Pharm - Pain Flashcards by mhari scott

Nociceptive pain is best treated with…

…opioids, NSAIDS or acetaminophen

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Neuropathic pain is best treated with…

Anti-seizure meds or antidepressants

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You would treat diabetic neuropathy with…

… antidepressants or antiepileptic

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Treatment options for acute musculoskeletal pain (5)

OTC NSAIDS
Rx NSAIDS
Skeletal muscle relaxants
Opioid analgesics
Topical analgesics

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Acetaminophen: indications, warnings, max dose

First-line for musculoskeletal pain (mild)

Acute pain, joint pain (osteoarthritis), headaches, fever

Careful with hepatic impairment and alcohol abuse. Max 4g/day.
BBW: don’t take if you have 3+ alcoholic drinks per day

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OTC NSAIDs: MOA, SEs, indications

Cox-blockers (cyclooxygenase) for mild to moderately severe pain.

Include aspirin, ibuprofen and naproxen.

SEs:
kidney/RENAL toxicity: inhibits prostaglandin synthesis
stomach: gastric ulcers
Bleeding: platelet inhibition
SEs are b/c they non-selectively block cox1 in addition to cox2

ASA also has metabolic acidosis (salicylate toxicity) as a worry. Shares this with pepto bismol. (Life-threatening)

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Rx NSAIDs: which are most similar to the OTC ones?

Nabumetone
Indomethacin
Sulindac

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Rx NSAIDS: which are the most potent?

Ketorolac (injection - in ED)

- Meloxicam (oral)

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Cox-2 selective Rx NSAID

Celecoxib

Still causes kidney issues, not any more effective. Rarely used

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Why do we avoid using NSAIDs long-term?

What disease state might require it anyway?

Heart failure and renal failure can occur

Rheumatoid arthritis or other inflammatory problems might need l/t NSAID therapy.

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Topical NSAID: what and why?

What should you tell your patient?

Diclofenac gel

Good for joint pain (OA, RA)
No systemic side effects

Wash hands and don’t get it in your eyes

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When would you use muscle relaxants for pain?

What should patients look out for?

When there’s a major neurologic injury or long-term treatment is needed. Will relieve muscle spasms.
(TBI, spinal cord injury, MS, severe back injury)

Likely to be sedating, especially at first.

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Baclofen:
Class
MOA
Route

Muscle relaxant
Oral, IV, intrathecal pump
Good for l/t spastic conditions

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When would you use BZDs for pain?

Treatment-resistant muscle spasticity

Relieves muscle spasms

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Cyclobenzaprine- what do we know?

Muscle relaxant

For very short term use only: it’s super sedating

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Tizanidine - what do we know?

Works as a muscle relaxant
Alpha-2 adrenergic agonist
Watch for low BP

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Methocarbamol - what do we know?

Used for muscle spasms

Very sedating - it’s a general CNS depressant

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Opioids:
MOA, effects
What does SUV CARR stand for?

Mu agonist
Decrease ability to sense pain
Cause general CNS depression

Sedation
U: euphoria
V: vasodilation
C: Constipation
A: analgesia
R: respiratory depression
R: reduced cough

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Opioids: Which are the full/pure agonists and what should we know about them?

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MOFOM
Morphine
Oxycodone
Fentanyl
Oxymorphone
Methadone

Bind to opioid receptors with no antagonist activity, so there’s no ceiling effect (both on the high and on the pain relief)

What do we know about opioid agonist-antagonists?

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Butorphanol, nalbuphine, pentazocine

There’s a ceiling effect for analgesia and they can reverse the effects of the pure agonists

What partial agonist do we know about and what class/kind of opioid is it similar to?

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Buprenorphine

Similar to agonist-antagonists: there’s a ceiling effect for analgesia and it can reverse the effects of pure agonists.

What do we know about opioid antagonists?

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Naloxone!

Used to treat opioid OD/addiction.

Codeine is usually used for…

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… cough suppression

Fentanyl is dangerous because…

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… it’s 100x more potent than morphine

Meperidine is unusual because...

... it can produce tremors, delirium and seizures

Tramadol: MOA? Warnings?

Mu agonist AND inhibits serotonin and NE reuptake Increases seizure risk (Synthetic)

What’s Methadone’s MOA? Half-life?

Mu agonist NMDA-receptor antagonist SNRI 30 hour half-life (long-acting)

SEs of all opioids?

``` CONSTIPATION Slowed breathing rate Nausea/vomiting (usually will resolve) Sedation (usually resolves) Confusion (usually resolves) ```

Can you cut or crush long-acting opioids if needed?

No - no cutting, crushing or chewing

Guidelines for Nursing administration of opioids

- Assess respiratory status before administering - Schedule II - Don’t allow pts to walk without assistance until response is known (they’re vasodilators) - Measure I/Os for urinary retention or constipation Watch for toxicity: pinpoint pupils, resp depression, coma

What’s the technical term for pinpoint pupils?

Mitosis

What s/s of opioid dependence appear after about 10 hours of last dose?

Yawning, runny noise, sweating

What s/s of opioid dependence occur as withdrawal continues? | How long will they last if untreated? Is it lethal?

Sneezing violently NVD, cramping Muscle spasms, kicking, bone/muscle pain Weakness Lasts 7-10 days if not treated. Not Lethal.

Remember to treat the condition, not just the pain. Recommendations for pain due to: - infection? - sprained ankle? - chronic condition?

Infection: antibiotics Sprained ankle: RICE therapy Chronic condition: physical therapy

If a nerve is damaged at the dorsal root ganglion, is that peripheral nerve pain or central nerve pain?

Peripheral - central is only CNS and spinal cord

What does neuropathic pain feel like?

Tingling, burning, numbness, pins/needles Might be at a specific location Can progress to the loss of all sensation and even impaired circulation.

Which is more resistant to drug treatment: pain due to diabetic peripheral neuropathy and post-herpetic neuralgia? Or pain due to spinal cord injuries and HIV?

Spinal cord injury & HIV pain are most resistant to drug treatment.

What are the 1st line agents for neuropathic pain?

``` Antidepressants (TCAs and SNRIs) Antiepileptic agents (Gabapentin and pregabalin) ```

What are the most common TCAs used for neuropathic pain (3)? How long before you see the benefit? What NTs do they affect? What are the common SEs/warnings?

“AND” Amitryptaline Nortriptyline Desipramine 6-8 weeks to see the benefit Serotonin/norepinephrine Often see anticholinergic SEs Use caution with heart disease, glaucoma, suicide risk

Which SNRIs are most commonly used in neuropathic pain? What to watch out for? How long until effect? Scheduled?

Duloxetine (cymbalta), Venlafaxine (Effexor) Watch for increased BP Can take 4-6 weeks.

Gabapentin and neuropathic pain: why does it work? | SEs to watch out for? Scheduled?

Decreases neuronal excitation Watch for leg swelling (edema) and CNS depression Not a scheduled drug

Pregabalin and neuropathic pain: what else does it work for? Common SEs? Scheduled?

Neuropathic pain AND fibromyalgia Leg swelling & CNS depression, like gabapentin ALSO, Angioedema and peripheral edema increased risk Schedule V

Lidocaine gel/patches: uses, MOA?

Good for post-herpetic neuralgia (not diabetic peripheral neuropathy) Nerve conduction blockade Few adverse effects - good used in conjunction with other therapies

Capsaicin: topical | What for? MOA? SE?

Post-herpetic neuralgia pain (not so much diabetic neuropathy) Depletes/prevents accumulation of substance P Can have localized burning

Opioids or NSAIDs for neuropathic pain?

NSAIDs: really only if pain is d/t inflammation Opioids: chronic pain is not good for opioid use. Ok for quick relief while working for other agents to work.

Fibromyalgia: s/s

-Pain regulation disorder: widespread pain involving all 4 limbs and trunk. Pain inhibition is decreased and perceived pain is greater than normal. Also... -Fatigue -Memory dysfunction -Sleep is non-restorative -11 out of 18 pain points... consecutive symptoms for more than 3 months. Pain cannot be explained by any other disorder.

What drugs are commonly used to treat Fibromyalgia (3)?

TCAs, SNRIs, Pregabalin/Gabapentin Not opioids or tramadol unless absolutely last-line.

Pharm - Pain Flashcards

(47 cards)