Pharmacology test #3

MME

MME

________ is morphine milligram equivalent and can be found using conversion charts.

what are pain receptors knwn as

nociceptors: they are active when a stimulant could cause tissue damage

A(n) ________ is a drug that alleviates pain.

analgesic

Morphine

________ is the standard by which other opioids are measured.

CNS

Non-narcotic analgesics inhibits prostaglandin production in the ________.

what does the Peripheral Nervous System do

detects temperature, pressure, touch, pain

Sensation

Heat, cold, pressure, or chemical stimulus to sensory receptors and nerve endings in the peripheral nervous system

Pain Receptors

Perceive the sensation of pain when stimulated

Pain

as physically or emotionally sensed discomfort that is associated with acute tissue damage or a sensory system malfunction

how to combination opioids works

by relieving pain both centrally and peripherally

Inflammation

causes a cascade of events that untimely forms prostaglandins

what kind of pain involves bones, muscles and ligamant

nociceptive (Somatic)

what kind of pain involves kidneys, liver and intestines

nociceptive (Visceral)

what kind of pain involves nerve damage

neuropathic

what kind of pain involves dysregulated pain processing in the central nervous system

centralized

Somatic Pain

originates from injury to body tissue

Visceral Pain

originates from problems with internal organs

Neuropathic Pain

from damage of nerve tissue

Patient feels pain when there is no obvious stimulus for it

Sympathetic-mediated pain; centralized

Background pain

describes a constant level of pain

Breakthrough pain

describes when pain of greater intensity occurs intermittently for no particular reason

Provoked pain

describes pain that is more intense than background pain but has a clear cause

dependence

A physical and emotional reliance on a drug; Withdrawal when drug is discontinued or dose is reduced

addiction

Compulsive disorder leading to continued use of drug despite harm

what do nonnarcotic analgesics do

Inhibits prostaglandin production in the CNS

what does aspirin do

inhibits cyclooxygenase, the enzyme that converts arachidonic acid to prostaglandins

anesthesia

an intervention for intentional loss of feeling in a person’s body or part of the body when pain relief, anxiety relief, or muscle relaxation is required for patient care

neuraxial anesthesia

blocks sensation through injection of an anesthetic into the CNS without making the patient unconscious

local anesthesia

is used for local pain reduction

general anesthesia

causes reversible unconsciousness and absence of response to painful stimuli.

what are the most potent anethetics

gases and vapors

malignant hyperthermia

a rare disease; A sudden and rapid rise in body temperature with irregularities in heart rhythm and breathing Fever of 110°F or more

what is sufentanil

5-10 times more potent than fentanyl

Name 3 benzodiazepines induction agents

• diazepam (Valium)

• lorazepam (Ativan)

• midazolam

esters

are short-acting and are metabolized by pseudocholinesterase in the plasma

Amides

are longer-acting and are metabolized by liver enzymes

what is a migraine

A severe, throbbing, unilateral headache accompanied by symptoms such as nausea, vomiting, photophobia, phonophobia, hyperesthesia

Aura

Visual or sensory disturbances such as seeing flashing lights; shimmering heat waves; bright lights; dark halos in visual field; blurred, cloudy vision; transient loss of vision

pathophysiology

Dilation of cerebral surface vessels

Caffeine

A CNS stimulant used in combination with other analgesics to treat headache

what is nitrous oxide (N2O) used for

Memory loss, mildly slowed breathing

what is Capsaicin used for

topical pain treatment

Principles of OAT

must be treated with respect and dignity

What is Buprenorphine-Naloxone

therapeutic agent has been shown to be lower risk to patients in terms of safety. The potential for diversion exists however overdose is less likely to be fatal.

what is Sustained Release Oral Morphine (SROM)

Due to the risks of toxicity associated with bolus absorption and diversion, extra safeguards need to be in place and are referred to in the NBCP directive.

what is iOAT

not considered first line of therapy, however, injectable hydromorphone is a newer agent considered for use in OUD. It is considered to have high potential for diversion and risk to patient outcomes

Dispensing documentation

Pharmacists and pharmacy technicians must document each step in dispensing of OAT. Given that medication used in OUD may require dilution, and that the agents are desirable for purposes of diversion, the documentation required is greater than that required for dispensing of typical (non-OAT) oral dosage forms

Clinical Documentation

Pharmacists must document patient assessment. Pharmacists or pharmacy technicians must document follow-up of patients for observed dosing or take-home dispensing

• College documentation

The COllege must know who is providing OAT

what is a carry audit

they may be asked at any time to appear in the pharmacy and bring with them the remainder of their take-home doses and empty bottles, in their own lock box.

SROM

To limit potential for diversion, slow-release oral morphine is only to be provided via daily observed ingestion

iOAT

To limit potential for diversion and encourage safe injection technique, iOAT is only to be provided via daily observed self-administration in accordance with policy and practice guidelines

Education and Training Documentation

Pharmacy professionals must document within the pharmacy’s QMP that they have established and maintained competency for providing OAT for patients with OUD