Analgesic Drugs

Question 1

acetaminophen

Answer 1

MOA:

• analgesic, antipyretic
• not anti-inflammatory (no negative SE of nsaids)
• route:
• PO
• PR
• IV

Question 2

opioids

Answer 2

MOA:

• activate the same receptors that endorphins activate in CNS –> CNS depressant
• block pain stimuli
• SE: MORPHINE USDA
• contraindication: after head trauma/injury or hemorrhagic CVA is suspected or increased ICP

Question 3

Opioids - codeine sulfate

Answer 3

• indication: PRN for cough, diarrhea, mild pain
• pro-drug: metabolite is morphine
• route: PO, subQ, IM, IV
• acetaminophen/codeine (300/30) or (300/60)

Question 4

Opioids - hydrocodone

Answer 4

• indication: PRN moderate pain
• route: only PO
• hydrocodone/acetaminophen (also can be with aspirin and ibuprofen)

Question 5

Opioids - oxycodone

Answer 5

• indication: PRN moderate pain (stronger)

- oxycodone/acetaminophen (ibuprofen and aspirin)

Question 6

Opioids - tramadol

Answer 6

• route: PO
• pro-drug: metabolite is morphine (opioid-like but weaker properties)
• tramadol ER around the clock for pain
• max dose: 300mg/24 hours

Question 7

Opioids - morphine

Answer 7

• routes: PO/oral drop, PR, IV, IM, epidural, spinal
• 10x stronger than tramadol
• indication: PRN for severe pain

controlled release

Question 8

Opioids - hydromorphone

Answer 8

• Routes: PO, IV, PR, IM, subQ
• indication: PRN for severe pain
• 6x stronger than morphine

Question 9

Opiods - meperidine (opioid-like)

Answer 9

• routes: PO, subQ, IM, IV

MOA:

• anticholinergic with secondary analgesic effects
• less respiratory SE
• patients allergic to opiates
• short action – used in OR
• SE: neurotoxicity, dysrhythmia
• contraindication: RF (risk of seizure)

Question 10

Opioids - fentanyl

Answer 10

IV/IM:
- anesthesia

transdermal patch 12-100mcg/h:
- chronic pain

oral trans-mucosal lozenge:
- acute pain in ED

• 50-100x more potent then morphine (synthetic opioids)
• short-acting for severe pain (immediate: onset, duration: 30-60 min)

Question 11

Opioids - methadone

Answer 11

• Route: PO, subQ, IM
• indication: heroine intoxication and maintenance programs
• MOA: long acting opioids, reduces craving
• only through certified pharmacies

Question 12

Opioid Antagonist - Naloxone

Answer 12

Indication:

• treatment of opioid OD by competing for receptors
• reverse resp and CNS depression rapidly (life-saving)
• no effect in absence of opioid (used as a test)
• emergency medicine
• routes: IV, intranasal spray, PO