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PPI-2 > Analgesics for Neuropathic Pain > Flashcards

Analgesics for Neuropathic Pain Flashcards

1
Q

What is the mechanism of action of Ibuprofen?

A

Inhibits COX 1 and COX 2 (nonselective) and decreases the synthesis of prostaglandins so that the sensitivity to pain fibers is lowered

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2
Q

What is the mechanism of action of Celebrex?

A

Inhibits COX2 (selective) and decreases the synthesis of prostaglandins so that the sensitivity to pain fibers is lowered

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3
Q

What is the mechanism of action of aspirin?

A

In low concentrations (baby aspirin), it inhibits COX1 (selective) and decreases the synthesis of prostaglandins so that the sensitivity to pain fibers is lowered

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4
Q

What are predictable side effects of typical nonselective NSAIDs?

A
  1. Inhibition of COX1 causes GI effects= abdominal pain, ulcers, and GI bleeding
  2. Inhibition of COX2 causes renal effects= lowered renal blood flow and GFR
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5
Q

What are the predictable side effects of aspirin?

A

Increased risk of bleeding d/t less clotting from antithrombotic effect

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6
Q

What are the predictable side effects of celecoxib?

A

Increased risk of myocardial infarction and stroke d/t more clotting

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7
Q

T/F: Acetaminophen is an anti-inflammatory agent

A

False, possibly from its mechanism involving other unknown pathways outside of COX

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8
Q

What are adverse effects seen in acetaminophen?

A

Liver toxicity

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9
Q

What is the mechanism of action opioids?

A
  1. In midbrain: Block release of GABA in periaqueductal gray matter and increase NE and 5-HT so further inhibit pain input
  2. In dorsal horn: decrease release of substance P and causes hyperpolarization downstream
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10
Q

What opioids are full u (mu) agonists?

A

Morphine, methadone, fentanyl, and codeine

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11
Q

What are the clinical uses of morphine?

A

Chronic pain (cancer) and Postoperative pain (no PO option for this)

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12
Q

What are adverse effects seen with morphine?

A

Vasodilation and allergic symptoms from increased histamine release on mast cells

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13
Q

What are the clinical uses of methadone?

A

Chronic pain and maintenace drug for opioid dependent patients

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14
Q

What are the clinical uses of fentanyl?

A

used for anesthesia (IV) and in chronic pain (transmucosal, transdermal) and given also bu lozenge (quick onset)

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15
Q

What are the clinical uses of codeine?

A

Used to treat mild to moderate pain (ceiling effect on analgesic efficacy) but caution in CYP polymorphism for effectiveness

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16
Q

What drugs are partial u (mu) agonists?

A

Buprenorphine

17
Q

What are the clinical uses of buprenorphine?

A

Post-op pain and maintenance drug for opioid dependent patients (long half life)

18
Q

What drugs are opioid antagonists?

A

Naloxone and naltrexone as these block all opioid receptors

19
Q

What are the clinical uses of naloxone?

A

Opioid overdose (IM,IV,auto-inj)

20
Q

What are the clinical uses of naltrexone?

A

Used in opioid dependence (alcohol dependence) and given orally

21
Q

What is the MOA of tramadol?

A

Weakly stimulate u opioid receptors and inhibit NET/SERT

22
Q

What are clinical uses of tramadol?

A

Mild to moderate pain (po)

23
Q

What are adverse effects seen in tramadol?

A

Can cause seizures so use with caution in hx of seizures

24
Q

What is the MOA of clonidine?

A

Inhibit a2 receptors to decrease substance P neurotransmission

25
Q

What are clinical uses of clonidine?

A

Post-op pain management and neuropathic pain

26
Q

What are side effects of clonidine?

A

Hypotension, sedation, and dry mouth

27
Q

What are the clinical uses of gabapentin?

A

Neuropathic pain and seizures (adjunct therapy)

28
Q

What antiepileptic drugs prolong the inactivated state of Na-channels?

A

Carbamazepine, phenytoin, and topiramate

29
Q

What are the clinical uses of carbamazepine, phenytoin, and topiramate?

A

Seizures and neuropathic pain

30
Q

What antidepressants are NET and SERT inhibitors?

A

Amitriptyline and duloxetine

31
Q

What are the clinical uses of amitriptyline and duloxetine?

A

Used in depression and neuropathic pain

32
Q

What drugs are voltage gated sodium-channel blockers?

A

Lidocaine

33
Q

What are the clinical uses of lidocaine?

A

Used as a local anesthetic and for neuropathic pain (lower concentrations compared to when used as anesthetic)

PPI-2 (7 decks)

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