Dementia & Pain

Question 1

What is Naproxen?

Answer 1

reversible non selective NSAID w/ longer 1/2 time that permits 1x/day dosing

for pts w/ CV issues

Question 2

What are paresthesias?

Answer 2

abnormal sensation (numbness, pins & needles)

Question 3

What do IV opioids, alpha2 agonists and general anesthetics module?

Answer 3

perception of pain

Question 4

What is ziconotide?

Answer 4

last resort drug that blocks N-type voltage-sensitive Ca2+ channels on afferent nerves in dorsal horn

Question 5

MOA of ketamine

Answer 5

noncompetitive NMDA receptor antagonist

IV anesthesia, lower doses for chronic pain

Question 6

MOA of lasmiditan

Answer 6

5HT1F agonist to tx migraines & decrease trigeminal stimulation (w/o vasoconstriction)

Question 7

What lethal effect caused by acetaminophen OD?

Answer 7

hepatotoxicity

Question 8

MOA of aspirin

Answer 8

NSAID that irreversibly inhibits COX1, COX2, for lifetime in platelets

Question 9

What is dysesthesia?

Answer 9

unpleasant abnormal sensation

Question 10

MOA of ibuprofen

Answer 10

reversible NSAID

increase risk of MI, stroke

Question 11

What risk increased w/ aspirin & warfarin use?

Answer 11

risk of BLEEDING

Question 12

MOA of pregabalin

Answer 12

inhibits NT release @ nerve terminals

neuropathic pain (DM neuropathy, SC injury, postherpetic neuralgia)

Question 13

MOA of donepezil

Answer 13

reversible noncompetitive inhibitor of AChE

prolongs signaling of ACh in synaptic cleft

Question 14

What is hypoalgesia?

Answer 14

diminished response to normally painful stimulus

Question 15

MOA of acetaminophen

Answer 15

NO tx of inflammation

monotherapy for fever reduction

temporary relief of mild to moderate pain

Question 16

What is potentially lethal consequence of aspirin toxicity?

Answer 16

metabolic acidosis

Question 17

MOA of dexmedetomidine

Answer 17

selective A2 receptor agonist

IV for sedation, analgesia

Question 18

MOA of capsaicin

Answer 18

stimulates TRPV1 receptors

depletes substance P from neurons tx nociceptive & neuropathic pain

Question 19

What is added to acetaminophen to extend its utility in management of moderate to severe pain?

Answer 19

opioids (stimulate mu receptors)

Question 20

What is cardiac effect of donepezil?

Answer 20

QT prolongation

can lead to Torsades

Question 21

MOA of celecoxib

Answer 21

COX2 selective inhibitor

acute pain & inflammation

serious risk of thrombotic events

Question 22

MOA of sumatriptan

Answer 22

selective 5HT1B, D agonist

tx mod to severe migraines by decrease neurogenic inflam

Question 23

MOA of lasmiditan

Answer 23

5HT1F agonist

tx of migraine

Question 24

What is an important mediator of sensory pain?

Answer 24

substance P (from terminals of sensory nerves in response to noxious stimuli)

Question 25

What drug class used off-label to tx many forms of dementia besides Alzheimers?

Answer 25

AChE inhibitor

Question 26

What tract is the ascending pain pathway?

Answer 26

spinothalamic tract

Question 27

What are common indications for NSAIDs?

Answer 27

HA, fever, menstrual pain

Question 28

MOA of gabapentin

Answer 28

binds A2D subunit of Ca2+ channels to modulate Ca2+ influx

Question 29

Level of what can increase in serum w/ NSAID use?

Answer 29

serum Cr (esp if low GFR)

Question 30

MOA of tapentadol

Answer 30

moderate to strong mu agonist, blocks NE reuptake tx pain

Question 31

MOA of galantamine

Answer 31

AChE inhibitor tx dementia

Question 32

What is a common clinical problem in pts w/ advanced dementia?

Answer 32

recurrent infection

Question 33

What are triptans?

Answer 33

5HT agonists used to tx HA AE of QT prolong, coronary vasospasm (MI, stroke)

Question 34

What sxs are worsened by donepezil?

Answer 34

bradycardia | bronchoconstriction

Question 35

MOA of dihydroergotamine

Answer 35

ergot alkaloid derivative binds to vasoconstrictive receptors to tx migraine

Question 36

Role of PGEs

Answer 36

mediators of pain sensation by nociceptors cause sxs of inflammation

Question 37

What drug causes salicylism?

Answer 37

aspirin tinnitus, N/V

Question 38

MOA of tramadol

Answer 38

partial agonist @ mu opioid receptors & blocks NE/5HT reuptake used for pain relief

Question 39

What drugs have limited efficacy & increased mortality in pts w/ dementia?

Answer 39

anti psychotic agents

Question 40

What is neuropathic pain?

Answer 40

pain due to abnormal neural activity from disease, injury, or dysfxn of nervous system

Question 41

MOA of rivastigmine

Answer 41

AChE inhibitor for dementia TRANSDERMAL PATCH

Question 42

MOA of memantine

Answer 42

blocks excessive glutamate (excitatory) activity thought to contribute to Alzheimer dz progression

Question 43

MOA of duloxetine

Answer 43

SNRI tx neuropathic pain (fibromyalgia, DM, chemotherapy)

Question 44

MOA of amitriptyline

Answer 44

TCA for neuropathic pain

Question 45

What is black box concern for NSAID use by pregnant Fs?

Answer 45

oligohydramnios

Question 46

MOA of clonidine

Answer 46

A2 agonist intrathecal for pain

Question 47

How to tx apathy in Alzheimer dz?

Answer 47

low dose methylphenidate & antidepressant

Question 48

MOA of citalopram

Answer 48

SSRI to tx depression assoc w/ Alzheimer dz

Question 49

What are analgesics?

Answer 49

drugs that relieve pain w/o LOC