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Pharm - EXAM 2
Pain
| Question | Answer |
|---|---|
| What is nociceptive classification of pain? | Normal sensory processing of pain. The nerves are working fine. |
| Give 1 example of nociceptive pain. | Somatic which is well localized. Examples include bone pain, muscle pain. |
| Give a 2nd example of nocicptive pain. | Visceral which is poorly localized. Examples include organ pain such as gallbladder or intestinal. |
| How is nociceptive pain described? | Dull, aching, throbbing |
| What is neuropathic classification of pain? | Abnormal sensory processing; nerve damage. May also have muscle damage. |
| What is the mechanism of neuropathic pain? | Either the central and peripheral nervous system or both. |
| How is neuropathic pain described? | Shooting, stabbing pain with a background aching or burning. May say it feels like an "electrical shock". |
| What mental factors increase the sensation of pain? | Anxiety, depression, fatigue, anger, and fear. These problems also need treatment to help treat the pain. |
| What mental factors decrease the sensation of pain? | Rest, mood elevation, sympathy, diversion, understanding. Teach pts. new techniques to tx their pain. |
| What is acute pain? | Has a physical cause that can be treated (ie: broken bone). |
| What are the signs of acute pain? | Hypoxia, hypercapnia, HTN, tachycardia, emotional difficulties. |
| If left untreated, can acute pain lead to chronic pain? | Yes |
| What are the 4 subtypes of chronic pain? | 1. Persists past the normal healing for an acute injury. 2. r/t a chronic disease (ie: arthritis). 3. w/o identifiable organic cause (ie: fibromyalgia) 4. Involves both the chronic and acute pain associated w/ cancer. |
| What are the consequences of unrelieved pain? | Stress hormone response (increased BG); impaired muscle movements (can change muscles surrounding the injured muscle); QOL changes. |
| How does unrelieved pain affect QOL? | Decreased social relationships; decreased sleep; depression; anger; hopelessness |
| What are nonpharmacological treatments of pain? | Heat, cold, exercise as appropriate, massage, behavioral approaches (biofeedback, distraction, relaxation) |
| What class of drugs are non-opioid agents to treat pain? | NSAIDS, aspirin, acetaminophen |
| What class of drugs are opioid agents to treat pain? | Morphine and related compounds; meperidine and related compounds; methadone and related compounds. |
| List the opioid receptors, their function, and location. | Located in brain and spinal cord. Mu - medicate somatic and visceral analgesia Kappa - mediate visceral pain; Delta - antagonist activity |
| List the endogenous opioids (endophins) | beta - endorphins, enkephalins, dynorphins |
| What receptors do the beta-endorphins bind to and what is the response? | Bind to mu and delta receptors which causes analgesia, respiratory depression, physical dependence, and euphoria |
| What receptors do the enkephalins bind to and what is the response? | Bind to mu and delta receptors and causes spinal analgesia |
| What receptors do the dynorphins bind to and what is the response | Bind to the kappa receptors and cuases spinal analgesia, miosis, & sedation. |
| What are the opioid agonist effects? | Analgesia, sedation, euphoria, mental clouding, resp depression, miosis, decreased GI peristalsis, depression of cough reflex, orthostatic hypotension |
| What are the morphine-related opioid agonists? | Codeine, hydrocodone, hydromorphone (Dilaudid), levophanol (Levo-Dromoran), oxycodone (Oxy-Contin), oxymorphone (numorphan), propoxyphene (darvon) |
| What are the meperidine-related opioid agonists? | The "-il"s: alfentanil (Alfenta), sufentanil (Sufenta), and remifentanil (Ultiva)- used in anesthesia; fentanyl (Duragesic patch, Sublimaze) |
| Name a 3rd opioid agonist. | Methadone - long 1/2 life. Bad rap for being used w/ heroin addiction centers |
| What are opioid agonist-antagonists? | Partial agonists at both mu and kappa receptors. Will also cause antagonist effect when given w/ a full agonist at therapeutic doses causing reversal of some effects of the agonist drug. |
| What are the opioid agonist-antagonists? The "-ine"s and "-ol"s. | Buprenorphine (Subutex, buprenex), nalbuphine (Nubain), pentazocine (Talwin)-combo w/ naloxone (Talwin NX), butorphanol (Stadol), tramadol (Ultram)-alternative to straight agonist for someone allergic to other opioids. |
| What are the combination drugs (ie: opioid + NSAID or opioid + APAP)? | Hydrocodone/APAP (Vicodin, Lortab, Norco); Hydrocodone/ibuprofen (Vicoprofen, Reprexain); oxycodone/APAP (Percocet); oxycodone/ASA (Percodan); codeine/APAP (tylenol #2, #3, #4)-#'s related to how much coeine is in each one |
| What are the combination drugs used for cough suppression? | Hydrocodone/homatropine (hycodan); codeine/guaifenesin (Robutussin AC)-mucolytic |
| How do opioid antagonists work? | They have a high affinity for opioid receptors but cause no effects. Bind to mu, kappa, and delta receptor so the opioid can't. |
| What class of drug are naloxone(Narcan) and naltrxone (Revia)? | Opioid antagonists: Naloxone has a 1/2 life that's shorter than the opioid; once naloxone is metabolized, the opioid will bind to the receptor again. Naltrexone is and oral drug used to tx alcoholism |
| List 2 other opioid antagonists and their mechanism of action. | Alvimopan (Entereg) and methylnaltrexone (Relistor). Both act peripherally to prevent opioid induced constipation. Mu-receptor antagonists with low lipophilicity. |
| When are alvimopan and methylnaltrxone used? | For chronic pain to decrease constipation. |
| What is tolerance? | Pharmacologic effect; decreases drug effect over time so need more drug to get the same effect. |
| A patient develops tolerance to: | analgesia, respiratory effect, and euphoria |
| A patient does not develop tolerance to: | miosis or constipation (will always need stool softener and laxative while on opioid) |
| What is dependence? | A physiologic effect; if an opioid is taken for over a month or so, pts will exhibit withdrawal sx will be present when the drug is d/c'd. May need to taper medications. |
| List opioid withdrawal sx. | Sweating, runny nose, irritability, tremor, anorexia, N/V, diarrhea, cramps, muscle spasms, tachycardia, tachypnea |
| What is addiction? | Psychologic syndrome. Overwhelming obsession w/ obtianing and using a drug for a non medically approved purpose. Can be tolerant and dependent on drug but not be addicted. |
| What are adjuvant analgesics? | Drugs that can be given alone or with opioids to manage the pain to decrease the amount of opioid or non-opioid pain meds used. |
| List the anticonvulsants used for adjuvant analgesias. | Work on the brain to tx neuropathic pain: carbamazepine (Tegretol), gapentin (Neurontin), pregabalin (Lyrica) |
| List the corticosteroids used for adjuvant analgesia. | Quickly decrease inflammation - dexamethasone (Decadron) or prednisone. Can be given PO or injections (ie:into joint) for quick decrease in inflammation. |
| List the TCAs used for adjuvant analgesia. | Amitiptyline (Elavil) in lower doses to help with neuropathic pain. |
| List the anxiolytics used for adjuvant analgesia. | Alprazolam (Xanax) and lorazapan (ativan) |
Created by:
HJR
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