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68 Cards in this Set
- Front
- Back
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nociceptive pain
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from the stimulation of intact pain receptors
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somatic pain
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skin, soft tissue, skeletal muscle, and bone
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visceral pain
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internal visceral organs
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APAP MOA
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inhibits synthesis of prostaglandins in CNS and peripherally blocks pain impulse generation. inbhits hypothalamic heat-regulating center
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APAP clinical uses
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analgesia, antipyretic, no anti-inflammatory effects
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APAP onset of action
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<1hour
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APAP duration
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~4-6hours
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APAP od
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antidotal rx is acetylcysteine. replenishes hepatic stores of glutathione and supportive care
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APAP max dose
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1 gm/dose; 4 gm/day
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APAP AE
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hypersensitivity rxns, hepatotoxitcy, renal tubular necrosis
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APAP DIs
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warfarin, etoh, inducers of APAP metabolism
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APAP dosing
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adults: 325-1000 mg PO/PR q 4-6 hrs prn
children: dose 10-15 mg/kg PO/PR q 4-6h PRN. max 5 doses/24 hours dose adjust in hepatic/renal impairment |
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COX inhibitors examples of classes
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ASA
NSAIDS Cox-2 selective inhibitors |
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COX-I clinical uses
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antipyretic, analgesia, anti-inflammatory
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ASA MOA
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non-selective, irreversibly inhibits cox 1 and 2, blocking synthesis of thromboxane A2 and prostaglandins
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ASA PK
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rapidly absorbed via PO
metabolized via gut and plasma and liver highly protein bound renally excreted irreversible |
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ASA CI
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bleeding disorders
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ASA AEs
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GI, bleeding, renal impairment, hypersensitivity rxn, Reye's syndrome
not used in children without healthcare approval and should never be used in children and teens with chickenpox or flu s/s |
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ASA DIs
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drugs that inc bleeding risk, etoh, glucocorticoids, ACE/ARB, Li
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NSAIDs MOA
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cause reversible inhibition of Cox1 and Cox2
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NSAIDs Black Box
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CV risk: may inc risk of serious and potentially fatal CV thrombotic events, MI, and stroke
GI risk: inc risk serious GI events incl. bleeding, ulceration, and perforation |
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NSAIDs examples
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Diflunisal, Salsalate, Diclofenac, Cataflam, Zipsor, Cambia, Flector, Etodolac, Indomethacin, Tolmetin, Sulindac, Ketorolac, Meloxicam, Piroxicam, Flubirprofen, fenoprofen, ketoprofen, oxaproxin, naprosen, ibuprofen, mefenamic acid, meclofenamate, nabumetone
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NSAIDS AEs
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bleeding, renal impairment, fluid rentention, hypersensitivity rxns, Reye's syndrome (avoid in children with flu/chicken pox), inhibits plt aggregation and prolongs bleeding time
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Reye's syndrome
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persistent N/V, somnolence, lethargy, confusion, combative behavior, dec LOC, seizure, mortality rate of 20-30%
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Avoid ASA and NSAIDs in:
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hx of PUD, GI bleed
low plts, renal, hepatic sufficiency not recommended during pregnancy or while breast feeding use with caution in persons with asthma and those allergic to sulfonamides |
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Celecoxib MOA and PK
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causes selective inhibiton of Cox2
hepatically metabolized and renally eliminated |
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Celecoxib: CI
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sulfonamide allergy and for use post CABG
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Celecoxib Black Box
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CV: fatal CV thrombotic events, MI, stroke
GI risks |
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Celecoxib AEs
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GI
bleeding renal toxicity fluid retention CV risk sulfonamide ally avoid in pregnancy |
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Celecoxib DIs
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warfarin
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tolerance
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inc doses to obtain same response, develops analgesia, euphoria, sedation, resp depression, cross-tolderance to other opiod agonists
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physical dependence
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abstinence syndrome occurs if drug abruptly stopped
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addiction
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compulsive need for drug for psych reasons
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pure opiod agonists MOA and examples
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activate mu receptors and kappa receptors
morphine, codeine |
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agonist-antagonist opiods examples
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Talwin, Nubain, Stadol, Subutex
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pure opiod antagonists MOA and examples
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act as antagonists at mu and kappa receptors
Narcan, Naltrexone |
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moderate to strong opiod angonists
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codeine, oxycodone, hydrocodone
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strong opiod agonists
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fentanyl, alfentanil, sufentanil and remifentil, meperidine, methadone, hydromorphone, oxymorphone, levophanol
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equianalgesic dosing
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degree of painr elief achieved in analgesic equivalents which is dose of an analgesic required to produce same analgesic effect as a 10 mg dose of morphone
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opiods AEs
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resp depression
urticaria, pruritis constipation OH urinary retention cough suppression biliary colic emesis elevation of intracranial pressure |
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opiods DIs
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CNS depressants, hypotensive drugs, monoamine oxidase inhibitors, linezolid, anticholinergic drugs, inhibitors/inducers of metabolisms, St. John's wort, kava kava, valerian, agonist-antagonist opioids, opiopid antagonists
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Tapentadol MOA
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Central opiod agonist- thought to bind to mu opioid receptor and inhibit NE reuptake, producing analgesia
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Tapentadol AEs
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resp depression
urticaria, pruritis constipation OH urinary retention cough suppression biliary colic emesis elevation of intracranial pressure dizziness, sedation, GI seizures, SJS, TEN OH, withdrawal if abrupt d/c |
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tapentadol DIs
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CNs depressants, MAOIs, Linezolid, TCA, SNRIs
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Tramadol MOA
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nonopiod centrally acting analgesic, binds to mu receptor, weakly inhibits Ne/5HT uptake, producing analgesia
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Tramadol use
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moderate to moderately severe pain
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Tramadol AEs
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dizziness, sedation, GI, serotonin syndrome, seizures, SJS, TEN, OH, withdrawal if abrupt DC, resp depression
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fentanyl patches avoid:
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fever, broken skin, totate sites to avoid irritation
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Naltrexone Therapeutic use
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prevent relapse to opiod dependence following opiod detoxification, alcohol dependence, combined with morphine sulfate to treat chronic moderate/severe pain
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naltrexone BBW
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hepatotoxity
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naloxone uses
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reversal of opioid OD, reversal of postop opioid effects, reversal of opiod induced neonatal resp depression
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other agents for pain
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TCAs, A2 agonists-clonidine, dexmedetomidine,
anticonvulsants- gabapentin, prefabalin, topirmate NMDA receptor antagonists- Ketamine non-narcotic mu receptor agonist- tramadol |
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abortive therapy for migraines: limit use to:
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1-2 days/week b/c can lead to medication overuse HA (MOH)
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analgesics used for migraines
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ASa, APAP, NSAIDs, APAP only in combo with other drugs
opiod analgesics reserved for severe migraine that has no responded to first-line meds, butorphanol nasal spray |
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ergot alkaloids MOA
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alters transmission of serotonergic, dopaminergic and alpha-adrenergic junctions
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ergot alkaloids excretion
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bile
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ergot alkaloids AEs
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N/V/D
Preg Cat X Myalgia, weaness, numbness, tingling in extremeties tachyc/bradyc |
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ergot alkaloids DIs
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triptans, potent 3A4 inhibitors
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ergot alkaloids BBW
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peripheral ischemia
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ergot alkaloids CI
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CAD, PVD, sepsis, preg, hepatic/ renal impairment, concomitant use of ___
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Serotonin IB/ID receptor agonists MOA and examples
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selective serotonin agonists, act by constricting intracranial BV and suppressing release of inflammatory neuropeptides
triptans |
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Serotonin IB/ID receptor agonists AEs
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drowsiness, dizziness
throat and chest s/s sensations/ paresthesias coronary vasospasm teratogenesis |
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Serotonin IB/ID receptor agonists DIs
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other tryptans and ergot alkaloids
MAOIs, Linezolid SSRI/SNRIs serotonin receptor agonists potent 3a inhibitors propranolol with frovatriptan and rizatriptan |
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preventative migraine therapy
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beta blockers- propranolol initial 20 mg BID or TID
TCAs- amitriptyline antiepileptic drugs- divalproex, topiramate estrogens for menstrual migraine other drugs for propylaxis |
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botox MOA
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inhibits acetylcholine release from nerve endings, reducing neuromuscular transmission and local muscle activity
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botox admin
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155 u IM div in 31 sites q12wks
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botox BBW
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stread of toxin effect
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botox DI
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muscle relaxants-inc muscle weakness
anticholinergics/ antihistamines- excessive anticholinergic response/SEs |
