Drugs For Pain Control

Front 1

There are two parts to pain: ________, which is the actual painful stimulus, and the _________, which is the emotional response to pain

Back 1

- sensory
- reactionary

Front 2

Pain can be _______, which has a short time course and is usually simple to evaluate treatment or _________, which has an undetermined time course with a more complex evaluation

Back 2

- Acute
- chronic

Front 3

________ is a sharp, well localized pain that subsides quickly with little emotional response, such as a needle jab

Back 3

Pricking pain

Front 4

_________ is a slower onset type of pain with greater persistence long after period of tissue damage; it is less localized and has a large emotional component and is associated with autonomic responses such as increased respiration and cardiovascular function

Back 4

Burning pain

Front 5

________ is an aching, poorly localized pain associated with referred pain (detects painful stimulus in areas removed from site where pain originated) such as when a dental patient has pain in maxillary sinuses (referred pain from maxillary molars)

Back 5

Visceral (deep) pain

Front 6

Two main types of Pain classifications

Back 6

- Nociceptive pain
- Neuropathic pain

Front 7

Nociceptive is _______ pain and Neuropathic is ______ pain

Back 7

- acute
- chronic

Front 8

The neuron protein called _________ is responsible for continuing the pain message and signals the brain to feel pain

Back 8

Substance P

Front 9

Control of nociceptive pain is usually accomplished with ___________ at the peripheral level and _________ at the central level within the CNS

Back 9

- nonnarcotic (nonopiod) analgesics (NSAIDs - nonsteroidal anti-inflammatory drugs)
- Opiods (Narcotic analgesics) (codeine, hydrocodone, etc)

Front 10

True/False
Narcotics are approved by the FDA to treat chronic neuropathic pain

Back 10

FALSE
narcotics are NOT FDA approved for chronic neuropathic pain

Front 11

________ are fatty acids found in all tissues, they are not stored in cells, but are synthesized during inflammation and once released they metabolize rapidly

Back 11

Prostaglandins (PGs)

Front 12

____________ explains the inflammatory events that occur locally after tissue trauma / damage

Back 12

the Prosaglandin Synthesis Pathway

Front 13

any slight trauma to a nerve fiber stimulates an enzyme called phospholipase A2, which breaks off ___________ from the phospholipds bound in the cell membrane

Back 13

Arachidonic acid

Front 14

The Arachidonic acid enters two metabolic pathways: in the first pathway an enzyme called __________ breaks down arachidonic acid into prostaglandins (PGE2) prostacyclin (PGI2) and thrombaxane A2; the second pathway invloves arachidonic acid being metabolized by the ___________ pathway into leukotrienes

Back 14

- cyclo-oxygenase
- lipoxygenase

Front 15

________ and _______ play a role in regulating the aggregation of platelets

Back 15

- Prostacyclin
- thromboxane A2

Front 16

________ produce bronchoconstriction in allergic reactions

Back 16

Leukotrienes

Front 17

Currently there are three cyclo-oxygenase isoenzymes known:

Back 17

- COX-1
- COX-2
- COX-3

Front 18

_________ is normally found in the gastrointestinal tract, kidneys, and platelets and under its influence prostaglandins maintain and protect the gastric mucosa (lining of the stomach), maintain normal platlet function (aggregation and homeostasis) through the formation of thromboxane A2, and prostacyclin (PGI2) and regulate renal blood flow

Back 18

COX-1

Front 19

_________ is produced only during inflammation and is found only in low amounts in the tissue.

Back 19

COX-2

Front 20

The object of anti-inflammatory drugs is to reduce the inflammation which is caused by _______ but ideally the drug should not effect ________ which is a protective substance

Back 20

- COX-2
- COX-1

Front 21

Acetysalicylic acid is

Back 21

asprin (ASA)

Front 22

aspirin is a _________ COX inhibitor, but predominately inhibits _______

Back 22

- non-selective
- COX-1

Front 23

Therapeutic effects of aspirin inlcude:

Back 23

- analgesia (inhibit prostaglandins & bradykinin)
- anti-inflammatory (blocking formation of PGE2)
- anti-pyretic (reduce fever)
- anti-platelet (inhibits platelet aggregation)

Front 24

Aspirin is contraindicated in patients with

Back 24

- renal disease
- gastric ulcer
- bleeding tendencies
- children younger than 17 years of age
- patient's with Reye's syndrome
- nasal polyps, allergic rhinitis

Front 25

about ___% of patients with asthma are intolerant to aspirin and other NSAIDs

Back 25

10%

Front 26

one baby aspirin contains _____ of aspirin, and one regular aspirin contains _______

Back 26

- 81 mg
- 325 mg

Front 27

Treatment for aspirin overdose is

Back 27

- gastric lavage
- activated charcoal

Front 28

Aspirin may be more toxic to children than adults, a child's toxicity is seen with ____ of asprin and a lethal dose is _____

Back 28

- 1 g (1000 mg)
- 10 g

Front 29

_________ is a more potent anti-inflammatory than aspirin with less intense gastrointestinal and antiplatelet effects

Back 29

Diflunisal (Dolobid)

Front 30

NSAIDs are indicated for

Back 30

- Analgesia (dental pain)
- anti-inflammatory
- anti-pyretic

Front 31

NSAIDs DO / DO NOT:
- covalently bind to cyclooxygenase enzyme
- Irreversibly inhibit platelet function as aspirin
- NSAIDs not used for prevention of strokes & heart attacks

Back 31

DO NOT

Front 32

True or False
All NSAIDs can contribute to hypertension

Back 32

TRUE

Front 33

NSAID contraindications

*hint (HAN)

Back 33

(HAN)
- Nasal polyps
- Asthma
- Hypersensitivity to NSAIDs

Front 34

True or False
Acetaminophen (tylenol) is a type of NSAID

Back 34

FALSE
Acetaminophen is NOT an NSAID

Front 35

_______ is the only COX-2 inhibitor currently available

Back 35

Celebrex

Front 36

________ is any natural or synthetic drug that has morphine-like pharmacolgoic action

Back 36

opioid

Front 37

Opiods act as an _______ and affect specific binding sites called opiate receptors in the CNS

Back 37

agonist

Front 38

_______ and ________ are the bodies natural opiates that inhibit painful stimuli, and are released from neurons in brain and activate opioid receptors thereby blocking transmission of pain impulses

Back 38

- Enkephalins
- Endorphins

Front 39

Opioid Receptor Classification depending upon their affinity for the different opioids:

Back 39

- Mu
- Delta
- Kappa

Front 40

Morphine has an affinity for _____ receptors

Back 40

mu

Front 41

________ receptors are involved in anlgesic, respiratory, depression, euphoric effects, and physical dependency
(PEAR)

Back 41

Mu

Front 42

______ receptors are involved with respiratory depression, miosis (pulpil constriction) and sedation

Back 42

Kappa

Front 43

Opioid Adverse effects include

*hint - SCRAM

Back 43

(SCRAM)
-Synergistic CNS depression with other drugs
- Constipation
- Respiratory depression
- Addiction - tolerance can develop
- Miosis (pupil constriction)

Front 44

Morphine indications

Back 44

severe pain due to trauma, cancer, or myocardial infarcation (heart attack)

Front 45

________ is a long acting synthetic morphine derivative used orally in the treatment of opioid (usually heroin) addiction

Back 45

methadone

Front 46

________ is a less effective analgesic than morphine with half duration of action

Back 46

Meperidine (Demerol)

Front 47

Opioid Classification includes:
_______, ________, or __________

Back 47

- full agonists - strong or moderate in producing an analgesic effect
- mixed opioid agonist / antagonist - analgesic effect with some antagonist activity
- pure antagonist - no analgesic effects, usually in opioid overdose

Front 48

________ is the prototype narcotic analgesic that is the standard against which other narcotic analgesics are compared

Back 48

Morphine

Front 49

_______ and ______ are a semisythetic morphine derivative used in the treatment of moderate to severe pain and are most effective when combined with NSAIDs, aspirin, or acetaminophen (e.g. Vicodin)

Back 49

- Oxycodone
- Hydrocodone

Front 50

________ is a naturally occuring narcotic agonist obtained from the opium poppy but in lesser amounts than morphine and is also a less potent analgesic than morphine

Back 50

Codeine

Front 51

Guidelines for patients taking Codeine include

Back 51

- Monitor patient for drymouth
- Monitor Vital signs due to effects on heart and respiratory system
- causes drowsiness / sedation

Front 52

________ is a chemical realated to methadone and with less analgesic activity than codeine

Back 52

Propoxyphene (Darvon)

Front 53

Other agonists include

Back 53

- Dextromethorphan (cough medicines)
- Loperamide (Imodium)
- Diphenoxylate
- Tramadol (Ultram)

Front 54

Aspirin can be used for prevention of heart attack and stroke in low doses by taking

Back 54

- 81 - 100 mg / day
or
- 325 mg every other day

Front 55

NSAIDs and aspirin have a ________ effect, which means there are no additional benefits in taking more than a certain dose

Back 55

ceiling effect

Front 56

______ are drugs of choice for severe pain

Back 56

opioids

Front 57

All Opioids are controlled substaces except for

Back 57

Tramadol

Front 58

There may be abnormal liver function in alcoholics, decreased metabolism of local anesthetics and increased bleeding time, therefore avoid

Back 58

acetaminophen

Front 59

which of the following opioid family is most commonly used perioperative or during general anesthesia?
a) Morphine / codeine family
b) Fentanyl family
c) methadone family
d) morphinan family

Back 59

b) fentanyl family

Front 60

Methadone (Dolophine) has all of the following advantages over morphine except one:
a) longer duration of action, easier withdrawal from drug
b) good bioavailability
c) cost effective
d) oral rather than parenteral route of administration
e) great risk for death and life-threatening changes in respiration and heart rate

Back 60

e) great risk for death and life-threatening changes in respiration and heart rate
- low dosages given b/c of this occurance

Front 61

Morphine side effects include:
(MORPHINE)

Back 61

MORPHINE
M - Myosis
O - Out of it (sedation)
R - Respiratory depression
P - pneumonia (aspiration)
H - Hypotension
I - infrequent BM (constipation)
N - Naseau
E - Emesis

Front 62

Aspirin side effects include:
(ASPIRIN)

Back 62

(ASPIRIN)
A - asthma
S - Salicyalism
P - pepltic ulcer disease
I - Intestinal blood loss
R - Reye's syndrome
I - Idiosyncracy
N - Noise (tinnitus)

Front 63

Opioid effects:
(BAD AMERICANS)

Back 63

(BAD AMERICANS)
B - bradycardia & hypotension
A - anorexia
D - Diminished pupilary size
A - Analgesics
M - miosis
E - Euphoria
R - Respiratory depression
I - increased smooth muscle activity
C - constipation
A - Ameliorate cough reflex
N - Nausea and vomiting
S - Sedations