Analgesics

Question 1

Peripheral pain stimulus is blocked by?

Answer 1

NSAIDs

Question 2

Conduction of afferent peripheral nerve is blocked by?

Answer 2

Voltage gated sodium channel blockers; the “caines” (Lidocaine)

Question 3

Spinal cord transmission of pain is blocked by?

Answer 3

Everything

Question 4

Cortical modulation of pain is blocked by?

Answer 4

Opioids only

Question 5

What are the NMDA receptor blockers and when are they typically used?

Answer 5

Ketamine, Dextromethorphan.. Used pre-surgery to prevent “Wind-up”

Question 6

AE’s of Ketamine?

Answer 6

Hallucinations, amnesia, HTN, ICP

Question 7

AE’s of Dextromethorphan?

Answer 7

Dizziness, confusion, fatigue. It is an antitussive

Question 8

Carbamazepine MOA? What does it tx?

Answer 8

Voltage gated Na channel blocker. Tx: Trigeminal neuralgia, neuropathic pain (also recall that it tx depression in Huntington’s)

Question 9

List the opiate antagonists

Answer 9

Naloxone, Naltrexone, Nalmefene

Question 10

Which opioid antagonist treats overdose?

Answer 10

Naloxone

Question 11

Which opioid antagonist is used in addiction programs?

Answer 11

Naltrexone (long half life); it also decreases alcohol cravings in alcoholics

Question 12

What is the biggest reservoir for opiates?

Answer 12

Muscle

Question 13

Where is the long term depot for opioids?

Answer 13

Adipose

Question 14

What are the AE’s of opioids? There are a shit ton..

Answer 14

Restlessness, hyperactivity, convulsions, respiratory depression, N/V, increased ICP, ortho hypoTN, constipation, urinary retention, pruritis, bradycardia, miosis

Question 15

Which AE’s are immune to tolerance?

Answer 15

Constipation, miosis, convulsions

Question 16

When does N/V occur with giving opioids?

Answer 16

When you give them too quickly

Question 17

When does respiratory depression occur with opioids?

Answer 17

When someone overdoses (reverse with Naloxone)

Question 18

Which opioid causes histamine release?

Answer 18

Morphine (counter with anti-histamines)

Question 19

Triad of opioid overdose?

Answer 19

Coma, respiratory acidosis, pinpoint pupils (give Naloxone)

Question 20

Drug interaction w/ opioids?

Answer 20

*SAM: Sedatives, antipsychotics, MAOIs

Question 21

Which opiate are you worrying about polymorphisms in CYPs or other drugs interacting with CYPs?

Answer 21

Codine.. Also, codine is contra’d in pregnancy & breastfeeding!!!

Question 22

All opiates are contra’d in renal failure except which two?

Answer 22

Hydromorpone & Fentanyl

Question 23

Which opioid is used to manage opioid withdraw due to its long half life?

Answer 23

Methadone (can be used in pregnant addicts); can cause decreased libido, prolonged QT

Question 24

Which opioid can be given via transdermal patch or lozenge?

Answer 24

Fentanyl (remember, this drug is OK for renal failure)

Question 25

Which opioid gets converted to morphine by CYP2D6?

Answer 25

Codine.. watch for interaction w/ CYP drugs and CYP polymorphisms

Question 26

Which opioid is sneaky sneaky? Used for addicts in dependence programs

Answer 26

Buprenorphine.. it is an opioid receptor agonist when taken orally, but if an addict crushes it up and shoots it it becomes an antagonist. Also has a plateau effect

Question 27

Symptoms of opiate withdraw?

Answer 27

Skin crawling, diaphoresis, rhinorrhea, anxiety, fear, arthralgia, myalgia. On PE: agitated, sweaty, lacrimation, piloerection, pupillary dilation, tachycardia (from agitation)

Question 28

What drugs treat opioid dependence?

Answer 28

Methadone, Naltrexone, Buprenorphine

Question 29

What drug can be false positive for urine opioid screen?

Answer 29

Fluoroquinolones

Question 30

What opioids can treat diarrhea?

Answer 30

1. Loperamide: OTC cuz it doesnt cross BBB

2. Diphenoxylate: Rx; formulated w/ Atropine to prevent abuse