Analgesics

Question 1

NSAIDS

Answer 1

Ibuprofen, Acetaminophen

MOA: Inhibit COX, decrease prostaglandins

AE: GMBR
-Abd. pain, ulcers, GI bleeding
-Decrease RBF/GFR
-Increase risk of bleeding (antithrombotic)
-Increase risk of MI/stroke

Question 2

Opioids

Answer 2

MOA: analgesic effect
-MB: block GABA release
-DH: decrease NT release/hyperpolarization

AE: ABC DUMP RNR
-Reward (risk of SUD)
-Miosis
-Nausea/emesis
-Constipation
-Urinary retention
-Drowsiness
-Resp. depression
-Antitussive (suppress cough)
-Bradycardia, hypo
-Pruritus

Question 3

Morphine

Answer 3

Full agonist (FVAP)

USE: chronic pain, post op pain

-First pass metabolism when PO

AE:
-Vasodilation
-Allergic sx (Pruritus)

Question 4

Methadone

Answer 4

FOCL

Full agonist

USE: chronic pain, opioid dependent pts

-Long half life

Question 5

Fentanyl

Answer 5

CLAF

Full agonist

USE: anesthesia, chronic pain

-Transmucosal lozenge + other roa

Question 6

Codeine

Answer 6

Full agonist

USE: mild/mod pain

-Dependent upon conversion of
codeine to morphine by CYP2D6
-10% have morphism of CYP, so codeine ineffective

Question 7

Buprenorphine

Answer 7

LOPP

Partial agonist

USE: post op pain, opioid dependent pts

-Long half life

Question 8

Naloxone

Answer 8

Antagonist

MOA: block opioid receptors

USE: opioid overdose

Admin: IM, IV, auto inj

Question 9

Naltrexone

Answer 9

Antagonist

MOA: block opioid receptors

USE: opioid dependence (or alcohol)

Admin: PO

Question 10

Tramadol

Answer 10

PS SON

MOA: weakly stimulate opioid receptors, inhibit NET and SERT

USE: mild to mod pain (PO)

AE:
-Risk of seizures in normal individuals
-Caution in preexisting/history of seizure disorders

Question 11

Opioid Considerations

Answer 11

Interactions:
-CYP, codeine
-CNS depressants

Tolerance:
-Cross tolerance between opioids, degree of tolerance

Question 12

Clonidine

Answer 12

SHAD

MOA: alpha2 agonist

USE: post op pain, neuropathic pain

AE:
– Hypotension
– Sedation
– Dry mouth