Bolded Drugs Unit II

Question 1

Cocaine

Answer 1

Local anesthetic with anti-NET properties, causes vasoconstriction and extreme euphoria if it gets central

Question 2

Lidocaine

Answer 2

Used for most applications of sodium channel blockers in local anesthesia.
-Shorter acting, lower cardiotoxicity

Question 3

Bupivacaine

Answer 3

Used in some applications as a sodium channel blocker for local anesthesia
-Longer acting, significant cardiotoxicity

Question 4

Mepivacaine

Answer 4

Sodium channel blocking local anesthetic

-Not really discussed so who the fuck knows?

Question 5

Morphine

Answer 5

Mu agonist– Prototypical among opioids

Question 6

Hydrocodone

Answer 6

Mu agonist– About as strong as codeine, solid antitussive

Question 7

Oxycodone

Answer 7

Mu agonist– About as strong as morphine, the basis of a new american overuse epidemic

Question 8

Codeine

Answer 8

Mu agonist– significantly weaker analgesia than morphine

• About 10% is metabolized to morphine by CYP
• About 10% of caucasians don’t do this right
• Often mixed with an NSAID and sold in a combo deal

Question 9

Tramadol

Answer 9

Mu agonist– but also has MAOI effects

Question 10

Fentanyl

Answer 10

Mu-Agoinst– Powerful as all get out, but a very short period of effectiveness
-We make lollipops and lozenges out of it that help slow and spread the administration

Question 11

Loperamide

Answer 11

AKA Imodium– helps stop diarrhea}

-Opiate but poorly absorbed from mucosa so safe to administer

Question 12

Dextromethorphan

Answer 12

The “DM” in Robotussin DM

-Potent antitussive, can be abused because it causes dissociation

Question 13

Buprenorphine

Answer 13

Mixed mu and kappa agonist with weaker analgesic effect than morphine
-Competitively inhibits morphine

Question 14

Naloxone

Answer 14

Mu antagonist– treatment of choice in stopping opioid analgesia, but short acting so needs a lot of dosing

Question 15

Ibuprofen

Answer 15

Non-selective COX1/COX2 inhibitor

• GI side effects
• Renal side effects
• IV formulation available

Question 16

Naproxen

Answer 16

Non-selective COX1/COX2 inhibitor

• GI side effects
• Renal side effects

Question 17

Ketorolac

Answer 17

Non-selective COX1/COX2 inhibitor

• GI side effects
• Renal side effects
• IV formulation available

Question 18

Celecoxib

Answer 18

Selective Cox 2 inhibitor

-Decreases GI side effects, increases cardiac side effects

Question 19

Acetaminophen

Answer 19

Selective COX2 inhibitor working only in CNS

-Effective but has serious hepatotoxicity problems you must be aware of in dosing it

Question 20

Ketamine

Answer 20

NMDA receptor antagonist– slows the rate that people become tolerant to opioids if administering long term
-TONS of side effects– hypertension, diplopia, arrhythmia, nausea and vomiting, psychomimetic reactions

Question 21

TCADs, SNRIs, SSRIs

Answer 21

Block reuptake of monoamines, enhances descending pathway control of pain
-Useful in diabetic neuropathy, migraine, back pain, postherpetic neuralgia

Question 22

Gabapentin

Answer 22

• Anticonvulsant, blocks VSCCs and hence blocks NT release

- Good for primary neurological problems, like diabetic neuropathy, trigeminal neuralgia, spinal cord injury

Question 23

Lidocaine in pain management

Answer 23

Good for post-herpetic neuralgia, allodynia, any well-localized pain from a somatic source

Question 24

Donepezil

Answer 24

Cholinesterase inhibitor, useful in Alzheimer’s disease

Question 25

Memantine

Answer 25

NMDA-glutamate agonist– Useful adjunctive therapy in Alzheimer’s that may slow down progression

Question 26

NSAIDs used for abortive migraine therapy

Answer 26

Ibuprofen, Naproxen, Acetaminophen

Question 27

Metoclopramide

Answer 27

Dopamine receptor antagonists– for nausea and vomiting

Question 28

Sumatriptan

Answer 28

For stopping migraines

• 5HT1B/1D receptor agonist that helps revasoconstrict and prevent progression of migraine
• Available oral (sumatriptan doesn’t get into CNS well, though)
• Causes tingling, flushing, dizziness, drowsiness, fatigue
• Don’t combine with an ergot, a MOAI, or an SSRI

Question 29

Dihydroergotamine

Answer 29

Ergot– useful in stopping migraines

• Less effective, more toxic than triptans but also target 5HT1B/1D
• Available oral, sublingual, rectal– Dihydroergotamine can be IM or intranasal
• Can cause naus/vom/diah, muscle cramp, parasthesia, vertigo– VASCULAR OCCLUSION + GANGRENE
• Don’t push with NS beta blocker or triptan
• Don’t push with strong CYP3A4 inhibitor or dose increases

Question 30

First line for preventing migraines?

Answer 30

Beta blockers and anticonvulsants

Question 31

Second line for preventing migraines

Answer 31

Maybe ACEI/ARB, antidepressants (not sure why)

Maybe Botox

Question 32

Third line for preventing migraines?

Answer 32

Calcium channel blockers