Adjuncts Opioid Therapy - Goldstein

Front 1

Adjuncts to opioid therapy improve pain management by (2)

Back 1

- Enhance opioid analgesia
- Provide analgesia through non-opioid MOA

Front 2

3 narcotics that do not contain acetaminophen (do contain ASA)

Back 2

- Percodan
- Perdocdan-Demi
- Lortab ASA

Front 3

In alcohol, this drug's sustained release capsule can be broken down --> get drastic inc in drug

Back 3

Hydromorphone

Front 4

Tertiary TCAs not good in geriatrics b/c of ______ effect

Back 4

Anti-cholinergic

Front 5

NSAIDS used as adjuncts to opioid therapy (2)

Back 5

- Aspirin (irreversible inhibitor of prostaglandin synthesis)
- COX 1 and 2 inhibitors (reversible)

Front 6

Adjunt to opioid therapy
- Block reuptake of serotonin at pre-synaptic membrane --> inc serotonin levels --> inc analgesia

Back 6

Antidepressants

Front 7

Antidepressants serve as an adjunct to opiod therapy by increasing ______ (major NT of pain supression) and also ____

Back 7

Serotonin
NE

Front 8

Some TCAs may stablize _____ membranes

Back 8

Nerve

Front 9

Adjunct to opioid therapy
- Causes depletion of substance P from terminals of PNS --> reduced conduction of C fibers

Back 9

Capsaicin

Front 10

Major NT of pain signals from periphery to CNS

Back 10

Capsaicin

Front 11

Capsaicin cream used to tx pain in diabetic neuropathy and mastectomy

Back 11

Zostrix

Front 12

Capsaicin cream used to tx pain of shingles

Back 12

Qutenza

Front 13

Adjunct to opiod = calcium channel blocker --> MOA =

Back 13

Dec entry of Ca2+ --> dec release of substance P

Front 14

2 Calcium channel blockers used as adjuncts to opioid therapy

Back 14

- Nifedipine
- Ziconotide

Front 15

Approved for intrathecal analgesia in patients with refractory chronic pain (related to snail toxin)

Back 15

Ziconotide (a Ca2+ channel blocker)

Front 16

Study: morphine tolerant pts added ____ --> inc efficacy of morphine

Back 16

Ca channel blocker

Front 17

Alpha 2 agonist used as an adjunct to opioid therapy

Back 17

Clonidine

Front 18

- MOA unknown
- Potentiates narcotics, GA, LA
- Shown to be effective in pts tolerant to morphine

Back 18

Clonidine

Front 19

Anticonvulsants used as adjuncts in opioid therapy (2)
- Stablize nerve membranes

Back 19

Carbamazepine
Phenytoin

Front 20

Anticonvulsants MOA as adjuncts to opioid therapy

Back 20

- Dec Na+ channel fx --> dec neuronal hyperexcitability

Front 21

Adjunct to opioid therapy
-An anticonvulsant that decs Na+ channel fx AND inhibits Ca2+ channels

Back 21

Lamotrigine

Front 22

Adjunct to opioid therapy
-An anticonvulsant that decs Na+ channel fx AND potentiates GABA

Back 22

Topiramate

Front 23

Increased GABA activity causes a dec in neuropathic pain by inhibition of _______ release in spinal cord dorsal horn

Back 23

Glutamate

Front 24

Local anesthetics that serve as adjuncts to opioid therapy (2)
--> block Na+ channel --> dec neuron excitability

Back 24

- Lidocaine
- Mexilitine

Front 25

Psychostimulants that may be additive to analgesia (3)

Back 25

- Caffeine
- Dextroamphetamine
- Methylphenidate

Front 26

Psychostimulants MOA as adjuncts to opioid therapy

Back 26

- Inc CNS activity --> counteracts narcotic induced drowsiness, sedation, confusion

Front 27

Corticosteroids that may be used as adjuncts to opioid therapy (3)

Back 27

- Dexamethasone
- Methylprednisone
- Prednisone

Front 28

Corticosteroids MOA as adjuncts to opioid therapy (3)

Back 28

- Anti-inflm (dec prostagland synth)
- Dec edema (dec capillary perm)
- Dec neuronal excitability

Front 29

Corticosteroids may help improve ______ and dec nausea

Back 29

Appetite

Front 30

Used to dec inflm around a brain tumor --> decs area needing radiation

Back 30

Corticosteroids

Front 31

Used for
- Pain from spinal cord compression
- Bone pain
- H/a from brain mets
- Neuropathic pain
- Mets prostate cancer (dec androgens)

Back 31

Corticosteroids

Front 32

Immediate (up to 2 wks) ADRs of Corticosteroids (5)

Back 32

- HTN
- Hyperglycemia
- Immunosuppression
- Psych disorders
- Peptic ulcer

Front 33

Long term ADRs of corticosteroids (4)

Back 33

- Cushings
- Proximal myopathy
- Osteoporosis
- Aseptic bone necrosis

Front 34

NMDA recepto antagonists used as adjuncts to opioid therapy (3)

Back 34

- Dextromethorphan
- Ketamine
- Memantine

Front 35

Receptors involved in central sensitization

Back 35

NMDA

Front 36

Bisphosphanates (bone resorption inhibitors) used as adjuncts to opioid therapy (4)

Back 36

- Alendronate
- Pamidronate
- Risedronate
- Zoledronic Acid

Front 37

Bisphosphonates inhibit bone resorption by (2)

Back 37

- Adsorpation to calcium phosphate (hydroxyapatite) crystals in bone blocks dissolution
- Inhibits osteoclasts

Front 38

Help dec pain due to bone mets which are common in multiple myeloma and breast cancer

Back 38

Bisphosphonates

Front 39

Must give bisphosphonates with adequate hydration to prevent ______

Back 39

Nephrotoxicity

Front 40

Antispastic used as adjunct to opioid therapy

Back 40

Baclofen

Front 41

Adjunct to opioid therapy
- Activates GABA R's
- Intrathecal --> decs pain in pts with spinal lesions
- Antispastic

Back 41

Baclofen

Front 42

Spasmolytic used as adjunct to opioid therapy

Back 42

Scopolamine

Front 43

Adjunct to opioid therapy
-anticholinergic
- decs pain due to distension of hollow organs

Back 43

Scopolamine

Front 44

Hemorheologic used as adjunct to opioid therapy

Back 44

Pentoxifylline

Front 45

Hemorheologic
- Incs BF to oxygen to tissues (decs blood viscosity, incs flexibility of RBCs, antiplatelet activity)

Back 45

Pentoxifylline

Front 46

Shown to dec pain in patient with severe atherosclerosis and purpuric toe lesion

Back 46

Pentoxifylline

Front 47

Adjunt to opioid therapy
- Not inherently analgesic --> more for pt comfort

Back 47

Benzodiazepines

Front 48

Relieve anxiety and muscle spasms occuring with chronic pain --> which in turn may inc analgesia

Back 48

BZs

Front 49

2 BZ's that may reduce neuropathic pain (based on clinical reports)

Back 49

- Alprazolam
- Clonazepam

Front 50

Antipsychotic used as adjunct to opioid therapy

Back 50

Methotrimeprazine

Front 51

Dose related analgesia of this antipsychotic is about the same as opioid analgesia
- Will also dec anxiety
- Avail in US as IM only

Back 51

Methotrimeprazine

Front 52

All neuroleptics besides ___________ will inc sensitivity to pain

Back 52

Methotrimeprazine