Analgesics

Question 1

COX1 v 2

Answer 1

1 - antiplatelet, GI side effects
2 - antipyretic, analgesic, prothrombotic side effects

Question 2

COX 2 selective inhibitor

Answer 2

celecoxib, meloxicam

Question 3

Tolerance to opioids - not developed to

Answer 3

miosis, constopation, seizures
some tolerance to bradycardia

Question 4

Withdrawal timeframe opioids

Answer 4

meperidine - <24h
morphine and fentanyl - onset 6-10h, peak 36-48h, lasts 5/7
Methadone - peak several days, 2w total

Question 5

MOAI and opioids

Answer 5

Risk seratonin syndrome and hyperpyrexic coma
inc BP

Question 6

Phenanthrenes

Answer 6

strong agonist - morphine and heroin
Mild-mid - codeine and oxycodone
mixed - buprenorphine (mu agonist, kappa antagonist)

Question 7

Phenylheptylamines

Answer 7

strong - methadone
mild - propoxyphene (half the strength codeine)

Question 8

Phenypiperidines

Answer 8

strong - meperidine and fentanyl
mild-mid agonists - diphenoxylate, loperamide

Question 9

Fentanyl type drugs

Answer 9

sufentanyl -5x stronger
alfentanyl - less potent but faster T1/2 15m-30m
remi - shortest length 5m

Question 10

Morphinans

Answer 10

strong agonist - levorphanol
mixed - butorphanol (kappa agonist)

Question 11

Tramadol

Answer 11

blocks seratonin and NA uptake
Weak mu agonist
Tox - seizures, N&V
Has active metabolite

Question 12

Opioid antagonists

Answer 12

naloxone lasts 1-2h
naltrexone - PO good absorb but high 1st pass T1/2 10h, lasts 48h
nalmefene - IV version naltrexone

Question 13

Risk of seratonin syndrome with MAOIs and which opiods

Answer 13

tramadol, pethidine, dectromethorphan

Question 14

Duration analgeisa opiates

Answer 14

codeine - 3-4h
morphine - 4-5h
methadone - 4-6h
Buprenorphine - 4-8h (can reduce etoh cravings)

Question 15

Opioids without active metabolites

Answer 15

methadone and fentanyl

Question 16

piroxicam half life

Answer 16

57 hours

Question 17

Opioid with cardiotoxicity

Answer 17

Dextroprpoxyphene

Question 18

NSAID with GI SEs

Answer 18

Indomethacin (cox1>2)

Question 19

Methadone bioavailability

Answer 19

75%

Question 20

Colchicine mechanism

Answer 20

Binds tubulin so cant polymerise into microtubules
Inhibits leukocyte migration
Inhibits leukotriene B4
Does not affect urates

Question 21

Colchicine pk

Answer 21

Rapid absorption peak plasma 2h
Deacytelation liver
Excreted 90% in stool

Question 22

SE colchicine

Answer 22

GI bleed
Aplastic anaemia
Hair loss
Throat pain
Bloody diarrhoea

Question 23

Allopurinol SEs

Answer 23

Rash
Fever
Lfts
Sjs
Peripheral neuropathy
Aplastic anaemia and vasculitis
Inc warfarin and thiazides
Can be dialysed (not pb)

Question 24

Interaction NSAIDs and ACIis

Answer 24

Decreased hypotensive effect of aceis

Question 25

Unionised aspirin

Answer 25

More in acidic environment

Question 26

Aspirin effect on probenecid

Answer 26

Inhibits uricosuric effect

Question 27

Aspirin and uric acid

Answer 27

At low doses increases blood urate