N210 Pain Medications Lecture

Front 1

Types of pain:

Back 1

Visceral
Somatic
Inflammatory
Neuropathic

Front 2

How is neuropathic pain treated?

Back 2

TCAs or gabapentin

Front 3

Three classes of opioid receptors:

Back 3

Mu
Kappa
Delta

Front 4

Which class of opioid receptor offers the most pain relief?

Back 4

Mu

Front 5

What actions are associated with mu receptors?

Back 5

Analgesia, respiratory depression, euphoria, sedation

Front 6

What actions are associated with kappa receptors?

Back 6

Analgesia and sedation

Front 7

Commonly used opioid antagonist:

Back 7

naloxone (Narcan)

Front 8

Strong opioid agonists:

Back 8

Morphine
Fentanyl
Meperidine
Hydromorphone
Methadone
Heroid

Front 9

Moderate to strong opioid agonists:

Back 9

Codeine
Oxycodone
Hydrocodone
Propoxyphene

Front 10

Opioid agonist-antagonists:

Back 10

Butorphanol
Nalbuphine
Pentazocine

Front 11

Which drug are all opioids measured against?

Back 11

Morphine sulfate

Front 12

Action of opioids:

Back 12

Mimicking the actions of various "endorphins"

Front 13

Use of opioids:

Back 13

Moderate to severe pain

Front 14

Effects of morphine:

Back 14

Analgesia, sedation, euphoria, anxiety reduction, respiratory depression, cough suppression (bad idea post-op!), decreased bowel motility

Front 15

Pharmacokinetics of opioids:

Back 15

Metabolized by liver
Excreted by kidneys
First pass effect is large

Front 16

Ratio of dosing of opioids, oral:IV:

Back 16

3:1

Front 17

Precautions with opioid use:

Back 17

Head injury
Acute asthma
Sleep apnea
BPH
IBD
Pregnancy/labor
Age extremes
Liver impairment

Front 18

Interactions with opioids:

Back 18

CNS depressants
Anticholinergics
Antihypertensives
MAO-Is
Opioid antagonists

Front 19

Signs of opioid toxicity:

Back 19

Respiratory depression <12
Pinpoint pupils <2mm
Hypoxia, shock, death

Front 20

Fentanyl dosing units:

Back 20

mcg, NOT mg

Front 21

Use of fentanyl:

Back 21

Conscious sedation, anesthesia, analgesia

Front 22

Onset/duration of fentanyl:

Back 22

Rapid onset, short duration

Front 23

Routes of administration for fentanyl:

Back 23

IV, patch, buccal tablets, lozenge on a stick

Front 24

Reasons not to use Demerol:

Back 24

Frequent dosing, many interactions, toxic metabolite with long-term use causing confusion and seizure

Front 25

Uses of meperidine (Demerol):

Back 25

Conscious sedation, anesthesia, obstetrics, preventing rigors

Front 26

Contraindiations for meperidine (Demerol):

Back 26

Renal insufficiency

Front 27

Uses of methadone:

Back 27

Pain, opiate addiction

Front 28

Adverse effects of methadone:

Back 28

QT prolongation, dysrhythmias

Front 29

Agonist-antagonists should not be given to:

Back 29

Patients physically dependent on pure opioid

Front 30

Side effects of agonist-antagonists compared to pure opioids:

Back 30

Less respiratory depression, no euphoria, low abuse potential

Front 31

Action of tramadol (Ultram):

Back 31

Weak mu agonist, blocks NE/serotonin reuptake

Front 32

Side effects of tramadol (Ultram):

Back 32

Sedation, dizziness, headache, dry mouth, constipation, SEIZURES

Front 33

Which opioid is an option for patients who cannot take NSAIDs?

Back 33

Tramadol (Ultram)

Front 34

Assessment of pain with opioid use:

Back 34

Prior to administration and about 1 hour later

Front 35

Dosing schedule of opioids:

Back 35

Fixed schedule

Front 36

How long does it take to become dependent on opioids?

Back 36

Moderate to high doses, 20 days or more

Front 37

Symptoms of opioid withdrawal:

Back 37

Anxiety, sweating, cravings, restlessness, insomnia, muscle ache, abdominal pain, hot flash, cold flash, yawning, muscle twitching

Front 38

At what point do withdrawal symptoms peak?

Back 38

36-72 hours

Front 39

Best route of administration of opioids for steady pain control:

Back 39

PCA pump

Front 40

What's the maximum amount of time meperidine (Demerol) should be given?

Back 40

48 hours

Front 41

What inflammatory markers cause pain?

Back 41

Prostaglandins

Front 42

How do NSAIDs work?

Back 42

Inhibit COX at the site of injury, decreasing formation of mediators of pain

Front 43

Uses of COX inhibitors:

Back 43

Suppress inflammation, relieve pain, reduce fever

Front 44

Adverse effects of COX inhibitors:

Back 44

Gastric ulcers, bleeding, renal impairment

Front 45

Which COX inhibitor is NOT anti-inflammatory?

Back 45

acetaminophen

Front 46

Uses of first-generation NSAIDs (aspirin, nonaspirin NSAIDs)

Back 46

Inflammatory disorders
Dysmenorrhea
Mild to moderate pain
Suppress fever

Front 47

First-generation NSAIDs have risk of harm to:

Back 47

GI, kidney, liver

Front 48

Action of aspirin:

Back 48

Nonselective COX inhibitor

Front 49

Uses of aspirin:

Back 49

Analgesic
Antipyretic
Antiinflammatory
Suppresses platelet aggregation
Dysmenorrhea
Cancer prevention
Alzheimer's prevention

Front 50

Length of time of aspirin's platelet effects?

Back 50

7 days

Front 51

Adverse effects of aspirin:

Back 51

GI effects
Bleeding
Renal impairment
Reye's syndrome
Salicylism

Front 52

Symptoms of salicylism:

Back 52

Tinnitis, sweating, headache, vertigo

Front 53

Interactions with aspirin:

Back 53

Anticoagulants
Glucocorticoids
Alcohol
Ibuprofen
ACE inhibitors, ARBS

Front 54

Uses of nonaspirin first-generation NSAIDs:

Back 54

Arthritis, gout, dysmenorrhea

Front 55

Action of nonaspirin first-generation NSAIDs:

Back 55

Inhibit COX-1 and COX-2

Front 56

Examples of nonaspirin first-generation NSAIDs:

Back 56

ibuprofen
ketoprofen
naproxen
indomethacin
ketoralac (Toradol)

Front 57

Nonaspirin NSAID interactions:

Back 57

lithium
warfarin
aspirin
antiHTNs

Front 58

Effectiveness of first-generation vs. second-generation NSAIDs:

Back 58

Equally effective

Front 59

Risks of GI side effects, first- vs. second-generation NSAIDs:

Back 59

Second generation is lower risk

Front 60

Adverse effects of second-generation NSAIDs:

Back 60

Renal impairment, HTN, edema

Front 61

Action of celecoxib (Celebrex):

Back 61

Second-generation COX-2 inhibitor

Front 62

Risk of celecoxib (Celebrex):

Back 62

CV risks

Front 63

Uses of celecoxib (Celebrex):

Back 63

OA, RA
Acute pain
Dysmenorrhea
Familial adenomatous polyposis

Front 64

Adverse effects of celecoxib (Celebrex):

Back 64

Dyspepsia
Abdominal pain
Renal toxicity
Sulfonamide allergy
CV impact

Front 65

Drug interactions with celecoxib (Celebrex):

Back 65

Warfarin
Furosemide (decreased effect)
ACE inhibitors (decreased effect)
Lithium (levels increased)

Front 66

Action of acetaminophen:

Back 66

Does not block prostaglandin synthesis; action suspected to be in CNS

Front 67

Drug of choice for children with mild to moderate pain:

Back 67

Acetaminophen

Front 68

Adverse effects of acetaminophen:

Back 68

Few, at therapeutic doses

Front 69

Treatment for acetaminophen overdose:

Back 69

Acetylcysteine (Mucomyst)

Front 70

Interactions with acetaminophen:

Back 70

Alcohol
Warfarin

Front 71

Three classes of drugs for rheumatoid arthritis:

Back 71

NSAIDs
DMARDs
Glucocorticoids

Front 72

Protocol for RA treatment:

Back 72

Start NSAID for symptom relief
Start DMARD within 3 months of dx
Glucocorticoids for short-term "flare up" and symptom control

Front 73

First choice of drug for RA:

Back 73

methotrexate (Rheumatrex)

Front 74

Action of methotrexate:

Back 74

Interferes with folic acid

Front 75

Time until effect of methotrexate:

Back 75

3-6 weeks

Front 76

Adverse effects of methotrexate:

Back 76

Hepatic fibrosis
Bone marrow suppression
GI ulceration
Pneumonitis

Front 77

Labs required of pts taking methotrexate:

Back 77

Liver, kidney, CBCs

Front 78

Action of etanercept (Enbrel):

Back 78

Inactivates TNF

Front 79

Adverse effects of etanercept (Enbrel):

Back 79

Infection
Injection site reactions
TB
Heart failure
Cancer
Live vaccine reactions

Front 80

Stages of gout:

Back 80

Asymptomatic
Acute gouty attacks
Intercritical
Tophaceous

Front 81

First choice for gout treatment:

Back 81

NSAIDs (indomethacin)

Front 82

What precipitates acute gout attacks?

Back 82

Trauma/surgery
Starvation
Beer and spirits, but NOT wine
Diuretics and allopurinol
Meat, fish consumption

Front 83

Short-term drug therapy for gout:

Back 83

NSAIDs
Glucocorticoids

Front 84

Long-term drug therapy for gout:

Back 84

Colchicine
Allopurinol

Front 85

Action of colchicine:

Back 85

Inhibit leukocyte infiltration

Front 86

Side effects of colchicine:

Back 86

N/V/D/pain occurs in 80% of patients!!

Front 87

Precautions with using colchicine:

Back 87

Elderly, cardiac, renal, GI, pregnancy

Front 88

Action of allopurinol (Zyloprim):

Back 88

Inhibits xanthine oxidase to block uric acid production

Front 89

Uses of allopurinol (Zyloprim):

Back 89

Chronic tophaceous gout, chemo-induced hyperuricemia

Front 90

Immediate unwanted effect of allopurinol (Zyloprim):

Back 90

Increases uric acid levels at first

Front 91

Adverse effects of allopurinol (Zyloprim):

Back 91

GI, neuro, cataracts
Generally well tolerated

Front 92

Interactions with allopurinol (Zyloprim):

Back 92

Inhibits hepatic enzymes, increases levels of warfarin