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Exam #3 - Pharmacologic Approaches to Pain Management
N/A
21
Pharmacology
Graduate
10/24/2009

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Term
Pain
Definition
generalized physiological & psychological response to noxious stimuli; can warn us that some physiologic process has gone awry; often serves no purpose other than to make a person miserable
Term
Two components of Pain
Definition
1) physiological process; 2) emotional & psychological reaction to that sensation - represents it as "suffering"
Term
Approaches to Pharmacological Management of Pain
Definition
1) remove cause; 2) decrease inflammation, irritation, & sensitivity of nerve endings; 3) block conduction of impulses by pain fibers; 4) modify processing of pain information in CNS
Term
Aspirin, ibuprofen, NSAIDs
Definition
inhibitors of prostaglandin synthesis (COX-1 & COX-2); acts at nerve endings and in CNS; antiinflammatory effects may contribute to pain relief; GI side effects; potential for serious CV side effects
Term
acetaminophen (Tylenol)
Definition
inhibits prostaglandin synthesis in nerve endings & CNS, but NOT in periphery; exact mechanism of action is still not clear; NO antiinflammatory activity; does NOT usually cause GI irritation; potential for hepatotoxicity at high doses
Term
ketorolac (Toradol)
Definition
injectable NSAID; useful alternative to opioids for pain; can cause GI irritation; OK for short term (<1-2 days) but not chronic use
Term
Selective COX-2 Inhibitors
Definition
celecoxib (Celebrex), rofecoxib (Vioxx), & valdecoxib (Bextra)
Term
Actions of COX-1 Enzyme
Definition
pain pathways in CNS; gastric protection in stomach (increased mucous production, decreased acid secretion); increased renal perfusion (slight); increase thromboxane A2 (platelet aggregation)
Term
Actions of COX-2 Enzyme
Definition
causes inflammation in periphery; pain pathways in CNS; increases renal perfusion (larger); increases prostacyclin causing vasodilation & decreased platelet aggregation
Term
Local Anesthetics (lidocaine, etc.)
Definition
block sodium channels in nerve endings & axons & stop generation & conduction of action potentials; powerful pain relief with spinal, regional, & nerve block techniques; small, unmyelanated pain fibers are most sensitivebut other neurons can be affected as well
Term
Drug Dependence
Definition
physiologic state resulting from chronic exposure to a drug
Term
Drug Addiction
Definition
pattern of behavior in which use of a drug assumes a central role in a person's life
Term
Adjuvant Drugs for Pain Management
Definition
corticosteroids, Disease Modifying Antirheumatic Drugs (DMARDs), & immunomodulators; muscle relaxants; antidepressants; anticonvulsants; clonidine
Term
Use of muscle relaxants in pain management
Definition
by relaxing skeletal muscle, they can break muscle spasms & are useful in management of low back pain (cyclobenzaprine, metaxalone, diazepam)
Term
Use of Antidepressants as Adjuvant Drugs for Pain Managment
Definition
alleviate symptoms of depression that commonly occur in pts with chronic pain & can enhance analgesic effects of opioids & may be beneficial in treatment of neurogenic pain (amitriptyline, imipramine, desipramine, fluoxetine)
Term
Anticonvulsants used in Pain Management
Definition
useful in management of various types of neurogenic pain (carbamazepine, valproic acid, gabapentin [Neurontin] & pregabalin [Lyrica])
Term
Use of Clonidine in Pain Management
Definition
alpha-2 agonist originally used as antihypertensive med; enhances analgesic effects of opioids; preparation approved for spinal analgesia; may be beneficial in pain syndromes involving activaiton of sympathetic nervous system
Term
General Principles for Drug Selection in Pain Management
Definition
proper assessment of patient; if possible, treat or remove pain; select drugs that are appropriate for type & level of pain; consider health status; use medications at proper dosage levels; consider legal issues
Term
Drug Selection for Mild Pain
Definition
acetaminophen, aspirin, ibuprofen, ketoprofen, naproxen
Term
Drug Selection for Moderate Pain
Definition
oral NSAIDs (especially for arthritis, musculoskeletal, postsurgical, & dental pain); intermediate potency opioids (codeine, hydrocodone, usually in combo with acetaminophen or aspirin); also mixed agonist-antagonists would be appropriate (i.e. tramadol)
Term
Drug Selection for Severe Pain
Definition
strong opioids (morphine, oxycodone, fentanyl, hyrdomorphone, methadone); NSAIDs; adjuvant drugs such as antidepressants, anticonvulsants
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