Analgesics - Neuropathic Agents

Question 1

Which of the following is NOT an opioid receptor?

1 - Mu
2 - Kappa
3 - Delta
4 - Alpha

Answer 1

4 - Alpha

Question 2

Which endogenous opioid (made in the body) can bind with opioid receptors which then inhibits GABA release and allows neurotransmitters such as dopamine, serotonin and noradrenaline to be released?

1 - endorphins
2 - methadone
3 - heroin
4 - fentanyl

Answer 2

1 - endorphins

Question 3

Once opioid receptors are activated this inhibits GABA in the brain at specific locations. Those locations are pain processing regions of the brain. Which 2 neurotransmitters are released in the pain processing regions and thus reduce sensitivity to pain?

1 - dopamine
2 - serotonin
3 - noradrenaline
4 - GABA

Answer 3

2 - serotonin
3 - noradrenaline

Question 4

Once opioid receptors are activated this inhibits GABA in the brain at specific locations. This location can be in the reward pathways creating a calming effect. Which neurotransmitters is released in the reward pathway regions of the brain?

1 - dopamine
2 - serotonin
3 - noradrenaline
4 - GABA

Answer 4

1 - dopamine

Question 5

Which 2 of the dopamine drugs below are also indicated in neuropathic pain?

1 - Morphine sulphate
2 - Oxycodone
3 - Codeine phosphate
4 - Tramadol

Answer 5

1 - Morphine sulphate
4 - Tramadol

Question 6

Capsaicin chemical compound that was first isolated from chili peppers that can be used to treat neuropathic pain. What id the mechanism of action for capsaicin?

1 - increases effect of substance P
2 - dysfunction of nociceptors
3 - inhibition of mu recpeotrs
4 - inhibition of Gas GPCR

Answer 6

2 - dysfunction of nociceptors

Question 7

Which 2 of the following anti-epileptics can also be indicated in neuropathic pain?

1 - Carbamazepine
2 - Phenytoin
3 - Gabapentin
4 - Pregabalin

Answer 7

3 - Gabapentin
4 - Pregabalin

Question 8

Gabapentin and Pregabalin are anti-epileptics that can also be indicated in neuropathic pain. What is the mechanism of action of these drugs?

1 - increase GABA binding to GABA receptors
2 - inhibition of GABA receptors on post synapse
3 - inhibition of Ca2+ voltage channels on pre synapse
4 - inhibition of Ca2+ channels on endoplasmic reticulum

Answer 8

3 - inhibition of Ca2+ voltage channels on pre synapse

• no Ca2+ released into the synapse means that excitatory neurotransmitters will not be released into the synaptic cleft
• also suspected to alter GABA levels

Question 9

Which of the following is an indication to use gabapentin in adults?

1 - neuropathic pain in adults
2 - chronic joint pain
3 - prophylactic for migraines
4 - alcohol withdrawal

Answer 9

1 - neuropathic pain in adults

Question 10

Which of the following is NOT an adverse event of gabapentin in adults?

1 - Acute pancreatitis
2 - Suicidal behaviour
3 - Liver failure
4 - Dizziness
5 - Hypersensitivity
6 - Anaphylaxis

Answer 10

3 - Liver failure

• gabapentin + morphine = CNS depression
• gabapentin with antacids containing aluminium and magnesium, reduces gabapentin bioavailability up to 24%

Question 11

Which of the following Serotonin and norepinephrine reuptake inhibitors (SNRI) and Selective serotonin re-uptake inhibitors is indicated for use with neuropathic pain?

1 - Duloxetine
2 - Venlafaxine
3 - Fluoxetine
4 - Sertraline

Answer 11

1 - Duloxetine

Question 12

Duloxetine is Serotonin and norepinephrine reuptake inhibitors (SNRI) that is indicated in the use of neuropathic pain. What is the mechanism of action of this drug?

1 - inhibits re-uptake of noradrenaline + serotonin
2 - inhibits of re-uptake of serotonin
3 - inhibition of Ca2+ voltage channels on pre synapse
4 - inhibits of re-uptake of noradrenaline

Answer 12

1 - inhibits re-uptake of noradrenaline + serotonin

• essentially keeps more of it in the synaptic cleft
• more of serotonin and noradrenaline means pain processing regions of the brain are reduced
• similar result as opioids in increasing the levels of noradrenaline + serotonin

Question 13

Which of the following is an indication to use duloxetine in adults?

1 - neuropathic pain in adults
2 - chronic joint pain
3 - prophylactic for migraines
4 - alcohol withdrawal

Answer 13

1 - neuropathic pain in adults

Question 14

Which of the following is an adverse event of duloxetine in adults?

1 - Hepatitis
2 - Hypertension
3 - Hypersensitivity
4 - Renal Impairment
5 - Serotonin syndrome
6 - All of the above

Answer 14

6 - All of the above

Question 15

Which of the following classes of drugs should duloxetine not be used with?

1 - stimulants
2 - SSRIs
3 - ACE-I
4 - NSAIDs

Answer 15

2 - SSRIs
- some SSRIs are able to inhibit CYP450
- inhibition of CYP450 could cause toxicity in duloxetine

Question 16

Which of the following anti-depressants is indicated in the management of neuropathic pain?

1 - Amitriptyline
2 - Venlafaxine
3 - Fluoxetine
4 - Sertraline

Answer 16

1 - Amitriptyline

Question 17

Amitriptyline is an anti-depressants that is indicated in the management of neuropathic pain. What is the mechanism of action of this drug?

1 - inhibits re-uptake of noradrenaline + serotonin
2 - inhibits of re-uptake of serotonin
3 - inhibition of Ca2+ voltage channels on pre synapse
4 - inhibits of re-uptake of noradrenaline

Answer 17

1 - inhibits re-uptake of noradrenaline + serotonin

• essentially keeps more of it in the synaptic cleft
• more of serotonin and noradrenaline means pain processing regions of the brain are reduced

Question 18

Which 2 of the following are indications to use amitriptyline?

1 - neuropathic pain in adults
2 - chronic joint pain
3 - prophylactic for migraines
4 - alcohol withdrawal

Answer 18

1 - neuropathic pain in adults
3 - prophylactic for migraines

Question 19

Which of the following is NOT an adverse event of amitriptyline?

1 - Sedation
2 - Otoxicity
3 - Cardiotoxicity
4 - Respiratory depression
5 - Serotonin syndrome

Answer 19

2 - Otoxicity

Question 20

Which 2 of the following are important drug actions of Drug interactions of amitriptyline?

1 - CNS depression with other central depressants, including ethanol, benzodiazepines, and opioids
2 - accentuates the effects of morphine
3 - metabolised by CYP450 and any inhibition could lead to toxicity
4 - binds with active metabolites of other drug in kidneys causing tubular necrosis

Answer 20

1 - CNS depression with other central depressants, including ethanol, benzodiazepines, and opioids

3 - metabolised by CYP450 and any inhibition could lead to toxicity