Pharm Pain, Martin I Flashcards Preview

Year 2 neuro exam 2 > Pharm Pain, Martin I > Flashcards

Flashcards in Pharm Pain, Martin I Deck (55):
1

What are the full agonists for opioid R

morphine
fentanyl
heroin
methadone

2

what are the partial agonists for opioid R

codeine, hydrocondone, oxycodone

3

what are the mixed agonists/antagonists

buprenorphine

4

opioid antagonists

naloxone

5

what are the weak opioid antonists or reuptake inhibitors

tramadol
tapentadol

6

what are the non opioid analgesics

acetaminphen, aspirin, other NSAIDs and selective COX2 inhibitors

7

what is analgesia

attenuation of pain perception without loss of consciousness

8

how is analgeisa accomplised

raising pain threshold at level of spinal cord and altering brains perception of pain

9

sensory component of pain

perceived as result of direct stimulatino of pain R

10

reactive component of pain

intensity of pain dramatically altered by lvel of anxiety and stress response related to original insult

11

narcotic

substance producing stupor associated with analgesia

12

opiates

natural products and dervatives obtained from opium poppy
opium, morphine, heroin, codeine

13

opioids

bind to opioid R
includes agonists, antagonists, partial agonists and mixed agonists/antagonists

14

endogenous opioid agonists

endorphin enkephalin, dynorphin and others

15

where are endogenous opioid peptides made

in nucleus and transported down

16

endogenous opioid peptide precursoe

pro-opiomelanocortin POMC

17

opioid effect in peraqueductal gray

inhibit GABA release which increase inhibitory nerve activity regulating projections to medulla that alter dorsal horn excitability

18

how do opiates work on spinal cord

presynaptically to block Ca influx and NT release
or
postsynaptically to open K Ch causing hyeprpolarization

19

mu opiod R

endorphins>enkephalins>dynorphins
supraspinal and spinal analgesia
sedation
inhibition respiration
slowed GI
modulation hormone and NT release

20

kappa opioid R

enkephalins>endorphins=dynorphins
supraspinal and spinal analgesia
modulation hormone and NT release

21

delta opioid R

dynorphins>endorphins>enkephalins
supraspinal and spinal analgesia
psychomimetic effects and slowed GI transit

22

principle signal mech of opioid R

GPCR
-inhbiit cAMP
-open K Channels allowing efflux and hyperpolarization
-reduce presynaptic Ca influx inhibiting NT release

23

brainstem opiod R influence

respiration, cough, nausea, vomiting, BP, pupillary diameter, stomach secretions

24

medial thalamus opioid R mediate

deep pain that is poorly localized

25

spinal cord opioid R mediate

reciept and integration of incoming sensory
change painful afferent stimuli

26

hypothalamic opioid R

effect neuroendocrine secretion

27

limbic system opioid R

high density of opioid R in amygdala

28

periphery opioid R

inhibit Ca influx and release of excitatory glutamate and pro inflammatory substanc eP

29

immune cell opioid R

function unknown

30

which opioid R is responsible for majoirty classical effects of opiods

mu R
analgesia, euphoria, miosis, resp depression, physio dependence, reduced GI motility (constipation)

31

main action of stimulation kappa R

dysphoria
analgesia
psychotomimetic responses

32

what occurs with respiratory depression from opioids

decreased response to CO2

33

what drugs are used to suppress cough

dextromethophan and codeine

34

why do opiates cause miosis

indirect parasympathetic actions
no tolerance develops in abusers

35

when does opiate overdose cause mydriasis

when asphyxia develops

36

opioids CI in what patients

with severe brain injury since increase the CSF from respiratory depression and CO2 retention

37

GI complication opioid therapy

constipation

38

why should asthmatics not be on opioids

can cause histamine induced bronchoconstriction
causes urticaria, sweating and vasodilation

39

what do you consider when giving morphine orally

high first pass metabolism so oral higher dose than IV
usually 4X higher dose

40

teratogenicity of opioids

do not use during labor

41

PK fentanyl

highly lipophilic cross BBB quick but redistributes to fat super fast

42

affinity of morphin

mu > delta or kappa

43

warning of morphine

high addiction potential

44

clinical uses morphine

analgesia
acute pulmonary edema
AcuteMI
cough suppression
diarrhea

45

type of pain to attempt analgesia with morphine

severe
constant

46

morphine and acute pulmonary edema

relief from dyspnea with L ventricular failure
reduced perception SOB
dec anxiety
reduce cardiac preload and afterload

47

what opioids are used for diarrhea

loperamide (imodium OTC)
diphenoxylate + atropine (lomotil)
difenoxin and atropine (motofen)

48

administration fentanyl

IV
epidural
intrathecal

49

fentanyl is used for what

analgesia labor
oral transucosal for cancer patients

50

which opioid has longer duration action than morphine but less euphoria

methadone

51

methadone used for

controlled withdrawal of dependent heroin and morphine abusers

52

what is the synthetic opioid used for acute pain

meperidine
"demerol"

53

reaction of pupils from meperidine

mydriasis
dilates

54

which opioid can be used in obstetrics

meperidine

55

meperidine time use limit

<48 hours since toxic metabolite accumulates and can cause seizures