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Pain DPA
Duke PA pharmacology pain
Question | Answer |
---|---|
Pain assessment includes 4 quality of life factors | physical, psychological, social, spiritual |
2 broad categories of pain | adaptive, maladaptive |
Adapative pain | protect from further injury or promote healing |
Maladaptive pain | pain as disease |
2 types of pain | nociceptive, neuropathic |
nociceptive pain | acute pain |
somatic pain | throbbing, squeezing, aching, stabbing |
visceral | cramping, gnawing, boring - less well localized |
nociceptors | free endings of primary afferent nerve fibers |
transduction releases what? | sensitizing substances - ex. Prostaglandins, etc. |
sensitizing local receptors causes which tissue reactions? | edema, vasodilation, inflammation |
A-delta fibers transmit which pain? | sharp, well localized, high-intensity mechanical, some thermal |
C fibers transmit which pain? | dull, aching, poorly localized pain, mechanical, thermal, chemical |
modulation inhibits transmission of what? | noxious stimuli |
Treatment for nociceptive pain includes which meds? | APAP, NSAIDS, Opiods, Adjuvants |
Inflammatory pain responds to which meds? | NSAIDS, corticosteroids |
Which type of pain results from damage to the nervous system? | neuropathic |
Hyperalgesia | painful stimulus --> increased response |
Allodynia | non-painful stimulus --> pain |
Persistent pain | prolonged after transient stimulus |
referred pain | spread of pain to uninjured tissue |
Does neuropathic pain respond to NSAIDS? | NO |
What can you treat neuropathic pain with? | antiepileptics, antidepresseants, local anesthetics, maybe opioids |
What is somatoform pain disorder? | psychological - pain doesn't match symptoms |
Treatment for psychogenic pain | adjuvant drugs,behavioral therapy |
What is APAP? | acetaminophen |
Does APAP have anti-inflammatory effect? | NO |
Does APAP cause GI damage? | NO |
Does APAP have anti-platelet activity? | NO |
Is APAP and analagesic and ani-pyretic? | YES |
What is ASA? | aspirin |
what is ASA's MOA? | inhibits Cox-1 and Cox-2 |
What are examples of non-salicylates? | Ibuprofen, Naproxen, etc. |
What is Celebrex's MOA? | Cox-2 inhibitor |
What is the risk of celebrex? | cardiovascular toxicity |
What are the three opiod receptors? | mu, delta, kappa |
What action do naloxone and naltrexone have? | antagonist - useful in overdoses |
What action do most opioids have? | full agonists |
What are the three classes of opioids? | morphine-like, meperidine-like, methadone-like |
Full or weak agonist - morphine? | full |
Full or weak agonist - fentanyl | full |
full or weak agonist - hydromorphone | full |
full or weak agonist - oxycodone | full |
full or weak agonist - methadone | full |
full or weak agonist - meperidine | full |
full or weak agonist - codeine | weak |
full or weak agonist - propoxyphene | weak |
full or weak agonist - hydrocodone | weak |
where do combination analgesics target? | multiple sites of action, so multiple pain pathways |
What is "dose-sparing" | combination analgesics allow for lower doses of both drugs |
Which combination analgesics have a ceiling effect? | only when adding to opioid |
What are the 4 A's of opioids? | Analgesia, ADLs, Adverse reactions, Aberrant drug-taking behavior |
What are examples of adjuvants? | Antidepressants, antiepileptic drugs, local anesthetics, topical agents, misc. |