
Constipation/ slow bowel movement
Sedation/additive or synergistic with CNS depressants
Euphoria/dependency/addiction

23

What is the tx for opioid OD

Naloxone (Narcan)
may precipitate withdrawals ( blocks endorphins)

24

What are opioids contraindications

history of substance abuse
severe constipation
Respiratory problems
Use of CNS depresants
History of allergies

25

What is the Tx for neuropathic pain (trigeminal neuralgia)

Gabapentin/Lyrica (anti-seizure) GABA/glutamate
Duloxetine (antidepressant) NE/5HT uptake blocker
Nortriptyline (antidepressant) NE uptake
Next
Tramadol (non-opioid but can cause dependance sch 4)

26

What is the def of misuse

Either not prescribed or clinically inappropriate

27

What is dependence

persistent use resulting in adaptations typically accompanied by accommodation or tolerance and withdrawal.

28

what is drug addiction

compulsive frug use tat consists of repetition to satisfy intense urges, despite severely negative consequences.

29

What is use

Prescribed and clinically appropriate

30

What schedule are opioids

II

31

What is the addiction cycle for Rx drugs

Relieve medical condition
Causes reinforcing effects (↑ DA in brain)
induces physical dependence
Tolerance/withdrawal issue due to lengthy use
Often pts have pre existing abuse risk (mental/prexisting prob)
Use of various strategies to maintain supply

32

How many americans are abusing Rx drugs

9 million at least once a year
4 million monthly

33

Where do abused Rx drugs come from

Friend/relative= 66%
Buy drug = 21 %
Doctor Rx = 19%
Took/stole = 12%
Dealer = 8 %

34

What is SBRIT

Screening
Brief interview
Intervention
Referral
Treatment

35

What is DOPL

Division of Occupational and Professional Licensing