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63 Cards in this Set
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Chapter 26
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Narcotics and Antimigraine Agents
Pain |
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Pain Definition
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A sensory and emotional experience associated with accute or potential tissue damage
What ever the patient says it is |
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Two types of drugs to relieve pain
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Narcotics
Antimigraine drugs |
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Narcotics def
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Opium derivatives used to treat many types of pain
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Antimigraine drugs
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Reserved for the treatment of migraine headaches
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A-Delta fibers
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Fast mylenated nerve fibers stimulated by mechanical and thermal receptors. Generate sharp, acute, electric pain sensation that runs up to the thalamus
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C-fibers
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Slow fibers transmit burning, aching, throbbing.
Stimulated by chemicals - inflammation. Terminate before the thalamus |
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Gate Control Theory
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Transmission of information along the spinothalamic tracts can be modulated/blocked all along these tracts by other impulses traveling up and down.
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Pain Threshold
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The physical level of stimulation to nerve fibers required to produce the perception of pain
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Pain Tolerance
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The psychological component which determines the amount of pain a patient can endure wo interfering with normal function
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Opioids are therapeutic because they
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Occupy specific ipioid receptors in teh CNS
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Location of Opioid receptors throughout the body
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CNS-thalamus, hypothalamus,
Nerves in the periphery GI Tract |
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Brain stem opioid receptors are responsible for
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Blood pressure
Pupil diameter GI secretions Chemoreceptor Trigger Zone controls nausea, vomiting, cough, respirations |
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Spinal cord and thatamus receptors are responsible for
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Integrate and relate incoming ifnormation about pain
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In the hypothalamus receptors are responsible for
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Interrelating the endocrine and neural response to pain
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In the limbic system receptors are responsible for
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Emotional aspects and response to pain
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At peripheral nerve sites opioids may
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block the release of neurotransmitters related to pain and inflammation
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Narcotic agonist
Actions |
Act at specific opioid receptor sites in the CNS
Produce analgesia, sedation Sense of well-being |
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Narcotic agonist
Indications |
Relief of severe acute or chronic pain
Analgesia during anesthesia |
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Narcotic agonist
Pharmacokinetics |
IV delivery most reliable for therapeutic response
IM and SubQ rate of absorption vary Liver metabolized Urine and bile excreted |
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Narcotic agonist
Contraindications |
Known allergy to opioids
Pregnancy, labor, lactation Diarrhea caused by poisons |
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Narcotic agonist
Cautions |
Respiratory dysfunction
GI or GU surgery Acute abdomen and ulcerative colitis |
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Narcotic agonist
Adverse reactions |
Respiratory depression with apnea
Shock Orthostatic hypotension Nausea, vomiting, constipation Biliary spsm Dizziness, psychosis, anxiety, fear, hallucinations |
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Narcotic agonists
D's of adverse reactions |
Dizziness, drowsiness, Dependence, Decreased BP, Decreased peristalsis
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Narcotic agonist
Drug-Drug interactions |
Barbiturates as general anesthesia
Phenothiazines-anti-emetics MAO's |
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Narcotic agonist
Prototype |
morphine
Roxanol |
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Narcotic Agonists-Antagonists
Prototype |
Stimulate certain opioid receptors but block other such receptors
pentazocine - Talwin |
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Narcotic Agonists-Antagonists
Actions |
Bind to specific iopiod receptor sites in the CNS
Produce analgesia, sedation, euphoria, hallucinations |
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Narcotic Agonists-Antagonists
Indications |
Moderate to severe pain
As an adjunct to general anesthesia Relief of pain during labor and delivery |
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Narcotic Agonists-Antagonists
Pharmacokinetics |
Readily absorbed IM
Quickly reach peak levels when given IV |
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Narcotic Agonists-Antagonists
Contraindications |
Known allergy to Narcotic Agonists-Antagonists
During pregnancy and lactation |
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Narcotic Agonists-Antagonists
Cautions |
Physical dependence to a narcotic
COPD and diseases of the respiratory tract rt respiratory depression Acute MI and documented CAD |
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Narcotic Agonists-Antagonists
Adverse reactions |
Respiratory depression
Nausea, vomiting, constipation, biliary spasm Headache, Dizziness, Psychoses, Anxiety, Hallucinations UReteral spasm and urinary retention |
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Narcotic Agonists-Antagonists
Drug-Drug interactions |
Barbiturate general anesthetics
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Narcotic Antagonists
Prototype drugs |
Reverse the effects of narcotics
Revex, Narcan, ReVia |
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Narcotic Agonists
Actions |
Drugs that bind strongly to opioid receptors but do not activate the receptor
Reverse the effects of opioids |
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Narcotic Antagonists
Indications |
Reversal of the adverse effects of narcotics
Treat narcotic and/or alcoholic dependence |
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Narcotic Antagonists
Pharmacokinetics |
Well absorbed IV, IM, SubQ
Widely distributed Liver metabolized Urine excreted Enters breast milk |
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Narcotic Antagonists
Contraindications |
Know allergy
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Narcotic Antagonists
Cautions |
Pregnancy and lactation
Narcotic addiction CV disease |
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Narcotic Antagonists
Adverse reactions |
Acute narcotic abstinence syndrome
CNS excitement Tachycardia BP changes Arrhythmias |
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Narcotic Antagonists
Adverse reactions P's of blocking Opioid Agonists |
Increased
Perspiration Pulse Puke Pain Blood Pressure |
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Narcotic Antagonists
Drug-Drug interactions |
Larger doses may be needed to reduce the effect of Antagonists-Agonists.
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Headaches
3 types of headaches |
Migraine
Cluster Tension Caused by vaso dilation |
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Migraine headaches
Women |
Severe, throbbing headaches on one side of the head
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Cluster headaches
Men |
Begin during sleep, sharp, steady eye pain, sweatting, flushing, tearing, nasal congestion
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Tension headaches
Women |
Usually occur at times of stress; dull band of pain around the entire head
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Ergot derivatives
Action |
Block alpha-andrenergic and serotonin receptor sites in teh brain to cause cranial vaso constriction
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Ergot derivatives
Indications |
Prevention of abortion adn migraine or vascular headaches
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Ergot derivatives
Pharmacokinetics |
Absorbed by many routes
15-30 minute onset Liver metabolizm Bile excretion Breast milk crossing |
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Ergot derivatives
Contraindications |
Known allergy
Pregnancy and lactation CAD HTN PVD |
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Ergot derivatives
Cautions |
Pruritus
Malnutrition |
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Ergot derivatives
Adverse reactions |
Numbness
Tingling of extremities Muscel pain Pulselessness Weakness Chest pain Arrhythnias Nausea Vomiting Diarrhea |
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Ergot derivitives
Drug-Drug interactions |
Beta blockers-blocks coronary B receptors
Causes vasoconstriction of lungs |
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Triptans
Actions |
Bind to selective serotonin receptor sites to cause cranial vasoconstricion
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Triptans
Indications |
Treatment of acute migraines
Not used for prevention of migranes |
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Triptans
Pharmacokinetics |
Absorbed from many sites
Liver metabolism Urine excretion Placenta and breast milk crossing |
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Triptans
Contraindications |
Known allergy
CAD, pregnancy |
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Triptans
Cautions |
In the elderly; risk of CAD and lactation
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Triptans
Adverse reactions |
Numbness, tingling, burning sensation, feeling of coldness, weakness, dysphagia, blood pressure alterations
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Triptans
Drug-Drug interactions |
Ergot containing drugs
MAO's |
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Triptan
Prototype |
Sumatriptan
Treatment of acute migraine; treatment of cluster headaches |
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Ergot
Prototype |
Ergotamine
Prevention or abortion of vascular headaches |