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pnm- pharm > week 7- Analgesic Agents and Anti-inflammatory Agents > Flashcards

week 7- Analgesic Agents and Anti-inflammatory Agents Flashcards

1
Q

Analgesics

A

Medications that relieve pain without causing loss of consciousness

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2
Q

Pain has two element—

A

physical and psychological

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3
Q

Classification of Pain

A

Somatic-originates from skeletal muscles, ligaments & joints

Visceral-originates from organs and smooth muscles

Superficial-originates from the skin and mucous membranes

Vascular-originates from vascular or prevascular tissue. Maybe responsible for migraine headaches

Referred-result of visceral nerve fibers synapse firing in the spinal cord which are close to other nerve fibers supplying tissue in the body

Neuropathic-results from injury or damage to peripheral nerve fibers or damage to the CNS. Not disease process due to injury.

Phantom-occurs in a body part that has been removed surgically or traumatically. Characterized as burning, itching, tingling or stabbing pain.

Cancer-pain due to pressure on nerves, organs or tissue. Hypoxia to an organ, circulatory blockage to an organ, metatasis, muscle spasms, side effects of chemotherapy, radiation or surgery

Psychogenic-originates from psychological issues, not physical.

Central-due to tumors, trauma or inflammation of the brain

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4
Q

2 types of nerve fibers

A

Fiber A-
have myelin sheaths, large fibers, fast speed conduction pain, sharp and localized
A-controls the closing of the gates which blocks or inhibits impulses from traveling to the brain

Fiber C-
have no myelin sheaths, small fibers, slow conduction speed with dull, non localized pain
controls the opening of the gates which allows impulses to travel to the brain therefore perceiving pain

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5
Q

Posterior dorsal horn is where the

A

pain fibers enter the spinal cord.

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6
Q

Opioid Analgesics

A

Narcotics: very strong pain relievers

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7
Q

mech of action for opioids

A

Opioids bind to opioid receptors in the brain which causes an analgesic response therefore reduces pain
Can be partial agonists causing limited response by binding to the pain receptors and producing very minimal or no responses

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8
Q

The endorphins are the own body’s mechanism

A

in response to pain. They are the pain killers in our system

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9
Q

Opioid receptors

A

MU –analgesia, respiratory depression, euphoria, sedation
KAPPA-spinal analgesia, sedation, miosis
DELTA-analgesia

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10
Q

Opioid Analgesics used in adjuct with

A

NSAIDs
Antidepressants
Anticonvulsants
Corticosteroids

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11
Q

besides pain, Opioids are also used for:

A

***Cough center suppression (DM or codeine)
Treatment of diarrhea (Imodium)
Balanced anesthesia (Fentanyl)

**Opioid analgesics mainly work with the CNS and brain but can also have some effects outside the CNS.

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12
Q

Opioid Analgesics: Side Effects

A 
Euphoria (initially)
***CNS depression
Respiratory depression
Nausea and vomiting
Hypotension (vasodilation)
Urinary retention (increased bladder tone)
Diaphoresis and flushing (vasodilation)
Pupil constriction (miosis)
***Constipation (decreased gi motility)
Itching (histamine release)
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13
Q

Narcan-

A

antidote which competes at the binding sites (has a higher affinity to the receptors thereby reverses symptoms). Antagonist at all opioid receptor sites in the CNS Mu KAPPA Delta. Given IM, SubQ, IV

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14
Q

Toradol/Tramadol/Tramacet:

A

new drug of choice for pain control for those individuals who may use, misuse or abuse narcotics

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15
Q

Non-opioid Analgesics:Acetaminophen

A

Analgesic and antipyretic effects
Little to no anti-inflammatory effects
Available OTC and in combination products with opioids

(((Blocks peripheral pain impulses in the CNS
Antipyretic effects from direct activity on the hypothalamus )))

USED FOR:Mild to moderate pain AND Fever

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16
Q

OVERDOSING ON ACETAMINOPHEN

A

Overdose, causes hepatic necrosis

Long-term ingestion of large doses also causes nephropathy

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17
Q

NAC (N-acetylcysteine) antidote

A

–prevents hepatotoxic metabolites from forming

FOR ACETAMINOPHEN

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18
Q

ACTEAMINOPEN SHOULD NOT BE TAKEN IF

A

Liver dysfunction
Possible liver failure
When taking other hepatotoxic drugs

Dangerous interactions may occur if taken with alcohol

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19
Q

Other Non-Opioid Analgesics:NSAID

A

– (non steroidal anti-inflammatory drugs) ie Ibuprofen, Advil, Motrin, Aleve, Diclofenac
adverse effects are GI intolerance, bleeding, and kidney impairment.

they have a ceiling effect

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20
Q

Other Non-Opioid Analgesics: Muscle Skeletal Medications

A

– Methacarbomal – Robaxisal, Robaxacet

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21
Q

Other Non-Opioid Analgesics: Acetylsalicylic acid

A

– Aspirin, ASA, Entrophen

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22
Q

Other Non-Opioid Analgesics: Corticosteroids

A
  • Prednisone
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23
Q

Other Non-Opioid Analgesics: Topical Anaesthetics

A

– Lidocaine, Benzocaine, Emla

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24
Q

Other Non-Opioid Analgesics: AllopurinoL

A
  • reduces the production of uric acid- uric acid buildup can lead to gout or kidney stones. Maintenance drug
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25
Q

Other Non-Opioid Analgesics: Colchicine

A
  • responds to uric acid crystals, which reduces swelling and pain for gout. Acute episodes. Very narrow therapeutic window – overdose can lead to generalized organ failure.
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26
Q

Other Non-Opioid Analgesics: Glucosamine

A
  • naturally occurring sugar protein found in bones, bone marrow that helps build cartilage (the hard connective tissue located mainly on the bones near your joints). Supplemental therapy
27
Q

Other Non-Opioid Analgesics: Chondroitin

A
  • naturally occurring substance formed of sugar chains.It helps the body maintain fluid and flexibility in the joints.Used in alternative medicine as a possibly effective aid in treating osteoarthritis pain
28
Q

Opioid Analgesics: Nursing Implications

A

Constipation is a common side effect to opioids and may be prevented with adequate fluid and fiber intake

Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension

29
Q

Drugs in the Opioid family

A 
Opium
Heroin
Codeine
Hydromorphone (long acting)
Meperidine (Demerol)
Morphine
Oxycodone (long acting)
Oxycocet (combination of codeine and acetaminophen)
Propoxyphene (Darvon)
30
Q

CLASSES OF OPIODS

A

Opium and heroin are Schedule I agents

(schedule F in Canada): This is due to the very high dependency rate. (Controlled Drugs

31
Q

Heroin

A

Causes a brief “rush,” followed by a few hours of a relaxation, content state

In large doses opioid can cause respiratory arrest

They block the receptors in the CNS thereby blocking the sensation of pain

32
Q

Imodium (Loperamide) –

A

used for diarrhea

33
Q

Codeine –

A

used for pain, cough and sedation

34
Q

Dextromethrophan (DM) –

A

used as a cough suppressant

35
Q

Fentanyl Patches –

A

used for severe, chronic or terminal pain

36
Q

Pentazocine (Talwin) –

A

frequently used post-op but now Morphine and Demerol are more popular

37
Q

Opioid Drug Withdrawal

A

Peak period: 1 to 3 days after the drug is withdrawn
Duration: 5 to 7 days

Signs & Symptoms
Drug seeking, intense desire for drugs, cravings
Mydriasis, lacrimation 
Diaphoresis 
Rhinorrhea
Muscle cramps 
Nausea, vomiting, diarrhea
Hypertension, tachycardia, 
Anxiety, restlessness
38
Q

Opioid Drug Withdrawal Treatment:

A

Narcan is the specific antidote - used in situations of respiratory distress

39
Q

Opioid Drug Withdrawal Treatment:

A

Clonidine (Catapres) (also used to treat hypertension therefore monitor closely for hypotension)

40
Q

Opioid Drug Withdrawal Treatment:

A

Methadone (used during detox as part of the maintenance programme)

41
Q

STIMULANTS

A

Drugs that are taken to decrease fatigue, increase alertness, elevate mood and make you feel happier

Stimulants can be used to treat narcolepsy (periods of acute sleepiness)

They block the feelings of depression

Can lead to physical and psychological dependence

(((Stimulants work by releasing norepinephrine (neurotransmitter)))

42
Q

Cocaine

A

Cocaine is a white powder that comes from the leaves of the Coca plant

It is a strong stimulant with vasoconstriction effects

43
Q

Methamphetamine

A

crystal meth IS THE MOST POTENT
Stronger CNS effects than other amphetamines
Powerful effects on the central nervous system which can lead to dependency within a few weeks

the release of large amounts of a dopamine

44
Q

Other Amphetamines

A

methylenedioxyamphetamine
MDA, “love drug”

methylenedioxymethamphetamine
MDMA, “ecstasy” (common rave party drug)

Pill form (methylphenidate Ritalin, Dexedrine)

LSD (Lysergic acid diethylamide)

45
Q

Stimulant Withdrawal:Signs and Symptoms

A 
Peak period: 1 to 3 days
Duration: 5 to 7 days
Signs & Symptoms 	
Social withdrawal
Insomnia	
Depression, 
Suicidal thoughts and behavior, 
Paranoid delusions, hallucinations, delirium

In the acute phase treated with high doses of Benzodiazepines

46
Q

DEPRESSANTS

A

Used to treat anxiety, irritability, tension, panic attacks, to control seizures and induce light short duration of anesthesia (for specific medical procedures)

47
Q

TWO CLASSES OF DEPRESSANTS

A

Two main classes:
Benzodiazepines
Barbiturates

48
Q

Benzodiazepines

A

Widely used for anxiety, panic disorders and insomnia

They are relatively safe but when combined with alcohol or other CNS depressants they can be fatal

Half life ranges from 1-100 hours

49
Q

Benzodiazepines:Flunitrazepam (Rohypnol)
“Roofies”
“Date Rape Drug”.

A

When combined with alcohol causes amnesia
This is generally slipped into one’s drink and when consumed causes symptoms in 1 minute
The victim has no recall of any events.

50
Q

Barbiturates

A

Cause more CNS and respiratory depression when compared to BZ

Rapidly penetrate into the brain to produce CNS depression and anesthesia

Their half life is very long.
Their abuse generally increases with those who do not get positive effects with BZ

They have a serious dependency effect on the body

51
Q

SAFETY

A

BZ are more commonly prescribed by physicians as they have a wide safety margin
Barbiturates lead to more serious side effects with increased duration of effects

Enhanced symptoms when combined with alcohol
Death is usual due to respiratory depression or arrest

52
Q

Depressant Withdrawal:Signs and Symptoms

A

Agitation; muscular weakness; diaphoresis; delirium; hallucinations, convulsions; anxiety, hypertension, tachycardia, hyperthermia and tremors.

Withdrawal occurs with abrupt discontinuation of BZ especially if the patient has been taking them for a long time (months to years)

53
Q

Benzodiazepine ANITDOTE

A

Fumazenil (Anexate) is the direct antidote which may be used to reverse the acute sedative effects of benzodiazepines

Flumazenil antagonizes the action of BZ by directly competing at the receptor site in the CNS

Because Flumazenil has a higher affinity at the receptor, it knocks the BZ off, which allows it to bind to the receptor thereby reversing the sedative effect

54
Q

ALCOHOL

A 
AKA ethanol (ETOH)
Causes CNS depression as well as respiratory depression with large consumption
55
Q

Ethanol:Drug Effects

A

Causes CNS depression
Respiratory depression
Vasodilation, producing warm, flushed skin
Diuretic effect
Hypotension
Cardiac arrhythmias (high amounts)
It is rapidly absorbed producing peak effects in 30-60 minutes
Widely distributed in body water to all body organs
Metabolized in the liver

Inhibits ADH (antidiuretic hormone) thereby producing diuresis *****

56
Q

Effects of Chronic Ethanol Ingestion

A

Nutritional and vitamin deficiencies (especially B vitamins)
Wernicke’s encephalopathy
Korsakoff’s psychosis
Polyneuritis

Seizures, mental disorders, confusion, stupor
Alcoholic hepatitis, progressing to cirrhosis
Can lead to fatalities

57
Q

Ethanol Withdrawal

A 
Hypertension
Tachycardia
Hyperthermia
Cardiac arrhythmia
Diaphoresis
Tremors (severe withdrawal can lead to seizures)
Agitation -irritability
Confusion
58
Q

Ethanol Withdrawal Treatment

A 
Initial treatment with glucose 
Thiamine (prevents encephalopathy, seizures)
Narcan (helps stimulate respiration)
Diazepam (Valium) or Lorazepam (Ativan)
Dosage and frequency depends on severity
For severe withdrawal, monitoring in an intensive care unit is recommended
Disulfiram (Antabuse) – selective use
Counseling
Individual
Alcoholics Anonymous
59
Q

NICOTINE

A

Releases epinephrine that creates physiologic stress rather than relaxation

60
Q

Nicotine: Drug Effects

A

Increased heart rate and BP (due to cardiac stimulation)

Increased gastric activity (vomiting)
Rapidly absorbed by all routes
Highly metabolized and excreted in the urine

61
Q

Nicotine Withdrawal

A

Manifested by cigarette craving
Irritability, restlessness, decreased heart rate and BP

Cardiac symptoms resolve in 3 to 4 weeks, but craving may persist for months or years

It is during this phase that people generally go back to smoking because of the intense cravings

Bupropion (Zyban) may be
prescribed to aid in smoking
cessation

62
Q

stimulation of the SNS may result in

A

elevated values for vital signs and use of analgesics will depress vital signs because of CNS depressive effects.

63
Q

acetaminophen poising

A

rapid weak pulse, dyspnea, cold and clammy

64
Q

salicylate intox

A

^ HR , tinnitus, headache, nausea,

pnm- pharm (19 decks)

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