Analgesics

Question 1

What are the classic analgesics?

Answer 1

Opiates and NSAID’s

Question 2

What alternative classes of drugs can be used to treat certain types of pain?

Answer 2

Antidepressants and anti epileptics

Question 3

What is acute/nociceptive pain?

Answer 3

Short term pain

Question 4

What is chronic/neuropathic pain?

Answer 4

Long term persistent pain

Question 5

What is allodynia?

Answer 5

Pain from stimulus that doesn’t normally cause pain

Question 6

What is parasthesis?

Answer 6

painful feelings with no apparent stimulus e.g. pins and needles

Question 7

Broad overview of opioids

Answer 7

They modify the transmission of pain signals and the subjective perception of pain

Question 8

Broad overview of antidepressants and anti epileptics

Answer 8

Treats trigeminal neuralgia and neuropathic pain which is resistant to oipids

Question 9

Broad overview of local anaesthetics in pain management

Answer 9

particularly effective for severe intractable or crescendo neuropathic pain emergency medicine

Question 10

Mechanism of action of opioids

Answer 10

1+2 - decrease neurotransmitter release and block postsynaptic receptors
3 - activate inhibitory pathways

Question 11

Advantages of opioids

Answer 11

Highly effective
Range of durations of effects
Variety of routes

Question 12

Disadvantages of opioids

Answer 12

Side effects
Cautions/contradictions
Intwrations with other drugs

Question 13

Neuropharmacology of opioids

Answer 13

• They mimic our endogenous pain killers
• They act as agonists at opioid receptors (3 types of receptors)
• Signal transduction (GPCR)
• Integrated physiology (act as suppressors)

Question 14

Which receptors do most opioids interact with?

Answer 14

mu receptors

Question 15

What type of pain do you treat with morphine?

Answer 15

Acute and chronic

Question 16

What are the side effects of morphine and diamorphine?

Answer 16

Sedation, respiratory depression, constipation, nausea, vomiting, itching, tolerance, dependency and euphoria

Question 17

What are SNRI’S? What kind of pain do they treat?

Answer 17

Serotonin and noradrenaline reuptake inhibitors. treat neuropathic pain but not in all patients. e.g. venafalaxine and duloxetine

Question 18

What are SNRI’S? What kind of pain do they treat?

Answer 18

gdwbs

Question 19

What is Duloxetine?

Answer 19

SNRI prescribed for peripheral neuropathic pain. Side effects of nausea vomiting somnolence insomnia and dizziness

Question 20

What is Venafalaxine? what kind of pain does it treat?

Answer 20

SNRI prescribed to treat diabetic neuropathy. Side effects of nausea sedation headache and dizziness

Question 21

Cautions/contradictions for SNRIs

Answer 21

Epilepsy, CV disease, diabetes, glaucoma, pregnancy/breastfeeding

Question 22

What do SNRIS interact with?

Answer 22

alcohol, NSAID’S, tram adolescent, opioids, SSRIs

Question 23

What is carbanazepine? what kind of pain does it treat?

Answer 23

Anti epileptic used to treat neuralgia and diabetic neuropathies

Question 24

What is gabapentin? What type of pain does it treat?

Answer 24

Various neuropathic pain states. It is currently the drug of choice due to limited side effects.

Question 25

What is lidocaine? what kind of pain does it treat?

Answer 25

Local anaesthetic sodium channel blocker that treats severe intractable or crescendo neuropathic pain

Question 26

What is ketamine? what kind of pain does it treat?

Answer 26

Local anaesthetic glutamate receptor blocker that treats intractable or crescendo neuropathic pain