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80 Cards in this Set

  • Front
  • Back
What is the definition of pain?
an unpleasant sensory or emotional experience associated with actual or potential tissue damage
Name and describe the two types of pain
• Acute pain: follows injury, stops when body heals
• Chronic pain: associated with tissue damage; often cannot be localized
What are the different ways to classify pain?
• by origin (cutaneous, visceral, deep)
• by character (pricking, fast, burning, aching)
• by severity
What are nociceptors?
• pain receptors (dendrites)
• can be activated by histamine, serotonin, bradykinin, and prostaglandins
Name and describe the two pathways for pain
• Neospinothalamic: transmits fast pain through A delta fibers (myelinated rapid conducting fibers)
• Paleospinothalamic: transmits slow pain through C fibers (unmyelinated slower conduction fibers)
What structure in the brain perceives pain?
What part of the brain perceives the quality of pain?
cerebral cortex
What are the 3 classifications of endogenous opioids?
• enkephalins
• endorphins
• dynorphins
List the different pain receptors
• Mu Type 1
• Mu Type 2
• Kappa
• Epsilon
• Delta
• Sigma
A drug that causes suprapinal analgesia affects which receptor
Mu Type 1
A drug that affects this receptor will cause respiratory depression, euphoria, and physical dependence
Mu Type 2
A drug that affects this receptor will cause spinal analgesia, short-term sedation, and respiratory depression
A drug that affects this receptor will cause dysphoria, hallucinations, and respiratory stimulation
A drug that affects this receptor will cause analgesia
Delta and Epsilon
Where are opiod receptors that affect analgesia located?
• dorsal horn of spinal cord
• periaqueductal gray matter
• raphae magnus
• thalamus
Where are opioid receptors that cause respiratory depression and emesis located?
ventral brainstem
Where are opioid receptors that cause neuroendocrine secretion or inhibition located?
• hypothalamus
• anterior pituitary
Where are opioid receptors that affect mood and behavior located?
• amygdala
• hippocampus
• venrtral tegmental areas (VTA)
What are the 5 major classes of opioids?
• Phenanthrenes
• Phenylheptylamines
• Phenylpiperidines
• Moriphans
• Benzomorphans
What are CNS effects of morphine-like drugs?
• analgesia
• behavior changes (drowsiness)
• cough suppresion (inhibits cough reflex centers in brainstem)
• emesis (stimulates CTZ)
• euphoria
• hypothalamus effects
• pituitary effects
• pupillary constriction (miosis)
• respiratory depression
What are effects of morphine-like drugs on the hypothalamus?
• decreased body temperature
• increased release of ADH
• inhibition of ACH
• inhibits GnRH
What are effects of morphine-like drugs on the pituitary gland?
• increase the release of prolactin
• decrease the release of growth hormone
How do morphine-like drugs cause euphoria?
• inhibits the firing of the locus coeruleus
• enhances release of dopamine in the nucleus accumbens

* Locus coeruleus usually produces feelings of alarm, panic, fear, & anxiety
What are peripheral effects of morphine?
• GI: decreased secretions, decreased peristalsis, delay in stomach emptying, slowed digestion, increased tone in anal sphincter

• Urinary: decrease renal plasma flow; urethral and bladder tone is increased

• Biliary tract: constrict biliary smooth muscle; leads to spasms
What are cardiovascular effects of morphine?
• induces venous and arteriole dilation and therefore orthostatic hypotension
• enhances histamine release (leads to itching and bronchospams)
• decreases myocardial oxygen demand
What are drugs that can be used for mild pain?
• aspirin
• acetaminophen
What drugs can you give for moderate pain?
• Codeine
• Hydrocodone
• Oxycodone
• Tramadol
What drugs can you give for severe pain?

• Morphine
• Methadone
• Levorphanol
• Fentanyl
• Hydromorphone
• Oxycodone
List examples of phenathrenes
• codeine
• morphine
• methadone
Structurally, how is codeine related to morphine?
• codeine is methylated morphine

* codeine has to be de-methylated to be used as an analgesic; potency is 10% of morphine
Codeine, at low doses, can be used to treat what?
cough (anti-tussive agent)
What drug and dose would you use to treat cough?
Hycodan 5cc Q6hrs PRN (for cough)
What drug is a diacetylated derivative of morphine?
• Heroin
• double the potency of morphine
• crosses the blood-brain barrier
What is the difference between Oxycodone IR and Oxycodone Long-acting?
• Oxycodone IR is used for moderate pain
• Oxycodone (long-acting) is used for severe pain
The combination Oxycodone + APAP is called _________
The combination Hydrocodone + APAP is called _________
Vicodin or Lortab
The combination Oxycodone + ASA is called _______
What is the dosing for Codeine for mild to moderate pain?
30-60 mg
What is the dosing for oxycodone for mild to moderate pain?
5 mg
What is the dosing for Meperedine (Demerol) for mild to moderate pain?
50 mg
What is the dosing for Propoxyphene for mild to moderate pain?
65 mg
What is the dosing of Hydrocodone for mild to moderate pain?
5-10 mg
What is the dosing for Tramadol for mild to moderate pain?
50-100 mg
Propoxyphene + APAP is __________
Is Hydromorphone (Dilaudid) more or less potent than morphine?
more potent than morphine
What are side effects of Hydromorphone (Dilaudid)?
same side effect profile of morphine
What are available formulations of Hydromorphone (Dilaudid)?
injection or PO
Name examples of phenylpiperidines
• Meperedine (Demerol)
• Fentanyl
• Sufentanil
Which effects of Meperedine (Demerol) are similar to morphine?
• Analgesic
• Euphoria
• Respiratory depression
• Sedation
What are adverse effects of Meperidine (Demerol)?
• convulsion
• Meperidine is N-demethylated to normeperidine (produces tremors, muscle twitches, and convulsions)
Meperidine (Demerol) is more or less potent than morphine?
• less potent than morphine
• Meperidine has less constipation, nausea, and vomiting than morphine
True/False: Meperidine (Demerol) should be avoided in patients with renal dysfunction
• The correct answer is: True
Which phenylpiperidines are fast acting and have the shortest duration?
Fentanyl and Sufentanil
What are indications for using Fentanyl or Sufentanil?
used in anesthesia and surgical procedures
Can Fentanyl or Sufentanil cross the blood barrier?
Both drugs cross the BBB and are very lipophillic
True/False: Fentanyl and Sufentanil are less potent than morphine
• Fentanyl and Sufentanil are very potent (50-100 times more potent than morphine)
• The correct answer is: False
Why should you monitor breathing for patients given either Fentanyl or Sulfentanil?
both drugs affect Mu receptors and can cause respiratory depression
What are available formulations of Fentanyl?
• patch (Fentanyl patch is called Duragesic)
• lollipop
• injection
What are uses of Diphenoxylate?
• very constipating; used as an antidiarrheal agent
• very high doses can start to see opioid-like effects
Diphenoxylate + Atropine is called _________
• Lomotil
• combined with atropine to prevent abuse
Give an example of a Benzomorphan
Pentazocine (Talwin)
How is the MOA of Benzomorphines different from morphine?
Benzomorpines stops nociceptive input in the spinal cord and not in the supraspinal loci
What is the effect of Pentazocine (Talwin) at elevated doses?
• at high doses: increase BP and heart rate
• at very high doses: overstimulates sigma receptors, causing hallucinations, vivid dreams, & uncontrollable weird thoughts
Give an example of a morphinan
Butorphanol (Stadol)
What are uses of Morphinans (like Butorphanol)?
• used in pregnant women giving birth
• used to prevent migrane headaches (nasal spray)
What are effects of Butorphanol (Stadol)?
• 5 times more potent than morphine when given IV on analgesic and respiratory depression
• stimulates the cardiovascular system
• more kappa receptor action than Mu
• drowsiness, feelings of floating, weakness
Morphine ___ mg PO = Morphine ___ mg IV
Morphine 30 mg PO = Morphine 10 mg IV
Hydromorphone ___ mg PO = Hydromorphone ___ mg IV
Hydromorphone 7.5 mg PO = Hydromorphone 1.5 mg IV
Methadone __ mg PO = Methadone __ mg IV
Methadone 20 mg PO = Methadone 10 mg IV
Levorphanol __ mg PO = Levorphanol __ mg IV
Levorphanol 4 mg PO = Levorphanol 2 mg IV
Meperidine ___ mg PO = Meperidine ___ mg IV
Meperidine 300 mg PO = Meperidine 75 mg IV
Morphine __ mg PO = Hydromorphone ___ mg PO = Oxycodone __ mg PO = Methadone __ mg PO = Levophanol __ mg PO = Meperidine ___ mg PO
Morphine 30 mg PO = Hydromorphone 7.5 mg PO = Oxycodone 20 mg PO = Methadone 20 mg PO = Levophanol 4 mg PO = Meperidine 300 mg PO
Morphine __ mg IV = Hydromorphone ___ mg IV = Methadone __ mg IV = Levophanol __ mg IV = Fentanyl __ mg IV Meperidine ___ mg IV = Butorphanol __ mg IV
Morphine 10 mg IV = Hydromorphone 1.5 mg IV = Methadone 10 mg IV = Levophanol 2 mg IV = Fentanyl 0.1 mg IV = Meperidine 75 mg IV = Butorphanol 2 mg IV
Name a drug that is a narcotic antagonist (used to treat opioid overdose)
Naloxone (Narcan)
What is the MOA of Naloxone (Narcan)?
competitive inhibitor at Mu, Kappa, Delta, and Sigma opioid receptors
What are available formulations of Naloxone (Narcan)?
• injectable
• PO
What is the half-life of Naloxone (Narcan)?
short half-life (1-4 hrs)
What are effects of Naloxone (Narcan)?
normalizes respiration, level of consciousness, pupil size, and stimulates bowel activity
What are adverse effects of of Naloxone (Narcan)?
What is the dosing for a patient with respiratory depression from opioid overdose?
• for an acute user of opioid meds: 0.4 mg over 1-2 min
• for a chronic user of opioid meds: 0.04 mg over 20 mins (give at a slower rate to avoid reversing all of the patient's pain management)