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Pain

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pharmd18's version from 2016-11-05 19:34

Section 1

Question Answer
ascending neurotransmittersGAS ( glutamate, aspartate, substance P)
Descending NeurotransmittersSEN (serotonin, endogenous opioids, nor-epi)
Periphery Neurotransmitters PG, bradykinin, 5HT, histamine, substance P
nociceptive painnormal processing of stimuli that damages normal tissues, somatic, visceral pain
neuropathic painabnormal processing of sensor input by peripheral or CNS, shooting, shock like or electric pain
nociceptive pain responsds to whatnon-opioids or opioids
neuropathic pain responds to adjuvant analgesics
somatic painfrom bone, joint, muscle, skin, aching and throbbing, well localized
visceral painfrom visceral organs, GI tract, and pancreas
memorize

Section 2

Question Answer
MOA of APAPblock action of COX, inhibit PG synthesis
side effects of APAPhepatox, renal tox with long-term use
place in therapy for APAPmild-moderate pain, OA, adjuvant analgesic
NSAIDS MOAblock PG synthesis by inhibiting COX 1 and or 2
side effects of NSAIDSGI, renal, CV, thrombocytopenia, dizzy, drowsy
role of NSAIDS in therapyinflammatory conditions, mild-mod pain, cancer bone pain, adjuvant analgesic
types of salicylatescholine & magnesium trisalicylate, diflunisal (dolobid), salsalte
anthranilic acidsmeclofenamate, mefenamic acid
indolacetic acidetodolac
phneylacetic acidsdiclofenac
propionic acidsibuprofen, fenoprofen, ketoprofen, naproxen
pyrrolacetic acidsketorlac
which nsaid has a max of 5 days useketorolac
cox-2 selective nsaidcelebrex
which nsaids have lowest CV risk naproxen and ibuprofen
memorize

Section 3

Question Answer
opioid analgesics place in therpaymanagement of pain severe enough to require daily, around the clock - long term opioid treatment
is there a ceiling effect for opioids?no
opioid naivepts who are not opioid tolerant
non-naive patients taking the following more than one week, atleast60 mg morphine/day, 25 mcg fentantyl/hr, 30 mg oxycodone/day, 8 mg hydromorphone/day
tolerancereduction of drug effect overtime
dependenceanxiety, irritability, insomnia, etc, after abrubt d/c
addictioncompulsive drug use
psuedoaddictiondrug seeking behavior from inadequate analgesia
memorize

Section 4

Question Answer
classes of drugs adjuvant agents for neuropathic pain TCA, SNRI, anticonvulsants, agents with dual activity, misc
TCA drugsamitriptyline , nortriptyline
MOA of TCAincreases conc of serotonin and NE, by inhib reuptake by presynaptic neuronal pump
side effects of TCAdry mouth, sedation, dizzy, weight gain, constipation, orthostatic hypotension
SNRI drugduloxetine
MOA of SNRIsnri, and inhibitor of dopamine reuptake
side effects of SNRInausea, headache, sedation, insomnia, weight gain, impaired memory, sweating, tremor, sex dysfunction
anticonvulsant drugs gabapentin, pregabalin
moa of anticonvulsants blockade of presynaptic voltage gated ion channels, inhibit glutamate
side effects of anticonvulsants dizzy, sedation, mood changes, nausea
agents with dual activitymilnacipran (savella), tramadol, tapentadol (nucynta)
moa of milnacipransnri
moa of tramadolmu agonist + snri
moa of tapentadol mu agonist + NE inhib
side effects of milnacipran headache, insomnia, hot flashes, nausea, constipation
side effects of tramadol similar to opioids
side effects of tapentadoldizzy, drowsy, nausea, vomiting
misc agents capsaicin cream, lidoderm patch
moa of capsaicin inhibits release of substance P
moa of lidocainsuppresses activity of peripheral sodium channesl -local effect
side effects of capsaicinburning sensation of application
lidocaine side effects erythmia
memorize

Section 5

Question Answer
active metabolite hydrocodonehydromorphone
active metb of morphineM6G, codeine(minimal)
active metab of oxycodone oxymorphone
active metab of oxymorphone6-hydroxyoxymorphone
active metab of methadonenone
active metab of fentanylnone
active metab of hydromorphonenone
hydrocodone clinical sigpoor metabolizer may experience little or no analgesia
hydromorphone clinical sigh3g may accumulate in renal insufficiency, h3g may possess neuroexcitatory prop
methadone sig used only by practitioners knowledgeable, may take 4-10 days to reach ss, long half life and risk of accumulation
morphine sigM6G more potent, longer half life and may accumulate in renal insuff, m3g responsible for hyperalgesia and neurotox
oxycodone sigpoor metabolizers will experience little to no analgesia
oxymorphone sigfood can increase plasma conc, take on empty stomach , alcohol ingestion can accelerate drug deliver of CR, and lead to increased plasma levels
memorize

Section 6

Question Answer
treat OAmild pain = apap , mod +severe = NSAIDS,
treat RAmild = APAP, mod- severe + Inflammatin = NSAIDS
fibromyalgia tx strongamitriptyline ,cyclobenzaprine
fibromyalgia tx modesttramadol, fluoxetine, venlafaxine, duloxetine, lyrica
low back pain txapap, nsaids, muscle relaxers, tca, benzodiazepine, tramadol, opioids
memorize