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Pharmacology > Pain Management > Flashcards

Pain Management Flashcards

1
Q

what are the non opioid analgesics and its use

A

Acetaminophen
NSAIDs

mild to moderate pain

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2
Q

adverse effect of acetaminophen and what increases this adverse effect

A

hepatotoxicity

increased by hepatitis or chronic alcohol use, binge drink, fasting state

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3
Q

opioids for mild to moderate pain

A

HOT MC

Hydrocodone
Oxycodone
Tramadol

Meperidine
Codeine

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4
Q

opioids for moderate to severe pain

A 
Morphine, Hydromophone, Oxymorphone
Levorphanol
Fentanyl
Sufentanil
Methadone
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5
Q

what are the opioid analgesics that do not have a ceiling effect (dose beyond which there is no more analgesic effect)

A

Morphine
Fentanyl
Hydromorphone

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6
Q

what opioids are not used for routine dosing

A
  • Meperidine - its metabolite normerpidine has longer half life and when it accumulates –> tremulousness, dysphoria, myoclonus, seizures
  • Mixed agonist-antagonists: Pentazocine, Nalbuphne, Butorphanol –> ceiling effect and can lead to psychotomimetic effects
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7
Q

When do you not give a mixed agonist-antagonist and why

A

when patients is on a pure opioid agonist because it reduces its effect

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8
Q

most common side effects seen in usage of opioid analgesic

A 
nausea
vomiting
sedation
itching 
constipation
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9
Q

what drugs can be used to treat rash and pruritus seen as adverse effects of opioids

A

hydroxyzine

diphenhydramine

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10
Q

what drugs can be used to treat constipation seen in opioids

A
  • stimulants like senna or bisacodyl
  • osmotic agents like magnesium hydroxide and lactulose
  • softeners like docusate are not useful on their own but can be if used with a stimulant
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11
Q

drugs that can be used to treat nausea and vomiting seen as adverse effects of opioids

A

Prochlorperazine
Hydroxyzine
Metoclopromaide

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12
Q

drugs used to treat sedation seen as adverse effect of opioids

A

amphetamine
methylphenidate
modanifil

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13
Q

if respiratory depression occurs due to opioid use, what drug can be used

A

naloxone

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14
Q

big class names for co-analgesics aka analgesic adjuvant that are not necessarily classified as analgesics

A

Antidepressives
Anticonvulsants
Glucocorticoids
Other drugs

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15
Q

why are antidepressants used as analgesics

A

they increase circulating serotonin and norepinephrine (via SNRI and TCAs) which mediate descending inhibition of ascending pain pathways in brain and spinal cord

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16
Q

what are the TCA antidepressants

A

DANI

Desipramine
Amitriptyline
Nortriptyline
Imipramine

17
Q

how do TCAs cause analgesia

A

they inhibit the reuptake of serotonin and norepinephrine thus enhancing the actions of these neurotransmitters

18
Q

adverse effects of TCA

A

-associated with anticholinergic effects: constipation, dry mouth, blurred vision, cognitive changes, tachycardia, urinary retention

19
Q

which TCAs are better used for the elderly

A

the secondary amines Desipramine and Nortriptyline because they exhibit fewer sedative and anticholinergic effects in comparison to tertiary amines Amitriptyline and Imipramine

also cause sexual dysfunction, orthostatic hypotension, weight gain

20
Q

contraindications for TCAs

A

angle closure glaucoma, BPH, constipation, CVD, heart conditions like arrhythmias, Impaired liver function

21
Q

what are the SNRIs and how do they differ from TCAs

A

Venlafaxine and Duloxetine

lack the anticholinergic, antihistamine, alpha adrenergic blocking effects of TCA

22
Q

what are the adverse effects of SNRIs

A

better tolerated than TCAs

somnolence, nausea, sexual dysfunction

23
Q

what are the anticonvulsants

A

CPG

Carbamazepine
Pregabalin
Gabapentin

24
Q

mechanism of Pregabalin and Gabapentin

A

block voltage gated calcium channels –> reduces influx of calcium into neurons –> decrease release of glutamate, NE, and substance P

25
Q

adverse effects of Pregabalin and Gabapentin

A

dizziness
somnolence
peripheral edema

26
Q

what is pregabalin and gabapentin used to treat

A

postherpetic neuralgia

27
Q

drug of choice for trigeminal neuralgia

A

carbamazepine

28
Q

mechanism of carbamazepine

A

blockage of voltage gated sodium channels

29
Q

adverse effects of carbamazepine

A

drowsiness, nausea, vomiting, dizziness

carbamazepine induced leukopenia
Aplastic Anemia

30
Q

Glucocorticoids used as co-analgesic

A

Dexamethasone***

Prednisone and Methylprednisolone

31
Q

why is dexamethasone usually the drug of choice for use of glucocorticoids as an analgesic

A

it has long half life with minimal mineralcorticoid effect

32
Q

drug that enhances the analgesic effect of acetaminophen and NSAIDs

A

caffeine

33
Q

drug approved for postherpetic neuralgia

A

Lidocaine
Capsaicin

anticonvulsants: Pregabalin and Gabapentin

34
Q

improves pain and hyperalgesia in sympathetically maintained pain

A

clonidine

Pharmacology (79 decks)

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