Ch 11 - Pain Medicine: Non-opioid Pharmacology Flashcards
MOA of acetaminophen
It inhibits prostaglandin synthesis within the CNS (crosses bloodbrain barrier) but not peripherally
What is the daily max dose of acetaminophen?
<3 grams/day max recommended d/t hepatotoxocity
MOA of NSAIDs
Inhibit COX-1 and COX-2 enzymes, which produce prostaglandins involved in promoting inflammatory responses after tissue injury
Which NSAIDs have more COX-2 selectivity
Most: Meloxicam, Celecoxib
Less: Diclofenac, Sulindac
Which NSAID is the MCC of liver failure?
Sulindac
Which NSAIDs have the less COX-2 selectivity?
Ibuprofen
Naproxen
Salicylate
Least: Indomethacin
Types of TCAs
amitriptyline desipramine nortriptyline, imipramine doxepin clomipramine
MOA of TCAs
Inhibit serotonergic and noradrenergic reuptake
SE of TCAs
QTc elongation
Lethal toxicity → the leading cause of overdose death
Which TCA has a lower incidence of SE?
Nortriptyline (an active metabolite of amitriptyline)
Types of SSRIs
citalopram
fluoxetine
paroxetine
sertraline
MOA of SSRIs
inhibit presynaptic serotonin reuptake in the CNS
Types of SNRIs
venlafaxine
duloxetine
MOA of SNRIs
inhibit serotonin and norepinephrine reuptake
What is Duloxetine approved for in the US?
diabetic peripheral neuropathic pain
fibromyalgia
generalized anxiety
major depression
What can Venlafaxine cause?
HTN
MOA of Gabapentin
interacts with the α2δ subunit of L-type calcium channels
What is Gabapentin used for?
diabetic neuropathy postherpetic neuralgia HIV-associated neuropathy Guillain–Barre syndrome phantom limb pain spinal cord injury (SCI) pain cancer-associated neuropathic pain
SE of Gabapentin (Neurontin)
Somnolence
dizziness
edema
MOA of Pregabalin (Lyrica)
interacts with the α2δ subunit of L-type calcium channels
What is Pregabalin used for?
postherpetic neuralgia
diabetic neuropathy
SCI pain
fibromyalgia
SE of Pregabalin
Somnolence
Dizziness
Dry mouth
Edema
MOA of Valproic acid (Depakote)
increases gamma-aminobutyric acid (GABA) effects and may inhibit
N-methyl-D-aspartate (NMDA)/glutamate receptors
What is Valproic acid used for?
antimanic antidepressant impulsivity seizures migraine prophylaxis
SE of Valproic acid (Depakote)
Thrombocytopenia* neutropenia* anemia* dizziness sedation hepatitis pancreatitis
MOA of Lamotrigine (Lamictal)
inhibits voltage-dependent sodium channels, although the exact mechanism is unknown
What is Lamotrigine (Lamictal) used for?
seizure
mood stabilization
migraine prophylaxis
SE of Lamotrigine (Lamictal)
Rash toxic epidermal necrolysis dizziness malaise headaches (HAs) ataxia
MOA of Carbamazepine (Tegretol)
inhibits voltage-gated sodium channels
What is Carbamazepine (Tegretol) used for?
seizures
mood stabilizer
trigeminal neuralgia**
SE of Carbamazepine (Tegretol)
Rash aplastic anemia* agranulocytosis* Need to monitor level closely in the beginning due to auto-induction
MOA of Oxcarbazepine (Trileptal)
inhibits voltage-gated sodium channels
What is Oxcarbazepine (Trileptal) used for?
seizures
trigeminal neuralgia*
SE of Oxcarbazepine (Trileptal)
Sedation hyponatremia* dizziness somnolence nausea vomiting
