Flashcards in PHARM - opioids and pain Deck (69):
1
what are the 5 types of pain?
- acute
- chronic
- visceral
- somatic
- neuropathic
2
allodynia
A nonpainful stimulus felt as painful in spite of normal-appearing tissues
3
analgesia
inability to feel pain
4
dysesthesia
abnormal response to touch
5
hyperalgesia
increased sensitivity to pain
6
hyperesthesia
Increased sensitivity to stimulation, excluding the special senses.
7
hyperpathia
Increased pain reaction to any stimulus, with increased threshold
8
paresthesia
An abnormal sensation, whether spontaneous or evoked
9
hypesthesia
Decreased sensitivity to stimulation, excluding the special senses.
10
hypesthesia
Decreased sensitivity to stimulation, excluding the special senses.
11
chronic pain
- persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process.
- Chronic defined as pain greater than 3 months duration
12
neuropathic pain
is typically burning in nature . It can be electrical, deep and aching, heavy, and cramping in nature
13
somatic pain
typical pain felt when one breaks a bone or cuts the skin. generally well-localized pain that results from the activation of peripheral nociceptors
14
visceral pain
pain is pain from ureteral colic, bowel obstruction, or urinary obstruction. nociceptors of the (organs). Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation/ generalized aching or squeezing,
Acute and chronic pain can share any one of these characteristics.
15
nocireceptive pain
includes both somatic and visceral pain.
16
peripheral nerve fibers enter the....
dorsal horn
17
three important types of peripheral sensory fibers
- A Delta fibers are sparsely myelinated, large-diameter, fast-conducting fibers, and transmit well-localized, sharp pain
- C fibers are unmyelinated, small diameter, slow-conducting, transmit poorly localized, dull, aching pain
- A Beta fibers are heavily myelinated, largest diameter, very fast, transmit touch, vibration, position sense
18
five categories of analgesics
- NSAIDs
- opioids
- anti-depressants
- anti-convulsants
- adjunctive drugs
19
NSAIDs work on what? which does what?
PGH synthase and COX
- convert arachidonic acid to prostaglandins and thromboxanes
20
key mediator of both central and peripheral pain sensitization
PGE2 (prostaglandin)
21
two types of COX and their importance in pain management
COX1 - constantly active, side effect of NSAID is its inhibition
COX2 - released in inflammation, inhibited by NSAIDs for analgesia
22
NSAID classification
Carboxylic Acids
- Salicylic Acids & Esters
- Acetic Acids
- Propionic Acids
- Antrancillic Acids
Enolic Acids
- Oxicams
Cox-2 Inhibitors
Analine Derivatives
23
contrast the three acetic acid derivatives
indomethicin
- COX inhibitor
- gout and osteoarthritis (synovial fluid)
- high incidence of side effects
diclofenac (potassium immediate, sodium delayed)
- COX2 selective
- post-operative pain relief
ketorolac
- COX inhibitor
- bad for kidney
- post-operative pain
24
contrast the three propionic acid derivatives
naproxen (aleve) - intermediate half life
ibuprofen - headache and migraine, menstrual pain, and acute postoperative pain, short half life
oxaprozin - long half life, once a day (shoulder pain)
25
what is the primary enolic acid derivative?
meloxicam - COX2 preferential, less GI issues than propionic and acetic acid derivatives, don't need to adjust dose for elderly
26
what is the primary analine derivative?
acetaminophen (tylenol)
- mechanism not clear
- overdose can cause liver failure
- safest and most cost effective non opioid analgesic
27
what is the primary analine derivative?
acetaminophen (tylenol)
- mechanism not clear
- overdose can cause liver failure
28
two NSAID hypersensitivity syndromes
- asthma
- angioedema and urticaria
29
gastrointestinal side effects of NSAIDs
- gastric distress
- superficial mucosal lesion
- serious ulceration
30
what is the most common cause of acute liver failure in the US?
salicylic acid and acetaminophen use for pain
31
when should NSAIDs be avoided in pregnancy?
third trimester
32
approved NSAIDs during breast feeding
naproxen
acetominophen
piroxicam
ibuprofen
indomethicin
33
lithium and NSAIDs
lithium toxicity
34
NSAIDs to avoid in renal disease and those to use
indomethicin
ketorolac
use none, or maybe acetaminophen
35
NSAIDs to avoid in sulfa allergies and those to use
celecoxib (celebrex)
use non-selective NSAID
36
NSAIDs to avoid in sulfa allergies
celecoxib (celebrex)
37
NSAIDs to avoid in hypertension
all but aspiring and sulindac
38
NSAIDs to avoid in elderly and those to use
diclofenac and ibuprofen
use meloxicam or celecoxib
39
NSAIDs to avoid in cardiac disease
diclofenac and ibuprofen
40
NSAIDs to avoid in GI disease
ketorolac
41
what is the important anticonvulsant to know
gabapentin
42
gabapentin mechanism
prevents Ca influx at dorsal horn
43
TCAs used for
- neuropathic pain
44
caution using TCAs in
- elderly
- those who don't want to gain weight
45
venlafexine and duloxetine are what type of drug?
SNRIs
46
SNRIs used for what type of pain?
- neuropathic pain
47
caution in using SNRIs
- weight gain
- other SNRIs
48
what are the natural opiates?
codein and morphine
49
caution in using morphine
- not with MAOIs
- dangerous in renal failure
50
when is morphine a good option?
- ok with hepatic failure but use lower doses
51
what are the fully synthetic opioids?
meperidine
fentanyl
52
cautions of meperidine
- not with MAOIs
- not for routine use
53
when use meperidine?
acute severe pain
54
what are the semi-synthetic opioids?
oxycodone
oxymorphone
hydrocodone
55
cautions with oxycodone
- additive with CNS depressants
- half life drastically lengthened in hepatic disease
56
half life of oxycodone
2-3 hours
57
caution with oxymorphone
- end product of oxycodone metabolism
- very addictive and twice as powerful as morphine
58
caution with methadone
- can cause arrhythmias and long QTc
- tremendous caution in elderly
59
methadone mechanism
- modulation phase of nocireception
- NMDA antagonist
60
methadone half life
8.5-47 hours, highly variable
61
fentanyl caution
- 80 times stronger than morphine
- half life increases in renal failure
- skin permeability can increase in hepatic failure
62
fentanyl administered by....
patch
63
hydrocodone caution
- most abused drug in US
64
hydromorphone potency
7.5 time stronger than morphine
65
hydromorphine best used in
renal failure patients
66
hydromorphone caution
- avoid sustained release in hepatic failure
67
tramadol cautions
- caution with methadone or with SNRIs
68
strategy for opioids in elderly
- do not withhold
- begin cautiously and monitor well
69