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Flashcards in Review 3 Deck (26)
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1
Q

Capsaicin

A

VR-1 agonist

Repeated application thought to deplete substance P from primary afferent pain neurons (cream)

Adverse Reactions: Burning, stinging, and erythema at the site of application

2
Q

Ketamine

A

Glutamate antagonist at NMDA receptors in ascending pain pathway blocking acute nociceptive pain

Prevents central sensitization process in chronic pain

3
Q

Low back pain

A

TCADs

4
Q

Fibromyalgia

A

SNRIs

5
Q

Topical local anesthetic

A

lidocaine

6
Q

VSCC α2δ ligands

A

pregabalin - gabapentin

7
Q

Nonopioid analgesics

A

NSAIDs, acetaminophen, COX-2 selective, aspirin

8
Q

Acute neuropathic pain

Neuropathic cancer pain

Episodic exacerbations of severe pain

A

Opioid analgesics may be used

9
Q

Chronic Mild pain

A

non-opioid, adjuvants useful

↓ central sense, perf sense, ↑ descending inhibition

10
Q

Nothing works better than ____ for inflamtions

A

glucocorticoids

11
Q

Nothing works better than____ for pain

A

Opioids

12
Q

Multimodal spare:

A

Opioid sparing

13
Q

What is Multimodal Analgesia?

A

Use of multiple classes of analgesics acting via different pathways

Opioid monotherapy remains a cornerstone of treatment for severe postoperative pain  BUT idiosyncratic and dose-limiting side effects curtail practical efficacy

Benefits of combining other agents with opioids

Greater analgesic efficacy from synergistic actions of agents with different mechanisms

Synergism between agents allows use of lower doses (“opioid-sparing”) limiting dose-related side effects

14
Q

Agonists at u-opioid receptors modulate

A

Transmission of pain (dorsal horn)

Perception - reaction to pain (cortex -limbic system)

15
Q

Mainstay of therapy for moderate-to-severe acute pain

A

Opiods

NOTE: Use of non-opioid and adjuvant medications is emphasized for treatment of chronic-persistent pain

16
Q

Opioids - Side Effects

A

NV
Constipation
Pruritus

resp depression serious, reverse with naloxone
monitor sedation

17
Q

Opioids - Side Effects Constipation

A

Tolerance to constipation does not develop to same level as to analgesia or respiratory depression

18
Q

Local Anesthetic Molecule INtermediate chain

A

Determines metabolic pathway and allergenicity

19
Q

Local Anesthetic Molecule lipophilic ring

A

Penetration of bio membrane

20
Q

Local Anesthetic Molecule hydrophilic R group

A

Ionizable amine - pH determines % of charged vs uncharged

21
Q

Local Anesthetic- Influence of pH on Distribution

A

Equilibrium reaction between bases and protons (H+ ions) is written as acid dissociations (loss of proton)

R-NH3+ (blocking) R-NH2 (soluble) + H+

Nonionized form (R-NH2) predominates at higher pHs and more readily crosses neuronal membranes

22
Q

Sodium Channel and Sites of LA Action

A

Use-dependent block [preferential binding to open and inactivated states] of Na+ channel by LA prevents propagation of action potential and transmission of pain impulses

23
Q

Local Anesthetics Side effects

A

Neurotoxicity, hypotension, dizziness, drowsiness

24
Q

NSAIDs – COX-2 Inhibitors

side affects

A

Side Effects:

GI ulceration (esp. ketorolac used in the elderly)

Increased bleeding risk

Renal dysfunction

COX-2 selective agents may increase CVS complications  increased thrombotic risk

25
Q

NON-Opioids are first line for everything

A

Ibuprofen is safest for GIIIII tract

26
Q

Acetaminophen Side Effects

A

Relative to NSAIDs: Little or no effects on peripheral COX-2: GI tract, platelets, kidneys, uterus

Hepatotoxicity major concern