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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

what is the most common cause of acute liver failure in the US?

salicylic acid and acetaminophen use for pain