Analgesic Drugs - Opioids and Opiates

Question 1

Describe the analgesic ladder

Answer 1

3 - strong opioid
2 - weak opioid
1 - NSAID and/or paracetamol

Question 2

How do NSAIDs work to reduce pain?

Answer 2

Act at site of injury blocking synthesis of prostaglandins

Question 3

Difference between opiates and opioids

Answer 3

Opiates - derived from opium

Opioids - any agent that acts on opioid receptors

Question 4

Excitation of what areas in the brain cause inhibition of nociceptive transmission?
NB: THIS IS THE PATHWAY THAT OPIOIDS USE AS THEIR MOA

Through what pathway does this occur?

Answer 4

PAG - Periaqueductal grey (midbrain)

Locus ceruleus (pons)

Nucleus raphe Magnus (medulla)

`Dorsal column system

Question 5

What are the most common side effects to ask a patient about? (3)

Answer 5

Nausea
Constipation
Drowsiness

Question 6

Analgesia occurs mainly through prolonged activation of u-opioid …?

Answer 6

receptors

Question 7

What is the drug name for heroin?

Answer 7

Diamorphine

Question 8

What method does codeine have to be given in?

Answer 8

Orally NOT IV

Question 9

What opioid must be avoided in patients with epilepsy?

Answer 9

Tramadol

Question 10

What is the name of the drug which is an opioid receptor antagonist and is used to manage opioid overdoses?

Answer 10

Naloxone

Question 11

Match the following drug used for neuropathic pain to their most common indication:
Gabapentin
Pregabalin
Carbamazepine

Migraine prophlyaxis
Trigeminal neuralgia
Painful diabetic neuropathy

Answer 11

Gabapentin - migraine prophlyaxis

Pregabalin - painful diabetic neuropathy

Carbamazepine - trigmeninal neuralgia

Question 12

Tricyclic antidepressants e.g. amitriptyline can be used in neuropathic pain, how do they work?

Answer 12

Decrease the uptake of noradrenaline