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NMSP > Drugs for Pain cont. > Flashcards

Drugs for Pain cont. Flashcards

1
Q

What is the MOA for NSAIDs?

A

(-) COX 1 and/or COX2

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2
Q

Which COX is expressed in all tissues and which COX is expressed in some tissues some times?

A

ALL tissues = COX1

Some tissues some times = COX2

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3
Q

MOA for Aspirin?

A

IRREVERSIBLY (-) COX

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4
Q

What are 3 side effects of Aspirin?

A
  • Ulcer
  • Increased risk for bleeding
  • Reye Syndrome
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5
Q

What is different about NON-Aspirin NSAIDs?

A

They (-) COX REVERSIBLY

– Also, have an increased risk for MI and stroke!

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6
Q

What do NON-Aspirin NSAIDs have an increased risk of compared to Aspirin?

A

Increased risk of MI and stroke

– reversibly (-) COX

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7
Q

NON-Aspirin NSAIDs are contraindicated in what patients?

A

CABG

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8
Q

What is the half life of Naproxen and what is good about it?

A

Half life = 12-17 hours

==> Best in patients that are at risk of cardiovascular complications

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9
Q

Which NON-Aspirin NSAID is the best choice in patients that are at risk of cardiovascular complications?

A

Naproxen

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10
Q

Which NSAID only (-) COX2?

A

Celecoxib

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11
Q

Celecoxib has LESS risk of what adverse effects seen with NSAIDs?

A

LESS gastric ulceration and LESS risk of bleeding

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12
Q

What are some adverse effects that can occur with NSAIDs that are taken during pregnancy?

A

Fetal oligohydramnios due to renal dysfunction

Closes ductus arteriosus early

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13
Q

List 4 contraindications for NSAID use

A
  1. Chronic Kidney Disease
  2. Gastric Ulcer
  3. Treatment with anticoagulants
  4. HTN or Heart failure
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14
Q

Acetaminophen does not suppress inflammation. What adverse effects can be seen with overdosage and what is the safe dose?

A
  • Safe dose = < 3g/day

==> liver failure and death can occur with overdose

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15
Q

Acetaminophen is a toxic metabolite when _____ is depleted. What is the antidote?

A

When Glutathione is depleted

- Antidote = N-acetylcysteine

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16
Q

What are 2 adverse effects of Amitriptyline?

A

Suicidal thinking and anticholinergic effects

17
Q

When may the onset of effects be seen when taking Amitriptyline?

A

6-8 weeks

18
Q

What is an adverse effect of Duloxetine?

A

Suicidal thinking

19
Q

Which alpha-2-delta calcium channel ligand is more sedating and has less reliable pharmacokinetics?

A

Gabapentin

20
Q

What are the adverse effects of Gabapentin and Pregabalin?

A

Depression and suicide ideation

21
Q

Which drug can (-) ascending pain pathways and increase descending inhibitory pain pathways?

A

Tramadol

22
Q

MOA for Tramadol

A

Partial agonist at Mu opiate receptors and (-) NE/5HT reuptake

23
Q

What are some (3) of the serious adverse effects of Tramadol?

A

Respiratory depression
Addiction/withdrawal syndrome
Interactions with drugs affecting the CYP450 enzymes

24
Q

Tapentadol is a ____ mu agonist with less ______

A

Stronger mu agonist with less constipation

25
Q

How is Ketamine given?

A

IV

26
Q

What does Ketamine induce?

A

Cataleptic state with dissociation from the environment

27
Q

Where does Ziconotide work?

A

Works at nociceptive afferent nerves of the dorsal horn

28
Q

How is Ziconotide given?

A

Intrathecal

29
Q

What is the adverse effect with Ziconotide?

A

Severe psych symptoms

30
Q

What topical treatments (+) TRPV1 to feel like “heat”?

A

Capsaicin

Camphor

31
Q

What topical treatment (+) TRPM8 to feel like “cold”?

A

Menthol

32
Q

MOA for Lasmiditan?

A

5-HT1F Agonist

33
Q

What are the effects of Lasmiditan?

A

Decreases stimulation of trigeminal system without causing vasoconstriction

34
Q

What should you not use Dihydroergotamine with?

A

CYP3A4 inhibitors

35
Q

What is there a risk of with Dihydroergotamine?

A

Vasospasm –> ischemia

NMSP (28 decks)

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