Week 9 Analgesia Flashcards
Pain is defined as an?
Unpleasant sensory and emotional experience associated with actual and potential tissue damage
Mediators involved in the transmission or relief of pain include?
Endogenous opioids
Prostaglandins
Tachykinins
Endogenous opioids, which are all……………………….include………………….?
Opioid peptides, include enkephalins, endorphins, dynorphans and nociceptin
Nociceptive pain arises from?
Physiological pain, arising from stimulation of superficial and visceral nociceptors, by noxious stimuli such as tissue injury and or inflammation
Neuropathic pain arises from?
A primary lesion or dysfunction in the somatosensory nervous system pathway, e.g nerve compression, amputation, inflammation, prolapsed intervertebral disc, trauma and or degeneration
Note: More examples are given in the textbook
Neuropathic pain responds less well to?
Opioid analgesia or NSAIDs, often requires the addition of adjunct medication
TRUE OR FALSE
Analgesia is associated only with DOR (opioid receptor subtype)?
FALSE
Subtypes of opioid receptors are classified by responses to different agonist and antagonist
Constipation is associated with all opioid receptors? TRUE/ FALSE
TRUE
Most serious adverse affects of opioids is respiratory depression, excessive sedation, dysphoria, CONSTIPATION, nausea, vomiting, tolerance and dependency
Euphoria is associated only with MOR? TRUE/ FALSE?
TRUE
MOR response include Supraspinal analgesia, EUPHORIA, respiratory depression, sedation, constipation, miosis, drug-dependence
Dysphoria is associated only with KOR? TRUE/ FALSE
TRUE
Response include; spinal and peripheral analgesia, sedation, miosis, DYSPHORIA, respiratory depression
Miosis is associated with MOR and KOR? TRUE/ FALSE
TRUE
Both MOR and KOR Opioid receptor responses include MIOSIS
Sedation is associated with all opioid receptors? TRUE/ FALSE?
FALSE
Sedation is associated with MOR and KOR Opioid receptors
Respiratory depression is associated with only DOR? TRUE/ FALSE?
FALSE
Respiratory depression is associated with DOR, KOR and MOR opioid receptors
Dependence is associated with only MOR? TRUE/FALSE
TRUE
Drug or opioid dependence is associated with only MOR opioid receptors
Which of the following effects is NOT associated with opioids? (Select all that apply)
a) Delirium
b) Diuresis
c) Hypotension
d) Nausea and vomiting
e) Diarrhoea
f) Cough
g) Itch
h) Hyperglycaemia
i) Hypethermia
a) delirium
b) Diuresis
e) diarrhoea
f) cough
g) itch
h) hyperglycaemia
i) hyperthermia
Which of the following opioids are prodrugs?
a) heroin
b) codeine
c) pethidine
d) tramadol
e) Fentanyl
b) codeine
d) Tramadol
Morphine (select all that apply)
a) use is associated with dependence but not tolerance
b) may cause histamine release and bronchoconstriction
c) has high hepatic extraction
d) forms an active metabolite
e) should be avoided in patients with severe hepatic or renal impairment
All of the above a) b) c) d) e)
With respect to opioids (Select all that apply)
a) Fentanyl is administered via the dermal and sublingual route
b) pethidine is only administered orally
c) oxycodone is combined with naloxone to reduce GI adverse effects
d) codeine is used as a cough suppressant
e) seizures are most common cause of death following opioid overdose
c) d)
Buprenorphine (Select all that apply)
a) may precipitate withdrawal symptoms in dependent people taking other opioids
b) has a low affinity for opioid receptors
c) patches have a prolonged onset and duration of action
d) is not recommended for the treatment of acute pain
e) is associated with more severe withdrawal syndrome than morphine
a) c) d)
Naloxone (select all that apply)
a) has little or no effect in a person who has not taken an opioid
b) has a long duration of action
c) is contraindicated in neonates
d) has a high oral bioavailability
e) is used as a diagnostic aid for opioid intoxication
All of the above
NOTE: naloxone is used to reverse the effects of opioids. Naloxone is short acting if given parenterally, however long acting if given orally. It is also contraindicated in neonates whose mother is known to be dependent on opioids
Aspirin (select all that apply)
a) inhibits COX-1
b) Has anti-inflammatory and analgesic, but not antipyretic actions
c) Reversibly inhibits the formation of thromboxane A2 in platelets
d) increases the synthesis of mucoprotective prostaglandin E2
e) has a short half-life
f) is metabolised to salicylic acid
g) is indicated in low doses for the primary prevention of stroke and myocardial infarction and for secondary prevention in ischaemic heart disease
e) f) g)
With respect to the adverse effects of aspirin (select all that apply)
a) commonly cause GI adverse effects
b) may cause renal dysfunction
c) may increase the risk of bleeding in patients receiving other anti platelet agents or anticoagulants
d) Chronic use is associated with tolerance
e) Causes Reye’s syndrome in elderly people
a) b) c)
Paracetamol (select all that apply)
a) has anti-inflammatory, antipyretic and analgesia actions
b) has very few adverse effects at therapeutic doses
c) is contraindicated in pregnancy
d) has low oral bioavailability
e) clearance is reduced in patients with renal dysfunction
a) b) e)
NOTE: Paracetamol is effective as a analgesic and antipyretic, has anti-inflammatory properties however very minimal
Four characteristic signs of inflammation are?
Erythema (redness), oedema (swelling), pain and heat
