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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

how do we know blood tests are not consistent with poppy seed use?

- morphine level greater than 1000 ng/ml
- no codeine detected