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Flashcards in Pharm 19 Deck (42)
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1

Identify where opioids act within the neurological pathway of pain transmission

- Opioids influence pain signals where peripheral nerve connects to the dorsal horn in the spine

- When activated opioid receptors generally create an inhibitory effect upon the neuron to which they are attached.

2

Acute pain

- 3-6 mos

- best treated with opioids

3

Chronic pain

- persist after normal healing process

- Fentanyl

4

Nociceptive pain

- Usually related to tissue damage, requires pain receptor activation

- normal opioid tx

5

Nociceptive pain: somatic

injury to body tissue, well localized

6

Nociceptive pain: Visceral

viscera mediated by stretch receptors 

7

Neuropathic pain

- Abnormal neural activity secondary to disease, injury, or dysfunction of CNS.

- Tramadol

8

Cancer pain

-Best treated with opioids

9

List opioid drugs that are receptor agonist

Morphine

Hydromorphone

Codeine

Hydrocodone

Oxycodone

Meperidine (Demerol)

Fentanyl

Methadone

10

List opioid drugs that are receptor partial agonist

- Buprenophine

- Tramadol

11

List opioid drugs that are receptor antagonist

- Naloxone (Narcan)

- Naltrexone

- Methylnaltrexone

- Naloxegol

12

MC COD from opioid overdose

-Respiratory depression:

- Decreased sensitivity of chemoreceptors that sense high levels of CO2 in blood and decrease respiratory volume and rate

- Essentially brain stops realizing the pts need to breathe.

13

Mu receptors are found where

brainstem and medial thalamus

14

Kappa receptors are found where

limbic and other diencephalic areas.

15

Delta receptors are found where?

largely in the brain

16

PK of opioids

- PK properties determine their analgesic and side effects

- bioavailability is about 75-85%

- highly water soluble, rapid onset of action

- duration of action if related to their t 1/2

- flow dependent hepatic clearance

17

Max morphine dose in Washington state

120 mg PO per day

18

What actions need to betaken to exceed morphine dose?

- If above 120 pt required to consult a pain specialist

- Pain specialist can be considered a DO, MD, ARNP, pediatric physician

19

Key drugs used for opioid addiction treatment:

- Buprenorphine + Naloxone

- Methadone

20

Why is Buprenorphine + Naloxone used for opioid addiction tx?

- Natural ceiling effect of buprenorphine plus taper proofing of naloxone

- partial agonist at mu opioid receptor

- Once daily, easy to adhere to

21

Why is Methadone used for opioid addiction tx?

- Longer duration of action, can be given under medial supervision, not allowed to be "prescribed".

- Less euphoria effect

22

Steps required for a Physician Assistant to qualify to prescribe medications for opioid addiction treatment?

- Need to apply for a separate DEA registration (X as first letter of DEA)

- Take and record no less than 24 hrs of certified training

- Apply for a DATA waiver from SAMSHA-skips CSAT approval stat.

23

Prescriptive limitations of a Physician Assistant compared to a MD or DO, in regards to prescribing for opioid addiction treatment

- PAs are allowed to care up to 30 pts for purposes of opioid addiction tx

VS MD OR DO:

- Initial limit: 30-100, petition for 275 pts.

24

List sedative/hypnotic drugs: benzodiazepine

- Alprazolam (Xanax)

- Chlordiazepoxide

- Clonazepam

- Diazepam

- Lorazepam (Ativan)

- Midazolam

- Triazolam

- Flumazenil—benzodiazepine overdose antidote

25

List sedative/hypnotic drugs: barbiturates

- Pentobarbital

- Phenobarbital

26

List sedative/hypnotic drugs: others

- Diphenhydramine—antihistamine

- Doxepin—tricyclic antidepressant

- Ramelteon—melatonin receptor agonist

- Buspirone—non-benzodiazepine anti-anxiety medication.

27

unique pharmacokinetic properties of the benzodiazepines

- Lipid solubility, big difference in onset and duration and extensively metabolized by the liver

28

Alprazolam best fit for?

- Anxiety, GAD, panic disorder.

- Short duration

29

Chlordiazepoxide best fit for?

- Alcohol withdrawal, anxiety.

- Long duration.

30

Clonazepam best fit for?

- Certain kind of seizures and panic disorder.

- Moderate duration.