Flashcards in PHARM - opioids and pain Deck (69)
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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
