SCH2105 - Module 10: drugs used to treat pain & inflammation flashcards

All 50 cards

1. Card 1

   Define acute pain and chronic pain, highlighting their key distinguishing characteristics.

   Acute pain has a sudden onset, a readily identifiable site, typical clinical manifestations, is self-limiting, and is readily corrected. In contrast, chronic pain persists for three or more months, is difficult to evaluate, treatment rarely brings complete relief, and is often accompanied by depression and a sense of hopelessness.

2. Card 2

   Distinguish between visceral and somatic pain, providing examples of their origins and typical characteristics.

   Somatic pain originates from skin, muscles, bones, joints, or connective tissue, and is usually acute and well localized. Visceral pain originates from internal organs like the heart, lungs, or GI tract, and is typically a diffuse, deep, or aching pain, responding better to opioid medication.

3. Card 3

   Outline the four main processes involved in the pathway of pain transmission from peripheral stimulation to the cerebral cortex.

   The four processes are Transduction (nociceptors convert stimuli to electrical signals), Transmission (impulses travel along afferents to the spinal cord and then to the thalamus via ascending pathways), Perception (thalamus sorts and sends information to the cortex for localization and full pain perception), and Modulation (signals are inhibited by descending pathways).

4. Card 4

   Which of the following neurotransmitters is NOT explicitly mentioned as being involved in nociceptive nerve pathways? A. Endogenous opioids B. Dopamine C. Noradrenaline D. Substance P

   B. Dopamine. While dopamine is involved in the reward pathway and opioid addiction, it is not explicitly listed as a neurotransmitter communicating nociceptive nerve pathways in the provided notes, unlike endogenous opioids, noradrenaline, GABA, serotonin, and Substance P.

5. Card 5

   A patient presents with a deep, aching pain in their abdomen that is difficult to pinpoint. Which type of pain is this most likely to be, and what medication might be more effective for it?

   This is most likely visceral pain, which originates from internal organs and is typically diffuse and deep. Visceral pain generally responds better to opioid medication compared to somatic pain.

6. Card 6

   Explain how opioid analgesics work at a cellular level to reduce pain perception and transmission.

   Opioid analgesics bind to and activate opioid receptors, primarily mu (µ) receptors, in the central nervous system. This activation modulates pain perception and transmission by decreasing the release of Substance P and Glutamate from the primary afferent neuron, thereby decreasing the activation of secondary afferents.

7. Card 7

   A patient is prescribed morphine for severe acute pain. What are two common gastrointestinal side effects they might experience, and why do these occur?

   The patient might experience reduced gastrointestinal motility and constipation. These effects occur because opioids activate opioid receptors in GI smooth muscles, which reduces secretions and motility while increasing sphincter tone.

8. Card 8

   Describe the primary function of mu (µ) opioid receptors and list three key physiological effects associated with their activation.

   Mu (µ) receptors are primarily responsible for strong analgesia. Their activation also leads to respiratory depression, euphoria, sedation, constipation, miosis, and physical dependence.

9. Card 9

   A patient on long-term opioid therapy requires increasingly higher doses to achieve the same level of pain relief. What pharmacological phenomenon is occurring, and how does it develop?

   This phenomenon is tolerance. Tolerance develops because continual exposure to the opioid changes the response of the receptors, making them less responsive, thus requiring more drug to produce the desired effect. This can be due to down-regulation of signaling mechanisms.

10. Card 10

    Which opioid receptor is associated with dysphoria and hallucinations, and what is its primary location?

    The kappa (κ) receptor is associated with dysphoria and hallucinations. It is primarily located in the brain (hypothalamus and limbic system) and spinal cord.

11. Card 11

    A patient is admitted to the emergency department with suspected opioid overdose. What specific ocular sign would be a helpful indicator, and why does this effect not develop tolerance?

    Miosis (pupil constriction) would be a helpful indicator. This effect does not develop tolerance because opioids act directly on the oculomotor nerve, making it a consistent sign for identifying opioid overdose.

12. Card 12

    Explain the mechanism by which opioids can cause respiratory depression.

    Opioids diminish the sensitivity of the brain's respiratory centers to carbon dioxide (CO2) levels. This reduced sensitivity leads to hypoventilation and a decreased respiratory rate, which is more pronounced when brain activity is suppressed, such as during sleep or anaesthesia.

13. Card 13

    A patient is experiencing severe chronic cancer pain. Which of the following opioids is considered the 'gold standard' for moderate to severe pain management and can be administered via multiple routes? A. Codeine B. Pethidine C. Morphine D. Tramadol

    C. Morphine. Morphine is considered the gold standard for moderate to severe pain management, including cancer pain, and can be given orally, intravenously, or via other routes like epidural or intrathecal.

14. Card 14

    What is the primary mechanism of action for NSAIDs in reducing pain and inflammation?

    NSAIDs primarily reduce pain and inflammation by inhibiting the synthesis of prostaglandins. Prostaglandins are inflammatory mediators that stimulate pain receptors and enhance the transmission of pain, so by reducing their production, NSAIDs alleviate these symptoms.

15. Card 15

    A patient with a history of respiratory disease and taking sedatives requires pain relief. Why should opioids be used with caution in this patient?

    Opioids should be used with caution because they can exacerbate respiratory depression, a significant risk in patients with pre-existing respiratory conditions. Additionally, combining opioids with sedatives can further suppress central nervous system activity, increasing the risk of severe respiratory depression and reduced consciousness.

16. Card 16

    Describe the dual mechanism of action of Tramadol for analgesia.

    Tramadol causes analgesia through multiple mechanisms. It activates opioid receptors, similar to other opioids, but it also inhibits the reuptake of noradrenaline and serotonin, which contributes to its pain-relieving effects.

17. Card 17

    A 45-year-old construction worker sustains a severe bone fracture. The pain is rated 8/10. What type of pain is this, and what class of analgesic would be most appropriate initially?

    This is acute somatic pain, originating from bone. For severe acute pain, opioid analgesics, such as morphine or oxycodone, would be most appropriate initially to provide effective pain relief.

18. Card 18

    What is the primary difference between addiction and physical dependence in the context of opioid use?

    Addiction is characterized by the inability to stop using a substance, involving adaptive changes in the mesolimbic pathway and a compulsive drive for the drug. Physical dependence, on the other hand, refers to the body's adaptation to the drug, where withdrawal symptoms occur if the drug is stopped, but it doesn't necessarily imply compulsive use or loss of control.

19. Card 19

    A patient is experiencing nausea and vomiting after receiving an opioid analgesic. Explain why this side effect occurs and what intervention can mitigate it.

    Nausea and vomiting occur because opioids directly activate opioid receptors in the chemoreceptor trigger zone, which then triggers the vomiting center in the brain. Pre-treatment or concurrent treatment with an anti-emetic medication can help mitigate this side effect.

20. Card 20

    Which of the following is a characteristic of delta (δ) opioid receptors? A. Strong respiratory depression B. Euphoria C. Modest analgesia D. Miosis

    C. Modest analgesia. Delta (δ) receptors are primarily associated with modest analgesia and mood modulation, whereas strong respiratory depression, euphoria, and miosis are more characteristic effects of mu (µ) receptor activation.

21. Card 21

    Explain how the information from the thalamus is processed to result in full pain perception and emotional responses.

    The thalamus sorts the incoming pain information and sends it to the cerebral cortex for localization and full pain perception. Concurrently, the thalamus also relays this information to the limbic system, brain stem, and hypothalamus, which are involved in generating the emotional and cognitive components of the pain response.

22. Card 22

    Why is Codeine no longer an over-the-counter (OTC) medicine in Australia?

    Codeine is no longer an OTC medicine due to recent changes in TGA approval. This change reflects concerns about its potential for abuse, the variability in its metabolism to morphine (meaning some individuals do not get analgesic effects), and the risks associated with its widespread availability.

23. Card 23

    What is the primary indication for the use of Fentanyl, and in what settings is it typically administered?

    Fentanyl is indicated for severe pain management. It is a highly potent synthetic opioid with a rapid onset and short duration of action, typically administered under specialist supervision in settings requiring strong analgesia, such as severe acute injuries or chronic pain conditions.

24. Card 24

    A patient is prescribed an opioid for chronic pain. Over time, they report a decrease in appetite, insomnia, and anxiety when trying to reduce their medication. What are these symptoms indicative of?

    These symptoms are indicative of opioid withdrawal. When dopamine levels fall due to adaptive changes in the mesolimbic pathway from chronic opioid use, individuals experience clear withdrawal symptoms such as anorexia, insomnia, and anxiety, among others.

25. Card 25

    What is Penthrox (methoxyflurane) primarily used for, and what is its typical route of administration?

    Penthrox (methoxyflurane) is primarily used for immediate, short-term relief of moderate to severe pain, often in emergency and pre-hospital care settings. It is administered via self-inhalation using a hand-held inhaler device.

26. Card 26

    Define the primary difference in the mechanism of action between aspirin and other non-selective NSAIDs regarding COX inhibition.

    Aspirin non-competitively and irreversibly inhibits cyclooxygenase, meaning its antiplatelet effect is long-lasting because platelets cannot resynthesize COX. In contrast, other non-selective NSAIDs like ibuprofen provide reversible inhibition of COX.

27. Card 27

    A 60-year-old patient with a history of gastric ulcers presents with mild to moderate musculoskeletal pain due to inflammation. Which of the following analgesics would be the most appropriate initial recommendation, considering their medical history?

    C) Paracetamol. Paracetamol is the most appropriate choice because it has minimal gastrointestinal side effects and does not increase bleeding risk, making it safer for a patient with a history of gastric ulcers. NSAIDs like ibuprofen, aspirin, and indomethacin carry a high risk of GI irritation and ulceration.

28. Card 28

    Explain why paracetamol is considered a weak anti-inflammatory agent despite inhibiting COX enzymes.

    Paracetamol is only a weak COX-1 and COX-2 inhibitor in peripheral tissues, which accounts for its lack of significant anti-inflammatory effect. Its primary analgesic and antipyretic actions are believed to stem from inhibiting COX-1 in the CNS and potentially the COX-3 isoform in the CNS.

29. Card 29

    A 45-year-old construction worker sustains a sprained ankle. He experiences significant pain and swelling. Given the presence of inflammation, which class of analgesic would be most effective, and why?

    Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen would be most effective. NSAIDs work by reversibly inhibiting COX-1 and COX-2 enzymes, thereby reducing prostaglandin synthesis. This action directly targets the inflammation, pain, and swelling associated with the injury.

30. Card 30

    Distinguish between the 'housekeeping' role of prostaglandins produced by COX-1 and the role of prostaglandins produced by COX-2.

    Prostaglandins produced by COX-1 are involved in maintaining homeostasis and normal physiological functions in healthy tissues, such as cell growth, thermoregulation, blood clotting, cardiovascular function, and protection of the gastric lining. In contrast, COX-2 is inducible and primarily manufactured in response to injury or damage, with its products playing a major role in tissue injury and inflammation.

31. Card 31

    What are the three major adverse effects associated with classic NSAIDs, primarily due to their interference with the homeostatic functions of prostaglandins?

    The major adverse effects of classic NSAIDs include gastric irritation and ulceration due to decreased mucus protection in the stomach, reduction in glomerular filtration rate leading to sodium and water retention, and increased bleeding time due to anti-platelet action.

32. Card 32

    A patient is prescribed an NSAID for chronic pain. The nurse explains that NSAIDs reduce the manifestations of inflammation but do not affect the underlying tissue damage or immunologic reactions. Why is this distinction important for patient understanding?

    This distinction is important because it clarifies that NSAIDs provide symptomatic relief by reducing pain, swelling, and fever, but they do not cure the root cause of the inflammation or repair damaged tissue. Patients should understand that while their symptoms improve, the underlying condition may still require other treatments or management strategies.

33. Card 33

    A 70-year-old patient with a history of heart failure and mild renal impairment is experiencing moderate pain from osteoarthritis. Which of the following analgesics should be used with extreme caution or avoided in this patient?

    C) Ibuprofen. NSAIDs like ibuprofen can cause a reduction in glomerular filtration rate and sodium and water retention, which can exacerbate heart failure and renal impairment, especially in elderly patients. Paracetamol, codeine, and tramadol do not carry these specific risks related to cardiovascular and renal function.

34. Card 34

    How does the inhibition of cyclooxygenase by NSAIDs lead to their antipyretic (fever-reducing) action?

    NSAIDs suppress prostaglandin synthesis in the Central Nervous System (CNS) that is stimulated by pyrogens. By reducing these prostaglandins, which are key mediators of fever, NSAIDs effectively lower body temperature and reduce fever.

35. Card 35

    A doctor is considering prescribing an analgesic for a child over 3 years old. Which pain rating scale would be most appropriate for assessing their pain level?

    C) Wong-Baker FACES Pain rating scale. This scale uses pictures of faces with different expressions to rate pain, making it suitable and easily understandable for children over 3 years of age, who may struggle with numerical or verbal scales.

36. Card 36

    Explain the significance of treating pain early rather than waiting for it to become established.

    Pain is best treated early because, once established, it becomes more difficult to manage effectively. There is also a growing body of evidence suggesting that appropriate early and aggressive management of acute pain can minimize the transition to chronic pain, preventing long-term suffering and complications.

37. Card 37

    A patient presents with neuropathic pain. Based on the provided medication effectiveness summary, which drug classes are indicated to be effective for this type of pain?

    For acute neuropathic pain, TCAs (Tricyclic Antidepressants) and Anticonvulsants are indicated as highly effective. Morphine also shows some effectiveness, but TCAs and Anticonvulsants are specifically highlighted for neuropathic pain.

38. Card 38

    Why is paracetamol often combined with NSAIDs or opioids in pain management strategies?

    Paracetamol is often combined with NSAIDs or opioids because it inhibits prostaglandin synthesis primarily in the CNS, offering analgesic and antipyretic effects with a different mechanism than NSAIDs and without the anti-inflammatory or antiplatelet effects. This allows for additive pain relief and a multi-modal approach, potentially reducing the dosage needed for more potent drugs like opioids or addressing different aspects of pain.

39. Card 39

    A patient is experiencing chronic non-cancer pain. According to the medication effectiveness summary, which opioid analgesic shows effectiveness for this condition, and which non-opioid class is also highly effective?

    For chronic non-cancer pain, Tramadol is indicated as effective among the opioids. Among the non-opioid classes, TCAs and Anticonvulsants are also highly effective for this type of pain.

40. Card 40

    A patient is prescribed an NSAID for acute inflammatory pain. They ask how the medication reduces the pain they are feeling. Explain the mechanism.

    NSAIDs diminish the sensitivity of peripheral pain sensors by reducing the production of prostaglandins in injured tissue. Prostaglandins normally enhance the transmission of pain and make nociceptors more sensitive to other pain mediators like bradykinin, so by inhibiting their synthesis, NSAIDs effectively reduce the perception of pain.

41. Card 41

    A 28-year-old athlete experiences a severe ankle sprain. The immediate treatment plan includes RICE. What does RICE stand for, and what is its primary purpose in this context?

    RICE stands for Rest, Ice, Compression, and Elevation. Its primary purpose in managing injuries like an ankle sprain is to limit damage, reduce swelling and inflammation, and promote healing by minimizing blood flow to the injured area and supporting the affected limb.

42. Card 42

    Why is aspirin not considered a first-line treatment for general pain relief, despite its analgesic properties?

    Aspirin is not considered first-line for general pain relief primarily due to its high gastrointestinal bleeding risk and the potential for Reye's syndrome in children with viral illnesses. Its unique benefit lies in its anti-platelet activity, making it primarily used for cardiovascular protection rather than routine analgesia.

43. Card 43

    A patient with a history of active peptic ulcer disease requires an analgesic for acute pain. Which of the following would be contraindicated?

    B) Aspirin. Aspirin is contraindicated in patients with active peptic ulcer disease due to its high GI bleeding risk, which can exacerbate the condition and lead to severe complications. Paracetamol, codeine, and oxycodone do not carry this specific contraindication.

44. Card 44

    Describe the process of inflammation, including the role of mediators like bradykinin and prostaglandins, and the resulting physical manifestations.

    Inflammation is a protective tissue response to injury, involving the release of substances like bradykinin and prostaglandins. Bradykinin directly activates nociceptors, causing pain, while prostaglandins enhance nociceptor sensitivity and pain transmission. This process leads to classic signs: redness, swelling, warmth, pain, and loss of function, as phagocytes migrate to destroy harmful substances and promote healing.

45. Card 45

    A 55-year-old patient with rheumatoid arthritis is considering an NSAID for long-term pain management. What specific NSAID classification might be preferred to minimize gastrointestinal side effects, and why?

    Selective COX-2 inhibitors (e.g., celecoxib, parecoxib) might be preferred. These NSAIDs primarily inhibit COX-2, which is inducible and involved in inflammation, while sparing COX-1, which is responsible for the 'housekeeping' functions including gastric lining protection. This selectivity helps reduce the risk of gastric irritation and ulceration compared to non-selective NSAIDs.

46. Card 46

    What is the primary reason why Pethidine is not used as much as other opioid analgesics in Australia?

    Pethidine is not used as much because it has no significant advantages over other opioids and carries a number of disadvantages, most notably the accumulation of its metabolite, which can lead to toxicity.

47. Card 47

    Fentanyl is described as a 'highly potent synthetic opioid'. What are its key characteristics regarding onset, duration of action, and typical indications?

    Fentanyl is characterized by a rapid onset and short duration of action. It is indicated for severe pain management, typically under specialist supervision, and is available in various formulations like patches, lozenges, nasal sprays, and injectable forms.

48. Card 48

    A patient is prescribed Codeine for mild to moderate pain. Explain how Codeine exerts its analgesic effects and why some individuals might not experience adequate pain relief from it.

    Codeine is metabolized to morphine in the liver to exert its analgesic effects. Some individuals are unable to metabolize codeine into morphine effectively due to genetic variations in the enzyme responsible for this conversion, meaning they may not experience adequate pain relief.

49. Card 49

    What is the primary mechanism by which Tramadol provides analgesia, distinguishing it from other typical opioids like morphine?

    Tramadol causes analgesia through multiple mechanisms. While it activates opioid receptors, it also uniquely inhibits the reuptake of noradrenaline and serotonin. This dual action provides analgesia with a potentially lower risk of respiratory depression compared to traditional opioids.

50. Card 50

    A patient is being treated for moderate to severe pain with Oxycodone. What are some common potential side effects they should be aware of?

    Common potential side effects of Oxycodone include constipation, nausea, dizziness, sedation, and respiratory depression. Patients should be advised on managing these side effects and recognizing signs of more serious adverse events.

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