Ch 11 - Pain Medicine: Non-opioid Pharmacology

Question 1

MOA of acetaminophen

Answer 1

It inhibits prostaglandin synthesis within the CNS (crosses bloodbrain barrier) but not peripherally

Question 2

What is the daily max dose of acetaminophen?

Answer 2

<3 grams/day max recommended d/t hepatotoxocity

Question 3

MOA of NSAIDs

Answer 3

Inhibit COX-1 and COX-2 enzymes, which produce prostaglandins involved in promoting inflammatory responses after tissue injury

Question 4

Which NSAIDs have more COX-2 selectivity

Answer 4

Most: Meloxicam, Celecoxib
Less: Diclofenac, Sulindac

Question 5

Which NSAID is the MCC of liver failure?

Answer 5

Sulindac

Question 6

Which NSAIDs have the less COX-2 selectivity?

Answer 6

Ibuprofen
Naproxen
Salicylate
Least: Indomethacin

Question 7

Types of TCAs

Answer 7

amitriptyline
desipramine
nortriptyline,
imipramine
doxepin
clomipramine

Question 8

MOA of TCAs

Answer 8

Inhibit serotonergic and noradrenergic reuptake

Question 9

SE of TCAs

Answer 9

QTc elongation

Lethal toxicity → the leading cause of overdose death

Question 10

Which TCA has a lower incidence of SE?

Answer 10

Nortriptyline (an active metabolite of amitriptyline)

Question 11

Types of SSRIs

Answer 11

citalopram
fluoxetine
paroxetine
sertraline

Question 12

MOA of SSRIs

Answer 12

inhibit presynaptic serotonin reuptake in the CNS

Question 13

Types of SNRIs

Answer 13

venlafaxine

duloxetine

Question 14

MOA of SNRIs

Answer 14

inhibit serotonin and norepinephrine reuptake

Question 15

What is Duloxetine approved for in the US?

Answer 15

diabetic peripheral neuropathic pain
fibromyalgia
generalized anxiety
major depression

Question 16

What can Venlafaxine cause?

Answer 16

HTN

Question 17

MOA of Gabapentin

Answer 17

interacts with the α2δ subunit of L-type calcium channels

Question 18

What is Gabapentin used for?

Answer 18

diabetic neuropathy
postherpetic neuralgia
HIV-associated neuropathy
Guillain–Barre syndrome
phantom limb pain
spinal cord injury (SCI) pain
cancer-associated neuropathic pain

Question 19

SE of Gabapentin (Neurontin)

Answer 19

Somnolence
dizziness
edema

Question 20

MOA of Pregabalin (Lyrica)

Answer 20

interacts with the α2δ subunit of L-type calcium channels

Question 21

What is Pregabalin used for?

Answer 21

postherpetic neuralgia
diabetic neuropathy
SCI pain
fibromyalgia

Question 22

SE of Pregabalin

Answer 22

Somnolence
Dizziness
Dry mouth
Edema

Question 23

MOA of Valproic acid (Depakote)

Answer 23

increases gamma-aminobutyric acid (GABA) effects and may inhibit
N-methyl-D-aspartate (NMDA)/glutamate receptors

Question 24

What is Valproic acid used for?

Answer 24

antimanic
antidepressant
impulsivity
seizures
migraine prophylaxis

Question 25

SE of Valproic acid (Depakote)

Answer 25

Thrombocytopenia* 
neutropenia*
anemia*
dizziness
sedation
hepatitis
pancreatitis

Question 26

MOA of Lamotrigine (Lamictal)

Answer 26

inhibits voltage-dependent sodium channels, although the exact mechanism is unknown

Question 27

What is Lamotrigine (Lamictal) used for?

Answer 27

seizure
mood stabilization
migraine prophylaxis

Question 28

SE of Lamotrigine (Lamictal)

Answer 28

Rash
toxic epidermal necrolysis
dizziness
malaise
headaches (HAs) 
ataxia

Question 29

MOA of Carbamazepine (Tegretol)

Answer 29

inhibits voltage-gated sodium channels

Question 30

What is Carbamazepine (Tegretol) used for?

Answer 30

seizures
mood stabilizer
trigeminal neuralgia**

Question 31

SE of Carbamazepine (Tegretol)

Answer 31

Rash
aplastic anemia*
agranulocytosis*
Need to monitor level
closely in the beginning due to auto-induction

Question 32

MOA of Oxcarbazepine (Trileptal)

Answer 32

inhibits voltage-gated sodium channels

Question 33

What is Oxcarbazepine (Trileptal) used for?

Answer 33

seizures

trigeminal neuralgia*

Question 34

SE of Oxcarbazepine (Trileptal)

Answer 34

Sedation
hyponatremia*
dizziness
somnolence
nausea
vomiting