Pain and Inflammation Overview

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Questions and Answers

Which type of opioid is primarily used for severe pain management?

Mixed agonists/antagonists

Weak agonists

Strong agonists (correct)

Moderate agonists

What is the primary mechanism of action for analgesics?

Act on spinal cord and brain (correct)

Suppress the immune system

Increase inflammation in the body

Interfere with blood circulation

Which medication is classified as a strong agonist?

Codeine

Methadone

Fentanyl (correct)

Hydrocodone

For which condition are opioids most commonly indicated?

Moderate to severe pain Signup and view all the answers

Which of the following is a non-opioid analgesic?

Ibuprofen Signup and view all the answers

What type of opioid is Naloxone classified as?

Antagonist Signup and view all the answers

Which opioid is primarily used to manage chronic cancer pain?

Morphine Signup and view all the answers

What characterizes mixed agonists/antagonists opioids?

They can act as both agonists and antagonists depending on the receptor. Signup and view all the answers

What could potentially decrease sensitivity in peripheral neurons that initiate painful impulses?

Decreased excitability of postsynaptic neurons Signup and view all the answers

Which of the following is NOT a common symptom of opioid withdrawal?

Increased sedation Signup and view all the answers

Which mechanism is responsible for the analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs)?

Inhibition of cyclooxygenase enzymes Signup and view all the answers

What is a significant risk associated with chronic use of opioids?

Development of opioid-induced hyperalgesia Signup and view all the answers

What is the primary adverse effect of glucocorticoids that patients should be made aware of?

Gastric ulcers Signup and view all the answers

Which of the following describes a common characteristic of COX-2 selective drugs?

They spare production of beneficial prostaglandins in the stomach. Signup and view all the answers

Which symptom is indicative of orthostatic hypotension that should be monitored in patients taking opioids?

Dizziness upon standing Signup and view all the answers

What effect do nonsteroidal anti-inflammatory drugs (NSAIDs) have in the body?

Inhibit the synthesis of prostaglandins Signup and view all the answers

What is the typical onset of withdrawal symptoms after the last dose of opioids?

6-10 hours Signup and view all the answers

Which of the following is a potential benefit of patient-controlled analgesia?

Better pain control with fewer side effects Signup and view all the answers

What is a common side effect of using acetaminophen?

Liver toxicity at high doses Signup and view all the answers

Which type of analgesic is primarily classified as an antipyretic?

Acetaminophen Signup and view all the answers

What is a primary concern with the use of NSAIDs for individuals with a history of cardiovascular issues?

Increased risk of heart attack and stroke Signup and view all the answers

What is the main function of glucocorticoids in the body?

Act as powerful anti-inflammatory agents Signup and view all the answers

What is a typical effect of using COX-2 selective NSAIDs?

Reduced gastrointestinal side effects Signup and view all the answers

Study Notes

Analgesics and Anti-Inflammatory Medications

Analgesics are divided into opioids and non-opioids.
Opioids have been used for 3000 years, derived from opium poppies, primarily to alter pain perception.
Opioids are indicated for both acute pain (surgery, trauma) and chronic pain (cancer).
Common opioids include codeine, fentanyl, hydrocodone, meperidine, oxycodone, propoxyphene, and tramadol.

Types of Opioids

Opioids classified as strong agonists include morphine, meperidine, and fentanyl.
Moderate agonists include codeine and oxycodone.
Antagonists include naloxone and naltrexone.
Mixed agonists/antagonists include butorphanol, nalbuphine, and pentazocine.

Mechanism of Action

Opioids primarily affect the spinal cord (dorsal gray matter) and brain (medial thalamus, hypothalamus).
They bind to specific receptors, decreasing neurotransmitter release and excitability of postsynaptic neurons.
They can control pain through decreasing synaptic activity, sensitivity of sensory neurons, and activating descending anti-pain pathways.

Adverse Effects of Opioids

Minor effects: sedation, mood changes, confusion, nausea, vomiting, constipation.
Severe effects: orthostatic hypotension, respiratory depression, potential for abuse and addiction.
Opioid Tolerance typically begins after the first dose, becomes obvious within 2-3 weeks, and persists for 1-2 weeks after discontinuation.

Opioid Withdrawal Symptoms

Symptoms begin 6-10 hours after the last dose, peaking within 2-3 days and lasting up to 5 days.
Physical symptoms include body aches, gooseflesh, fever, nausea, irritability, and more.

Risk Factors for Tolerance and Dependence

Minimal risk if no history of substance abuse and if pain is physiological with appropriate dosage.

Opioid-Induced Hyperalgesia

Some patients may find opioids ineffective or may experience increased pain, potentially due to genetic factors or activation of nociceptive pathways.

Patient-Controlled Analgesia (PCA)

PCA allows patients to self-administer opioids in controlled doses, improving pain management and patient satisfaction while minimizing overdose risk.

Non-Opioid Analgesics

Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen serve as non-opioid analgesics.
NSAIDs provide analgesic, anti-inflammatory, antipyretic, and anticoagulant effects, while acetaminophen is primarily analgesic and antipyretic.

Mechanism of NSAIDs

NSAIDs inhibit the synthesis of prostaglandins, which mediate pain and inflammation.
Subtypes of cyclooxygenase (COX): COX-1 protects normal cell functions, while COX-2 mediates injury responses.

COX-2 Selective Drugs

COX-2 selective NSAIDs aim to reduce pain and inflammation with decreased gastrointestinal toxicity but may have cardiovascular risks.

Acetaminophen Overview

Acetaminophen does not cause gastric irritation but can lead to liver toxicity in high doses.
Common combinations include acetaminophen with hydrocodone or oxycodone.

Adverse Effects of NSAIDs

Common issues include gastric irritation, hepatic/renal toxicity, cardiovascular problems, and impaired bone/cartilage healing.
NSAID overdose can result in symptoms such as hearing loss and confusion.

Glucocorticoids

Powerful anti-inflammatory agents with immunosuppressive effects used across various conditions.
Common glucocorticoids include betamethasone, prednisolone, and prednisone.

Mechanism of Glucocorticoids

Act on inflammatory cells by binding to specific receptors, leading to decreased expression of inflammatory proteins and enhanced anti-inflammatory protein production.

Administration of Glucocorticoids

Available via oral, injection, inhalation, topical, and other routes, with careful maintenance dosing recommended.

Adverse Effects of Glucocorticoids

Can cause catabolic effects on tissues, increased infection risk, gastric ulcers, and glucose intolerance.
Withdrawal can lead to adrenal suppression and severe hypotension, necessitating a gradual tapering of doses.

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Description

This quiz covers key concepts related to pain and inflammation, focusing on analgesics and anti-inflammatory medications. It explores both opioid and non-opioid analgesics, as well as various anti-inflammatory drugs including NSAIDs and glucocorticoids. Test your knowledge on how these medications alter pain perception and their applications in treating pain.