Analgesia 2

Question 1

Where do NSAIDS work?

Answer 1

At the site of injury - they decrease inflammation

Question 2

Morphine

Answer 2

Strong opioid

Question 3

Hydromorphone

Answer 3

Strong opioid

Question 4

Fentanyl

Answer 4

Strong opioid

Question 5

Heroin

Answer 5

Strong opioid

Question 6

Codeine

Answer 6

Weak opioid

Question 7

Tramadol

Answer 7

Weak opioid

Question 8

Dextropropoxyphene

Answer 8

Weak opioid

Question 9

Indomethacin

Answer 9

NSAID

Question 10

Diclofenac

Answer 10

NSAID

Question 11

Naproxen

Answer 11

NSAID

Question 12

What are enkephalins?

Answer 12

Endogenous opioids

Question 13

IMPORTANT: WHICH DRUGS MIMIC THE ACTIVITY OF ENKEPHALINERGIC INTERNEURONES?

Answer 13

OPIOIDS

Question 14

Give an example of inhibitory interneurons

Answer 14

Enkephalinergic and GABAergic - they suppress transmission by both pre- and post- synaptic mechanisms

Question 15

μ opioid receptors

Answer 15

Responsible for most of the analgesic action of opioids but have some major adverse effects:

• respiratory depression
• constipation
• euphoria
• sedation
• dependence

Question 16

δ opioid receptors

Answer 16

Contribute to analgesia but activation can be proconvulsant

Question 17

κ opioid receptors

Answer 17

Contribute to analgesia at the spinal and peripheral level and activation associated with sedation, dysphoria and hallucinations

(PROCONVULSANT)

Question 18

ORL1 opioid receptors

Answer 18

Activation of these receptors produces an anti-opioid effect

Question 19

COX1 and COX2, one of these is constitutively active and the other is induced by inflammation, which is which?

Answer 19

• COX1 always active
• COX2 induced by inflammation

Benefit of NSAIDS is because they stop COX2

Question 20

Most cells generate ____ in response to mechanical, thermal or chemical injury?

Answer 20

PGE2

(PGE2 sensitises nociceptive neurones and causes hyperalgesia)

i.e. sensitises pain sensing neurones and causes an increased sensitivity to pain

Question 21

Why do NSAIDS have a limited analgesic efficacy?

Answer 21

There are tonnes of pain pathways, not just the ones that involve arachidonic acid etc

Question 22

COX-1 produces ____ which helps protect against the gastric environment?

Answer 22

PGE2

Question 23

Why can COX-2 inhibitors be pretty bad?

Answer 23

They are prothrombotic

Question 24

Rofecoxib

Answer 24

Selective COX-2 inhibitor

Question 25

Celecoxib

Answer 25

Selective COX-2 inhibitor