3. Analgesics Flashcards
Where do we see prostaglandins in the body? Locally or throughout the body?
Locally
____ is thought to sensitize nerve endings to the action of bradykinin (seen in ACE inhibitors), histamine, and other chemical mediators.
PGE2
What are the common adverse side effects of Acetaminophen?
Nausea, rash and headache
what other serious side effects can Acetaminophen produce?
Acute hepatotoxicity (>4g/tid) Acute renal tubular necrosis, chronic analgesic nephropathy.
What is the drug interactions of Lidocaine Topical in the presence of Acetaminophen?
Additive methemoglobinemia. This drug increases the oxygen binding affinity. Therefore, oxygen is refuse to leaves, which then leads to hypoxia.
What is the mechanism of action of Ibuprofen?
inhibits COX, reducing PG (inflammation) and TXA2 (platelet aggregation) synthesis.
What is the drug interactions of ASA NSAIDs and Acetaminophen in the presence of Ibuprofen?
Additive hemorrhagic risk
What is the drug interactions of Cyclosporine and Acetaminophen in the presence of Ibuprofen?
Additive nephrotoxicity
What is the indications for Celecoxib?
Arthritis, Ankylosing Spondylitis, Dysmenorrhea, Acute pain
Dosing [50-400mg]… 200mg qd-bid
the mechanism of actions of Celecoxib is selectively inhibits ____ and reduces ____ synthesis.
COX-2, PG
Which NSAIDs has Black Box Warnings?
CV: Stroke, CHF, MI
GI: Bleed, ulceration/perforation
What is the drug interactions of NSAIDs (esp Ketorolac), Corticosteroids in the presence of Celecoxib?
Hemorrhage
What is the drug interactions of Azoles in the presence of Celecoxib?
impaired metabolism
T/F Celecoxib is contraindicated in sulfonamide allergies.
True. Same as with Furosemide.
T/F Celecoxib is contraindicated in sulfonamide allergies.
True. Same as with Furosemide.
Neurogenic pain responds best to ________ or ________.
anticonvulsants (anti-seizure), antidepressants (tricyclic antidepressant “non-selective”)
Which drug is the most prescribed Opiods?
Hydrocodone/Acetaminophen
What is the dosing for Hydrocodone/Acetaminophen?
5mg/500mg
1-2 tabs q4-6h; max 8 tabs/day
What is the mechanism of Hydrocodone?
Act through G-Protein-Coupled Mu, Kappa & Delta ‘opioid’ receptors; inhibit adenylyl cyclase activity; enhance K+ outflow; hyperpolarize nerves affecting neuronal excitability and muscle tone
Stimulate prolactin and growth hormone release
T/F It’s ok to give patients Opioids when they have blunt trauma to the head.
False. It will elevate intracranial pressure, enhanced with head trauma.
What are the notable adverse effects of Hydrocodone?
CNS: drowsiness (tolerance in about 1 wk), mood changes (quick tolerance); elevated intracranial pressure, enhanced w/ head injury
CV: bradycardia/tachycardia; orthostatic hypotension
Respiratory: dose-related respiratory depression at brain stem respiratory center
What is the classic side effect of Opioids?
Constipation. Ileum portion of the large intestine is paralyzed.
T/F Opioids don’t cause flushing throughout the body.
False. It does.
Tramadol have a similar mechanism of action with which of the drugs?
SNRI. inhibitor of NE/5-HT reuptake
What is the most common side effect of Tramadol?
Pruritus is the common side effect of this drug.
Tramadol causes orthostatic hypotension just like which analgesics?
hydrocodone
Can Tramadol cause breathing problems?
Yes. Bronchospasm is one of the notable adverse effects of this drug.
Acetaminophen act by inhibiting ______ and enhancing ______ release.
COX, 5-HT (attenuated pain mediator generation)
Acetaminophen regulates body temperature by acting centrally at the __________, which inhibits ____synthetase.
Hypothalamus, PG
Hydrocodone mainly act as a _____ and _____.
Painkiller, cough suppressant
What is the drug interactions with anticholinergic in the presence of Hydrocodone/acetaminophen?
Additive constipation
What is the drug interactions between argon if anhydrase inhibitors (CAI) with hydrocordone/acetaminophen?
Acetaminophine inhibits renal excretion of CAI, leading to CNS toxicity, metabolic acidosis.
Tramadol is a central acting ______ opioid analgesic.
Synthetic
