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NMSP 1 > Drugs for Dementia and Pain > Flashcards

Drugs for Dementia and Pain Flashcards

1
Q

What is the mechanism of action for memantine and what disease does it treat?

A
  • -NMDA (N-methyl-D-aspartate) receptor antagonist
  • –binds to the Mg2+ site w/ greater affinity
  • –blocks channel stimulation by glutamate

–Alzheimer Dz (moderate to severe)

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2
Q

What is neuropathic pain?

A

-arises from abnormal neural activity secondary to dz, injury, or dysfxn of the nervous system

  • sympathetically mediated pain
  • peripheral neuropathic pain (postherpetic neuralgia)
  • central pain (ex: phantom limb)
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3
Q

What is allodynia?

A

-pain resulting from a stimulus (such as light touch) that does not normally elicit pain

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4
Q

What is hyperesthesia?

A

-increased sensitivity to stimulation

excluding the special senses

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5
Q

What is dysesthesia?

A

-an unpleasant abnormal sensation, whether spontaneous or evoked

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6
Q

True or False: Delirium can be superimposed on dementia

A

True

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7
Q

What is the mechanism of action for rivastigmine and how is it administered?

A
  • AchE inhibitor for dementia

- transdermal patch

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8
Q

In what organ does COX-2 have a physiologic role?

A

kidney

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9
Q

With NSAID use (especially in patients w/ a lowered GFR) the serum level of what can rise?

A

creatinine

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10
Q

What is the most common clinical complication in advanced dementia?

A

feeding

-offer finger foods, small portions, favorite foods

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11
Q

What normally blocks the NMDA receptor pore?

A

Mg2+

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12
Q

How is menthol used to treat pain?

A

-stimulates TRPM8 “cold receptors” as a counterirritant

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13
Q

What is the mechanism of action of dexmedetomidine?

A

–alpha2-adrenergic agonist for analgesia/sedation

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14
Q

What is hypoalgesia?

A

-diminished response to normally painful stimulus

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15
Q

What is a black box warning of NSAID’s during pregnancy (past 20wks gestation)?

A
  • renal dysfunction

- oligohydramnios

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16
Q

What is the mechanism of action of gabapentin?

A

-binds to CNS alpha-2-delta subunit of voltage-gated calcium channels to inhibit release of NTR

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17
Q

What are three conditions that can be treated with gabapentin?

A
  • neuropathic pain (diabetic peripheral neuropathy)
  • partial focal seizures
  • restless leg syndrome
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18
Q

What is the method of administration for lidocaine?

A

topical analgesic

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19
Q

What is a potential GI complication of COX inhibitors such as aspirin, ibuprofen, celecoxib?

A

ulcers

GI bleeding

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20
Q

True or False: there is no such thing as a “standard dose” of opioids

A

True

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21
Q

What is the mechanism of action of tapentadol for pain treatment?

A
  • -opioid agonist at mu receptor (moderate to strong)

- -blocks NE re-uptake

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22
Q

How is capsaicin used to treat pain?

A
  • stimulates TRPV1 receptors as a counterirritant
  • desensitizes/depletes Substance P
  • treats both nociceptive AND neuropathic pain
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23
Q

What is the treatment for apathy as a symptom of dementia?

A
  • cholinesterase inhibitor
  • antidepressant
  • methylphenidate
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24
Q

Cyclooxygenase (COX) is important in the synthesis of what?

A

prostaglandins from arachidonic acid

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25
Q

What are examples of neuropsychiatric symptoms that can occur in 75% of Alzheimer patients that become more prevalent as the disease progresses?

A
  • delusions/hallucinations
  • euphoria
  • disinhibition
  • aggression
  • depression/anxiety

–these symptoms are not improved by AchE inhibitors

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26
Q

What are some side effects of donepezil (centrally active AchE inhibitor) used to treat Alzheimer dementia?

A
  • altered cardiac conduction (prolong QT, bradycardia)
  • N/V/D
  • can worsen peptic ulcers, asthma/COPD
  • bladder outflow obstruction
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27
Q

What is the mechanism of action of dihydroergotamine in the treatment of migraines?

A

-an ergot alkaloid that binds to multiple receptors to cause vasoconstriction

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28
Q

What is visceral pain?

A
  • pain that arises from viscera stretch receptors
  • poorly localized
  • deep, dull, cramping
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29
Q

What is the mechanism of action of duloxetine?

A

–serotonin and NE re-uptake inhibitor

30
Q

What can duloxetine be used to treat?

A
  • fibromyalgia
  • generalized anxiety disorder
  • major depressive disorder
  • chronic MSK pain
  • neuropathic pain d/t DM
31
Q

What is a side effect of duloxetine?

A

-increased risk of suicidal thoughts and behavior

32
Q

How do NSAID’s cause a decrease in pain?

A

-inhibit synthesis of prostaglandins from arachidonic acid

as opposed to steroids which block the release of arachidonic acid

33
Q

What class of drugs can be used to treat multiple kinds of dementia (off-label) more than just Alzheimer’s?

A

-acetylcholinesterase inhibitors

34
Q

What common component of dementia is preferred to be treated w/ non-pharmacologic strategies?

A

sleep disturbances

  • sleep hygiene
  • maximize natural light in the morning
  • daily exercise
35
Q

What is the mechanism of action in ubrogepant and rimegepant in the treatment of migraines?

A
  • calcitonin gene-related peptide receptor antagonist

- inhibits pathologic dilation of intracranial arteries

36
Q

What is the mechanism of action of amitriptyline and its use in treating chronic pain?

A
  • tricyclic antidepressant

- major depressive disorder associated w/ chronic pain

37
Q

What is a side effect of amitriptyline?

A

-increased risk of suicidal thinking and behavior in children, adolescents, and young adults

38
Q

What is the mechanism of action of tramadol that is used to treat severe pain?

A
  • -partial agonist at mu-opiate receptors in the CNS

- -inhibits re-uptake of NE and serotonin

39
Q

What is the mechanism of action of clonidine and its two main pharmaceutical uses?

A

–alpha2-adrenergic agonist (epidural catheter)

  • -HTN
  • -relief of severe pain (blocks pain signal transmission)
40
Q

Because clonidine and dexmedetomidine stimulate peripheral alpha2-receptors prior to entering the CNS, what can they cause?

A

-transient HTN

41
Q

What is hypoesthesia?

A

-diminished sensitivity to stimulation

excluding special senses

42
Q

What is the mechanism of action of ziconotide for chronic severe pain that is refractory to other treatments (administered intrathecally)?

A

–binds to N-type voltage-sensitive calcium channels on nociceptive afferent nerves of the dorsal horn in the spinal cord

–blocks release of excitatory NTR’s, causing reduced sensitivity to painful stimuli

43
Q

What is the major clinical application of acetaminophen?

A
  • temporary relief of minor aches, pains, headache

- -NOT an anti-inflammatory

44
Q

What is the antidote for the acetaminophen hepatotoxicity that occurs when glutathione is depleted?

A

N-acetylcysteine

  • -there is a limited dose range b/w safe and toxic
  • -does NOT impair renal function
45
Q

What is paresthesia?

A
  • an abnormal sensation, whether spontaneous or evoked

ex: numbness, “pins and needles”

46
Q

What is nociceptive pain?

A

-perception of input from a nociceptor, a nerve fiber that is preferentially sensitive to noxious stimuli

47
Q

What is the mechanism of action for galantamine in the treatment of dementia?

A

-AChE inhibitor (reversible)

48
Q

True or False: d/t risk of Reye Syndrome, aspirin should not be used to treat children w/ chicken pox or flu

A

True

49
Q

How might long-term aspirin use affect the kidney?

A

papillary necrosis

50
Q

What are the effects of aspirin during labor and delivery?

A
  • suppress uterine ctx
  • premature closure of ductus arteriosus
  • intensify uterine bleeding
51
Q

What is the mechanism of action of ketamine and its use?

A

-NMDA receptor antagonist that blocks glutamate

  • induction and maintenance of general anesthesia
  • lower dose for acute and chronic pain
  • reduces the amount of morphine needed for pain
52
Q

What is an endogenous opioid in the descending pain inhibitory fibers?

A

enkephalin

53
Q

When cyclooxygenase is blocked, what product can still be generated from arachidonic acid via a different pathway?

A

-leukotrienes that cause bronchoconstriction

54
Q

Aspirin toxicity causes hyperventilation leading to what, initially?

A

respiratory alkalosis

55
Q

What is the only COX-2 inhibitor on the US market?

A

celecoxib

56
Q

What is a serious side effect of celecoxib?

A
  • risk of thrombosis
  • risk of MI
  • risk of stroke
  • contraindicated in CABG patients

–benefits may outweigh risks in pts w/ GI problems

57
Q

What is hyperalgesia?

A

increased response to a stimulus that normally is painful

58
Q

What is the mechanism of action of naproxen and benefit to taking it over other NSAID’s?

A
  • -reversible non-selective COX inhibitor
  • -long half-life (15hrs) allows once daily dosing
  • -okay to take even with heart problems
59
Q

What can happen if you abruptly stop donepezil (AChE inhibitor) or memantine (NMDA receptor antagonist) that are used to treat dementia?

A

AMS

60
Q

What SSRI can be used to treat depression in Alzheimer patients?

A

citalopram

-sertraline could be an alternative

–AVOID tricyclic antidepressants (amitriptyline)

61
Q

What is the ascending pain transmission pathway?

A

spinothalamic tract

62
Q

True or False: recurrent infections is a common clinical problem in patients with advanced dementia

A

True

63
Q

True or False: chronic daily medications should be discontinued in pts with advanced dementia when they are no longer beneficial

A

True

64
Q

Does post-herpetic neuralgia cause peripheral nerve damage or autonomic nerve damage?

A

peripheral

65
Q

What are prostaglandins?

A

arachidonic acid metabolites that are important mediators of pain sensation by nociceptors

66
Q

How is the dorsal horn of the spinal cord important in pain?

A

-it’s where the nociceptor input converges with the descending neuromodulatory input on the neurons transmitting the pain

67
Q

What is lasmiditan (5-HT1F receptor agonist) used to treat and how does it work?

A

migraines

  • decreases stimulation of the trigeminal system
  • does NOT cause vasoconstriction
68
Q

What is somatic pain?

A
  • -arises from injury to body tissues
  • -well-localized
  • -variable in description and experience
69
Q

What is the mechanism of action of sumatriptan and what does is treat?

A
  • -selective 5-HT1B and 5-HT1D agonist

- -moderate to severe migraines

70
Q

What is the mechanism of action of pregabalin and what does it treat?

A

–binds to alpha-2-delta subunit of voltage-gated calcium channels and inhibits release of NTR’s

  • -neuropathic pain (d/t diabetic neuropathy)
  • -fibromyalgia
  • -focal partial seizures
71
Q

What is the mechanism of action of ibuprofen and what are the major risks?

A

-reversible COX inhibitor

  • increased risk of MI and stroke
  • increased risk of GI bleed
72
Q

What is the mechanism of action of aspirin?

A
  • irreversible binds COX

- antiplatelet agent

NMSP 1 (9 decks)

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