Pharm Chapter 14

Question 1

Pain is:

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Question 2

WHO Three-step analgesic ladder

Answer 2

Level 1- first choice for pain
Level 2- when pain is mild to moderate
Level 3- only use opioids when its moderate to severe pain

Question 3

Pain can be treated by:

Answer 3

Medications, E-stim, TENS, massage, rehab, hot/cold packs

Question 4

Types of Pain

Answer 4

nociceptive
neuropathic
malignant/cancer pain
acute vs. chronic pain

Question 5

Synthetic Opiod

Answer 5

(fentanyl, methadone) are chemically derived in the lab

Question 6

Natural Opiod

Answer 6

derived from poppy (morphine, codeine)

Question 7

Semi-synthetic Opiod

Answer 7

(oxycodone, oxymorphone) are chemically modified natural opioids;

Question 8

Which drug is considered the Gold Standard against which others are compared in pain management?

Answer 8

Morphine

Question 9

What dosage froms do Opioids comes in?

Answer 9

pills, patches, IV, epidural, lollipops, lozenges, and PCA pumps

Question 10

What are two types of doses for Opioids?

Answer 10

ATC: around-the-clock (chronic pain)

BTP- Break-through-pain (pain spikes)

Question 11

Differentiate between narcotic vs opiates vs opioids?

Answer 11

Narcotic - describes side effect, not action of the drug (ie: sedation, stupor, reduced responsiveness)
Opiate - derived from opium
Opioid - encompassing term for all narcotic analgesic-like agents

Question 12

Where are the opioid receptors in the body found?

Answer 12

Brain and spinal cord; also found in the GI tract and throughout the body but efficacy of opioids is due to their effects in the brain and spinal cord

Question 13

What does the existence of opioid receptors imply?

Answer 13

existence of endogenous compounds

Question 14

Name 3 endogenous opioid like substances:

Answer 14

Endorphins, enkephalines, dynorphins

Question 15

Name the 3 types of pain receptors

Answer 15

Mu - important for pain relief (analgesia)
Kappa
Delta

Question 16

Which pain receptor is most important to analgesia?

Answer 16

Mu, greatest analgesia when stimulated. ALSO greatest side effects (respiratory depression and constipation, ex: heroin OD) and relationship to addiction.

Question 17

Agonist:

Answer 17

bind to the receptor and stimulate it (elicits response)

Question 18

Antagonist:

Answer 18

blocks receptor response

Question 19

Name two strong opioid agonists indicated for severe pain?

Answer 19

Fentanyl, hydromorphone, meperidine, methadone(used for treatment of addiction), morphine, oxymorphone

Question 20

Name opioid agonists indicated for mild to moderate pain?

Answer 20

codeine, propoxyphene, hydrocodone, oxycodone

Question 21

Name opioid mixed agonist/antagonists?

Answer 21

pentazocine (talwin), butorphanol (stadol), nalbuphine (nubaine)

Question 22

Antagonists Examlples

Answer 22

(naloxone (narcan) Naltrexone (Vivitrol))

Question 23

What is the mechanism of action of the opioids?

Answer 23

Inhibition of signaling afferent pain transmission to ascending pathways (inhibit from periphery to the brain signaling)
Activate descending pathways to reduce pain signaling to the periphery - called disinhibition

Question 24

Explain the role of G proteins:

Answer 24

Second-messenger system that propagates a signal from external receptor into the cells to carry out an action

1) decrease Ca+ = decrease impulse propagation
2) decrease K+ = neuron harder to excite
3) inhibit adenylyl cyclase = decreased firing of post-synaptic neuron

Question 25

What are the top medications taken by patients in PT?

Answer 25

Opioids and nonopioids analgesics - APAP, ASA, NSAIDS

Question 26

Concerns with COX-2 inhibitors?

Answer 26

Cardiovascular risk - some of these agents were taken off the market by the FDA due to this risk. This is due to inhibition of prostaglandins that cause blood vessel dilation and inhibition of platelet aggregation

Question 27

What type of pain are the opioid analgesics best suited to manage?

Answer 27

Moderate to severe, postoperative or chronic pain for oncology

Question 28

What is the best route for administration of opioids?

Answer 28

PO (Lat: per oris - by mouth) for most, Intrathecal or epidural for post operative or severe intractable pain.

Question 29

List 3 common side effects of opioids:

Answer 29

N/V, constipation, respiratory depression, decrease GI motility. Most of these side effects are temporary and resolve with continued use of the meds.

Question 30

Addiction

Answer 30

seeks out and ingests certain substances for mood altering and pleasurable experiences. Continued use despite harm.

Question 31

Tolerance

Answer 31

need for more drug to achieve the same therapeutic effect due to downregulation of receptors and blunted impact on G proteins. *Explain down regulation” Often begins to develop at 3 weeks and takes 1-2 weeks of drug removal to return to normal

Question 32

Physical Dependence

Answer 32

onset of withdrawal symptoms in the drug is stopped. Begin 6-10 hours after last dose. Withdrawal symptoms typically peak at ~3 days and last ~5 days. Withdrawal symptoms are commonly the opposite of the opioids effects (hyperalgesia, diarrhea, anxiety, etc.) This is NOT psychological dependence or addiction.

Question 33

Pseudoaddiction

Answer 33

occurs when a patient is exhibiting addiction-like behaviors but doing so not to achieve a high or abuse the opioids, but because their pain is severe and they are not well controlled

Question 34

Name 3 symptoms of narcotic withdrawal

Answer 34

body aches, nausea, vomiting, tachycardia, sweating, hyperalgesia, anxiety, diarrhea (Receptors must repopulate)

Question 35

Impact on Physical Therapy?

Answer 35

Sedation, lack of coordination, optimal pain control will maximize the session.