Analgesics

Question 1

Phenanthrenes

Answer 1

morphine, hydromorphine

Question 2

Phenylpiperidines

Answer 2

fentanyl, meperidine

Question 3

buprenorphine

Answer 3

agonist/antagonist

Question 4

methadone

Answer 4

long duration of action

Question 5

activates inhibitory pathways for pain supression, and inhibits pathywas for the appreciation and transmission of pain

Answer 5

strong opiod agonists

Question 6

inhibits the synthesis of prostaglandins

Answer 6

NSAIDs

Question 7

methylmorphne is a pro-drung that must be metabolized via cytochrome p450 2D6 enzymes to the active compound morphine

Answer 7

codiene

Question 8

the exac mechanism of this drung is unknown, but this medication appears to work via inhibition of prostaglandin synthesis, although this compound does NOT have any anti-inflammatory or antithrombotic properties

Answer 8

acetaminophen

Question 9

All of the following are properties of opiods EXCEPT:
A) oral absorption of opioids is significantly less than SC or IV
B) unlike many other medications there is no plateau effects
C) long acting agents, and dose forms are easy and safe to titrate
D) NSAIDs and acetaminophen may be just as effective as mild to moderate opioid agonists

Answer 9

C) long acting agents, and dose forms are easy and safe to titrate

Question 10

what are the most important adverse effects of the following agents?
Opioids
NSAIDs
Acetaminophen

Answer 10

Opioids = respiratory depression
NSAIDs = GI bleeding
Acetaminophen = liver toxicity

Question 11

What are riskf factors for NSAID associated gastroduodenal ulcers?

Answer 11

age, concomiant use of corticosteroids, history of ulcers

Question 12

What is the main advantage of ketorolac over other NSAIDs?
A) can be combined saftely with an opiod such as codeine
B) does not prolong bleeding time
C) is available in a parenteral formulation for intramuscular or intravenous injection
D) is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment

Answer 12

it is available in parenteral formulation for intramuscular or intravenous injection

Question 13

A 22-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patients death?
arrythmia
hemorrhagic stroke
liver failure
ventilatory failure

Answer 13

liver failure

Question 14

which of the following is an analgesic and antipyretic drug that lacks anti-inflammatory action?
acetaminphen
celecoxib
colchicine
indomethacin

Answer 14

Acetaminophen

Acetaminophen is the only drg that fits this description. Indomethacin is a nonselective COX inhibitor and celecoxib is a COX-2 inhibitor; both have analgesic, antipyretic, and anti-inflammatory effects. Colchicine is a drug used for gout that also has an anti-inflammatory action

Question 15

A 54 year old women presents with signs and symptoms consistent with an early stage of rhemuatoid arthritis. you decide to initiate NSAID therapy
Which of the following paitnet characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis?

A) history of alcohol abuse
B) history of gout
C) history of myocardial infarction
D) history of osteoporosis

Answer 15

history of myocardial infarction

Celecoxib is a COX-2-selective inhibitor. COX-2 inhibitors have the advantage over nonselective NSAIDs of reduces gastrointestinal toxicity, BUT clinical data suggest that they are more likely to cause arterial thrombotic events. A history of myocardial infarction would be a compelling reason to avoid a COX-2 inhibitor

Question 16

A 63 year old man is undergoing radiation treatment as an outpatient for metastatic bone cancer, his pain is treated with a fixed combo of oxycodone plus acetaminophen taken orally. Despite increasing doses of the analgesic combo, the pain is getting worse. The most appropriate oral medication for his increasing pain is:

bruprenorphine
codeine plus asprin
hydromorphone
tramadol

Answer 16

Hydromorphone

In most situations, pain associated with metastatic carcinoma ultimtely necessitates the use of an opoid analgesic that is equivalent in strength to morphine, so hydromorphone, oxymorphone, or levorphanol would be indicated. The combo of codeine plus salicylate would not be as effective as the original drug combination. Propoxyphene and tramadol are less active than the original. Buprenorphine, a mixed agonist-antagonist, is not usually recomended for cancer-associated pain because it has a limited maximum analgesic effect (“ceiling”) and because of possible dysphoric and psychotomimetic effects

Question 17

A 16 year old gorl comes to the ED suffering from the effects of an aspirin overdose. Which of the following syndromes is this patient most likely to exhibit as a result of this drug overdose?

A) bone marrow suppression and possibly aplastic anemia
B) fever, hepatic dysfunction, and encephalopathy
C) rapid, fulminant hepatic failure
D) rash, interstitial nephritis, and acute renal failure
E) hyperthermia, metabolic acidosis, and coma

Answer 17

Hyperthermia, metabolic acidosis, and coma

Salicylate intoxication is associated with metabolic acidosis, dehydration, and hyperthermia. If these problems are not corrected, coma and death ensue

Question 18

A young man is brought to the emergency department in an anxious and agitated state. He informs the attending physician that he uses “street drugs” and that he gave himself an intravenous “fix” approximately 12 h ago. After an initial period of contentment and relaxation, he now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. You note that his pupil size is larger than normal.

What is the most likely cause of these signs and symptoms?
A) the patient had injected dextroamphetamine
B) the patient has overdosed with an opioid
C) the signs and symptoms are those of the opioid abstinence syndrom
D) the patient has hepatitis B

Answer 18

The signs ans symptoms are those of the opiod abstinence syndrome

The signs and symptoms are those of withdrawal in a patient physically dependent on an opioid agonist, especially morphine or heroin. They usually start within 6–10 h after the last dose; their intensity depends on the degree of physical dependence, and peak effects usually occur at 36–48 h. Mydriasis is a prominent feature of the abstinence syndrome; other symptoms include rhinorrhea, lacrimation, piloerection, muscle jerks, and yawning.

An overdose of dextroamphetamine would not produce an initial feeling of contentment and relaxation.