Analgesics PCol Quiz Flashcards
Select the best match:
Phenanthrenes
Phenylpiperidines
Buprenorphine
Methadone
A) Morphine, hydromorphone
B) Fentanyl, meperidine
C) Agonist/antagonist
D) Longest duration of action of this group
Phenanthrenes - A
Phenylpiperidines - B
Buprenorphine - C
Methadone - D
Match the medication with the most correct mechanism of action. Remember to choose the best answer.
Strong opioid agonists
NSAIDS
Codeine
Acetaminophen
A) Inhibit the synthesis of prostaglandins
B) The exact mechanism of unknown but this medication appears to work via inhibition of prostaglandin synthesis, although this compound does not have anti-inflammatory or anti-thrombotic properties
C) Methylmorphine is a prodrug that must be metabolized via cytochrome p450 2D6 enzymes to the active compound morphine
D) Activates inhibitory pathways for pain suppression, and inhibits pathways for the appreciation and transmission of pain
Strong opioid agonists - D
NSAIDS - A
Codeine - C
Acetaminophen - B
All of the following are properties of opioids EXCEPT:
A) Oral absorption of opioids is significantly less than SC or IV
B) Unlike many other medications there is no plateau effect
C) Long acting agents, and dose forms are easy and safe to titrate
D) NSAIDs and acetaminophen may be just as effective as mild to moderate opioid agonists
C
Match the medication with its most important adverse effect:
Opioids
NSAIDs
Acetaminophen
A) GI bleeding
B) Respiratory distress
C) Liver toxicity
Opioids - B
NSAIDs - A
Acetaminophen - C
Identify the statement that is NOT a risk factor for NSAID associated gastroduodenal ulcers:
A) Exposure to ancient sumerians
B) Age
C) Concomitant use of corticosteroids
D) History of ulcer
A
The main advantage of ketorolac over other NSAIDs is that ketorolac:
A) Can be combined safely with an opioid such as codeine
B) Does not prolong bleeding time
C) Is available in a parenteral formulation for intramuscular or intravenous injection
D) Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment
C
A 22 month old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient’s death?
A) Arrhythmia
B) Hemorrhagic stroke
C) Liver failure
D) Ventilatory failure
C
Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action?
A) Acetaminophen
B) Celecoxib
C) Colchicine
D) Indomethacin
A - acetaminophen is the only drug that fits this description. Indomethacin is a nonselective COX inhibitor and celecoxib is a COX-2 inhibitor; both have analgesic, antipyretic, and anti-inflammatory effects. Colchicine is a drug used for gout that also has an anti-inflammatory action
A 54 year old woman presents with signs and symptoms consistent with an early stage of rheumatoid arthritis. You decide to initiate NSAID therapy.
Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis?
A) History of alcohol abuse
B) History of gout
C) History of myocardial infarction
D) History of osteoporosis
C - celecoxib is a selective COX 2 inhibitor. COX 2 inhibitors have the advantage over nonselective NSAIDs of reduced GI toxicity, BUT clinical data suggest that they are more likely to cause arterial thrombotic events. A history of MI would be a compelling reason to avoid a COX 2 inhibitor
A 63 year old man is undergoing radiation treatment as an outpatient for metastatic bone cancer. His pain is treated with a fixed combination of oxycodone plus acetaminophen taken orally. Despite increasing doses of the analgesic combination, the pain is getting worse.
The most appropriate oral medication for his increasing pain is:
A) Buprenorphine
B) Codeine plus aspirin
C) Hydromorphone
D) Tramadol
C - in most situations, pain associated with metastatic carcinoma ultimately necessitates the use of an opioid analgesic that is equivalent in strength to morphine, so hydromorphone, oxymorphone, or levorphanol would be indicated. The combination of codeine plus salicylate would not be as effective as the original drug combination. Propoxyphene and tramadol are less active than the original. Buprenoprhine, a mixed agonist-antagonist, is not usually recommended for cancer associated pain because it has a limited maximum analgesic effect (“ceiling”) and because of possible dysphoric and psychotomimetic effects
A 16 year old girl comes to the ED suffering from the effects of an aspirin overdose. Which of the following syndromes is this patient most likely to exhibit as a result of this drug overdose?
A) Bone marrow suppression and possibly aplastic anemia
B) Fever, hepatic dysfunction, and encephalopathy
C) Rapid, fulminant hepatic failure
D) Rash, interstitial nephritis, and acute renal failure
E) Hyperthermia, metabolic acidosis, and coma
E - salicylate intoxication is associated with metabolic acidosis, dehydration, and hyperthermia. If these problems are not corrected, coma and death ensue.
A young man is brought to the ED in an anxious and agitated state. He informs the attending physician that he uses “street drugs” and that he gave himself an intravenous “fix” approximately 12 h ago. After an initial period of contentment and relaxation, he now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. You note that his pupil size is larger than normal.
What is the most likely cause of these signs and symptoms?
A) The patient had injected dextroamphetamine
B) The patient has overdosed with an opioid
C) The signs and symptoms are those of the opioid abstinence syndrome
D) The patient has hepatitis B
C - the signs and symptoms are those of withdrawal in a patient physically dependent on an opioid agonist, especially morphine or heroin. They usually start with 6-10 hours after the last dose, their intensity depends on the degree of physical dependence, and peak effects usually occur at 36-48 hours. Mydriasis is a prominent feature of the abstinence syndrome; other symptoms include rhinorrhea, lacrimation, piloerection, muscle jerks, and yawning.
An overdose of dextroamphetamine would not produce an initial feeling of contentment and relaxation.
