Analgesic Drugs

Question 1

1. Identify in general terms the four rungs on the ‘Analgesic ladder.’
2. Name the three nuclei associated with nociception on the brainstem
3. Excitation of the PAG by ________ stimulation produces profound _______. Endogenous opioids (_________), or morphine and related compounds, also cause excitation. The NRM and LC act to _______ nociceptive transmission to the _____ ____ of the spinal cord

Answer 1

1. Paracetamol to NSAIDs to weak opioids e.g. codeine to strong opioids e.g. morphine
2. The periaqueductal grey matter (midbrain), Locus cerulus (pons), nucleus raphe magnus (medulla)
3. Electrical, analgesia, enkephalins, inhibit, dorsal horn

Question 2

1. What are the three types of opioid receptors found in the body?
   OPIOIDS CAN CAUSE A SERIES OF CNS SIDE EFFECTS
2. Identify the major respiratory side effect of using opioid drugs
3. Identify the major cardiovascular side effect of using opioid drugs
4. Identify three GI side effects

Answer 2

1. Mu, Kappa, Delta
2. Apnoea
3. Orthostatic hypotension
4. Nausea, vomiting, diarrhoea

Question 3

1. Name 5 strong opioid drugs
2. Name 3 weak opioids
3. Name the main drug used to reverse opioid toxicity and explain its action.

Answer 3

1. Morphine, oxycodone, heroin, hydromorphone, fentanyl
2. Codeine, tramadol, dextropropoxyphene
3. Naloxone, competetive antagonist at ma-receptors

Question 4

1. Explain the mode of action of NSAIDs

2. What are the two types of NSAIDs?

Answer 4

1. They inhibit the synthesis and accumulation of prostaglandins by COX-1 and COX-2 enzymes
2. Non-selective NSAIDs and COX-2 selective inhibitors (Coxibs)
   3.

Question 5

1. Name two antiepileptic drugs used to treat neuropathic pain
2. Name three Tricyclic anti-depressants which are used against neuropathic pain
3. Describe the action of carbamazepine

Answer 5

1. Gabapentin and Pregabalin
2. Amitriptyline, nortryptiline, desipramine
3. blocks subtypes of voltage-activated Na+ channel that are upregulated in damaged nerve cells