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Pharm exam 2 > PPT pain and opioids > Flashcards

PPT pain and opioids Flashcards

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1
Q

What is nociception?

A

detection and perception of noxious stimuli

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2
Q

where are the receptors for pain?

A

free nerve endings in the skin, muscle, viscera.

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3
Q

NT for nociceptors include?

A

substance P

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4
Q

Inhibition of the release of substance P is the basis of pain relief by?

A

opioids

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5
Q

What fibers are responsible for fast sharp pain and what fibers are responsible for slow chronic pain?

A

A delta fibers = fast sharp pain

C fibers =Slow chronic pain

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6
Q

A delta fibers

A

rapid onset and offset and is well localized

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7
Q

C fibers

A

aching, burning, throbbing that is poorly localized

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8
Q

size of A-delta fibers?

A

thicker and mylinated

diameter 1-4um

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9
Q

size of C fibers?

A

thinner and unmyelinated

diameter 0.4-1.2 um

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10
Q

Neo-spinothalamic tract is what nerve fibers?

A

fast-sharp pain fibers (A)

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11
Q

Paleo-spinothalamic tract

A

Slow-chronic pain fibers (C)

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12
Q

Where is the substantia gelatinosa?

A

Lamina II and III

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13
Q

Which fibers ascend or descend in the track of Lissauer?

A

A-delta and C fibers

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14
Q

where do the A delta and C fibers enter at?

Where do the cell bodies lie?

A

posterior horn

DRG

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15
Q

what is the NT for A delta fiber?

A

glutamate

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16
Q

what is the NT for C fibers?

A

substance P which binds to NK-1 receptor on the postsynaptic membrane.

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17
Q

tell me the pathway for fast sharp pain?

A

A-delta fibers terminates in Lamina I , cross to the contralateral, lateral spinothalamic tract and ascend to the brain

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18
Q

Tell me the pathway for slow chronic pain?

A

C fibers terminates in Lamina II and Lamina III (Substantia Gelatinosa ).

Interneuron transmit C fibers impulses to Lamina V from Lamina II and III.

Neurons leaving Lamina V cross immediately to the contralateral, lateral spinothalamic tract and ascend to brain

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19
Q

which fibers cross over Lamina V?

A

C fibers

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20
Q

name the main hydrophilic opioid?

A

MORPHINE

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21
Q

Neuraxial (spinal and epidural) placement of hydrophilic opioids, onset, duration, ventilation effects?

A

SPINAL:
slow onset, long duration.
No early depression of ventilation, LATE DEPRESSION OF VENTILATION occur due to rostral spread of CSF.

EPIDURAL:
slow onset and long duration.
early depression of ventilation (within 2 hours) due to systemic uptake. LATE DEPRESSION of ventilation occur due to rostral spread.

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22
Q

If you place one of the fentanyl sisters in the dural space what will the patient have?

A

itchy nose

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23
Q

Neuraxial placement of lipophilic opioid, name the three examples of those opioids as well as spinal and epidural onset, duration, ventilation effects.

A

fentanyl, alfentanil, sufentanil

SPINAL AND EPIDURAL
rapid onset, short duration of analgesia.
EARLY DEPRESSION OF VENTILATION due systemic uptake.
late depression of ventilation DOES NOT OCCUR!

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24
Q

spinal analgesia, when does it occur?

A

Occurs when transmission of pain through substantia gelatinosa (L II) is suppressed

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25
mu-2 is the dominant receptor in what kind of analgesia?
SPINAL analgesia
26
After IV administration of spinal analgesia what specific area do the opioids act?
periventricular and periaquaductal gray
27
opioids produce both what and what analgesia?
spinal and supraspinal analgesia
28
Supraspinal analgesia, where do the opioids act?
on limbic system, hypothalamus and thalamus.
29
mu-1 is the dominant receptor in relation to what type of analgesia?
SUPRAspinal analgesia
30
With IV administration of opioids does it make the pain go away?
"I feel pain but I don't care"
31
Acupuncture releases what?
Endorphins
32
Descending neurons form periventricular and periaqueductal gray terminates on interneuron in substantia geletinosa (Enkephalin neurons) WHAT do the interneurons release?
enkephalin
33
Enkephalin inhibits the release of substance P and this leads to what?
Spinal Analgesia
34
How does the dorsolateral tract modulate pain?
by hyperpolarizing second order neurons.
35
What are the three opioid receptors located in the CNS, nerve terminals, GIT, and ANS?
u - Mu (1-2) K- Kappa d - Delta
36
list three endogenous opioids?
enkephalins, endorphins and dynorphins
37
which receptor is responsible respiratory depression and addiction (bad stuff)?
mu-2
38
mu -1
``` analgesia euphoria low abuse potential miosis (PPP) Bradycardia Hypothermia Urinary retention C/I in BPH ```
39
mu-2
analgesia (just spinal) respiratory depression addiction constipation (marked) decreased motility and tone of GI muscles increased CSF pressure (cerebral edema) C/I in head injury
40
which opioid receptor (if activated) is contraindicated in head injuries?
mu-2
41
K (kappa)
``` analgesia dysphoria low abuse potential miosis (PPP) Diuresis ```
42
all opioid receptors if activated cause supraspinal and spinal analgesia except for which one that only causes spinal?
u-2 (Mu 2)
43
d (Delta)
analgesia respiratory depression physical dependence constipation (mild)
44
which opioid receptors cause constipation?
mu-2 (maked) | delta (mild)
45
Which opioid receptor causes addiction?
mu-2 | delta is physical dependence
46
which opioid receptors cause respiratory depression?
mu-2 and delta
47
which opioid receptors cause PPP and have low abuse potential?
Mu-1 and Kappa
48
which opioid receptor causes euphoria and which one causes dysphoria?
``` mu-1 = euphoria (extreme happiness) kappa = dysphoria (feeling negative) ```
49
which endogenous opioids correlate to which opioid receptors?
mu=morphine delta=enkephalin kappa=dynorphin
50
how do opioid agonist work?
act on opioid receptors opening K channels and closing Ca++ channels which leads to decreased synaptic transmission and decreased release of neurotransmitters (Ach, NE, glutamate, substance P)
51
cough suppression with opioids
dexomethorphan and codeine
52
diarrhea relief with opioids
loperamide and diphenoxylate
53
maintenance program for addicts with opioids
methadone
54
opioids in general can clinically be used for?
pain, acute pulmonary edema
55
toxicity with opioids can cause?
addiction, resp. depression, constipation, pinpoint pupils.
56
pinpoint pupils and not being responsive would tell you what about someone who has taken opioids?
they have taken or been given too much.
57
what can happen if you push narcan too fast?
Vfib
58
opioid antagonist examples?
Naloxone (Narcan), Naltrexone (Trexate), Nalmefene
59
What type of antagonist are opioid antagonist?
competitive antagonist of opioid receptor.
60
Side effects of opioids antagonist?
``` increased sympathetic activity. reversal of analgesia excitement/ dysphoria tachycardia hypertension V-fib pulmonary edema ```
61
what are mixed agonist/antagonist?
stimulate one receptor but block another
62
example of mixed agonist/antagonists?
Stadol (Butorphanol) which is used in OB.
63
mixed agonist/antagonist are less likely to cause what and is mediated by what receptors.
less likely to cause sever resp. depression and mediate their effect by kappa and delta receptors.
64
due to the histamine release of opioids what happens?
pruritus (nose itching)
65
urinary retention as a side effect of opioids, why does that occur?
inhibit sacral (parasympathetic) nerve. Bladder relaxation leads to retention.
66
If respiratory depression occurs as a side effect of opioid use what will you do?
monitor pulse ox give supp. 02 prophylactic naloxone
67
list some other opioid side effects (not the important first three)
``` sedation CNS excitation viral reactivation sustained erection constipation addiction ```
68
what can cause CNS excitation in older people?
Ativan
69
what is a Dart?
3ml IM needle for children who do not have an IV who are having laryngospasm. 2ml of sux which is 40mg and 1ml atropine which is 0.4mg.
70
what will you do if someone has a bad reaction to morphine?
you will tube them bc have either overdosed or they have had a reaction to morphine.
71
Morphine how does it work, what receptors does it work on?
acts on kappa receptors in the Lamina I and II (spinal analgesia) and acts on mu-1 receptors (supraspinal analgesia) and decreases the release of substance P.
72
Does morphine cause loss of consciousness?
Analgesia- pain relief without loss of consciousness.
73
alter's brains pain perception "I feel the pain but I do not care" what drug does this describe?
Morphine - increases pain threshold
74
How does morphine cause resp. depression?
decreases sensitivity to CO2
75
How does morphine cause PPP
increases parasympathetic stimulation by III nerve. (occulomotor?)
76
Is morphine contraindicated in head injuries and if so then why?
Yes, increased CO2 retention, increased CSF pressure.
77
what would happen due to a histamine response to morphine?
itching and vasodilation (pressure drops) | bronchoconstriction, therefore C/I in asthma
78
The increased ICP with morphine is due to?
decreased breathing
79
urinary retention with morphine is due to?
relaxed bladder.
80
Do people build up tolerance to morphine?
tolerance to analgesic, euphoric and sedative effect.
81
What is morphine-6-Glucuronide?
650 x analgesia then morphine. metabolite of morphine. greater duration of action. low permeability to BBB.
82
mechanism of action of Meperidine (Demerol)? (receptors)
mu and kappa receptor
83
when will you mostly use Meperidine?
post op shivering
84
Meperidine actions?
increased total peripheral resistance increased CO | increased CSF pressure
85
Methadone MOA (receptor)
mu receptors
86
what is methadone used for?
control heroin withdrawal symptoms
87
Fentanyl- potency? is it water or fat loving?
100 x analgesic potency than morphine. | Highly lipophilic
88
adverse effect of fentanyl?
hypotension
89
Sufentanil, Alfentanil, and Remifentanil?
related to fentanyl | Sufentanil is more potent than fentanyl!
90
Codeine (moderate agonist), how does it allow for pain relief?
converts to morphine causing analgesia. much less analgesia than morphine.
91
what can codeine be used for, but not over the counter?
cough suppression (with analgesia)
92
Pentazocine, what receptors? and what patients would this med be bad for?
Agonist on kappa receptor and weak antagonist on mu and delta receptors not good for heart patients, puts them at risk for MI.
93
What opioid agaonist/antagonist type drug causes psychotic symptoms?
Nalbuphine and butorphanol
94
what receptors does Tramadol act on and what kind of opioid is it?
mu receptors and it is a opioid agonist/antagonist.
95
in relation to opioids what does Antagonist mean?
Bind to opioid receptor (mu) but fail to activate the receptor. Reverse the effects of agonist and precipitate opioid withdrawal
96
What is naloxone (NARCAN) used for and how does it work?
Use to reverse respiratory depression of opioid over dose Competitive antagonist of mu, delta, and kappa receptors Produces opioid withdrawal syndrome in abusers

Pharm exam 2 (4 decks)

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