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PHRM 845 Therapeutics > Exam 5 - Pain Barker > Flashcards

Exam 5 - Pain Barker Flashcards

1
Q

chronic pain lasts > ____ months

A

> 3 months

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2
Q

which of these peripheral receptors/channels are temperature sensitive? SELECT ALL THAT APPLY

a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin

A

a. TRPV (vanniloid) = heat
b. TRPM (melastatin) = cold

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3
Q

which of these peripheral receptors/channels are acid sensitive?

a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin

A

c. ASIC (acid sensing ion channel)

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4
Q

which of the following are chemical irritant sensitive? SELECT ALL THAT APPLY

a. TRPV
b. TRPM
c. ASIC
d. Histamine
e. Bradykinin

A

d. Histamine
e. Bradykinin

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5
Q

3 different pain fibers

A

A beta-fibers
A delta-fibers
C-fibers

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6
Q

which is the fastest pain fiber?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

a. A beta-fibers (35-75 m/s)

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7
Q

which is the slowest pain fiber?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

c. C-fibers (0.5-2 m/s)

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8
Q

which pain fiber innervates the skin and detects touch, pressure?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

a. A beta-fibers

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9
Q

which pain fiber is myelinated and detects “first pain” and cold?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

b. A delta-fibers

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10
Q

which pain fibers are unmyelinated and detects “second pain”?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

c. C-fibers

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11
Q

which pain fibers senses pain, temp, touch, pressure, and itch?

a. A beta-fibers
b. A delta-fibers
c. C-fibers

A

c. C-fibers

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12
Q

4 actions of Substance P in peripheral sensitization (slide 14)

A

-vasodilation
-degranulation of mast cells
-release of histamine
-inflammation and prostaglandins

(it also inc expression of pain receptors i.e. sensitization)

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13
Q

what is “referred pain”?

A

when you have injury in one area of body but you feel pain somewhere else

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14
Q

example of referred pain from the lecture

A

myocardial ischemia (there is a usual distribution of pain for this, but other less common sites can be affected)

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15
Q

throbbing, pulsating pain

a. inflammatory
b. neuropathic
c. visceral

A

a. inflammatory

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16
Q

stabbing, shooting, burning, tingling pain

a. inflammatory
b. neuropathic
c. visceral

A

b. neuropathic

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17
Q

squeezing pain

a. inflammatory
b. neuropathic
c. visceral

A

c. visceral

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18
Q

morphine, codeine, thebaine

a. phenanthrenes
b. non-phenanthrenes

A

a. phenanthrenes

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19
Q

tramadol, fentanyl, meperidine

a. phenanthrenes
b. non-phenanthrenes

A

b. non-phenanthrenes

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20
Q

T or F: methadone is a partial mu opioid agonist and also a NMDA antagonist

A

F (full mu agonist)

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21
Q

endogenous opioid at mu receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

a. endorphin

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22
Q

endogenous opioid of kappa receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

b. dynorphin

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23
Q

endogenous opioid at delta receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

c. enkephalin

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24
Q

endogenous opioid at nociceptin, orphanin FQ receptor

a. endorphin
b. dynorphin
c. enkephalin
d. nociceptin

A

c. nociceptin

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25
Q

the kappa opioid receptor has potential use for tx of ______ due to reduced dopamine release

A

addiction

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26
Q

has role in hypoxia/ischemia/stroke

a. mu receptor
b. kappa receptor
c. delta receptor

A

c. delta receptor

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27
Q

T or F: there are several FDA-approved delta opioids on the market

A

F (none)

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28
Q

SE of blocking delta opioid receptor

A

seizures

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29
Q

morphine bioavailability due to first pass metabolism

A

25%

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30
Q

what two CYPs metabolize morphine/phenanthrenes?

A

2D6, 3A4

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31
Q

3 opioids that are prodrugs

A

heroin, codeine, tramadol

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32
Q

T or F: fentanyl and methadone do NOT produce active metabolites

A

T

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33
Q

which opioids used in the hospital are broken down by plasma esterases due to ester linkage?

a. sufentanil, remifentanil, alfentanil
b. fentanyl
c. hydromorphone
d. hydrocodone
e. morphine

A

a. sufentanil, remifentanil, alfentanil

34
Q

T or F: tramadol has SNRI properties

A

T

35
Q

which opioid is used for cough?

a. diphenoxylate with atropine
b. loperamide
c. eluxadoline
d. nalbuphine
e. codeine

A

e. codeine

36
Q

can cause colonic contractions

a. PEG
b. Senna
c. Docusate

A

b. Senna

37
Q

which of the following is TRUE about methadone?

a. fast-acting (2-4 minutes)
b. partial agonist
c. accumulates with repeated dose
d. the (-) enantiomer = NMDA antagonist

A

c. accumulates with repeated dose

(a is slow acting 2-4 hours; b is full; d is (+)

38
Q

which formulation of buprenorphine has abuse potential?

A

subutex

39
Q

naloxone (Narcan) half-life range

a. 2-5 min
b. 10-20 min
c. 30-90 min
d. 4-8 hours

A

c. 30-90 min

40
Q

what is neonatal abstinence syndrome?

A

group of conditions caused when a baby withdraws from certain drugs (opioids) they are exposed to in the womb before birth

41
Q

nonpharm tx for neonatal abstinence syndrome (5)

A

swaddling
hypercaloric formula
frequent feedings
observation
rehydration

42
Q

pharmacological tx for neonatal abstinence syndrome (4)

A

morphine sulfate
SL buprenorphine
methadone
clonidine

43
Q

T or F: for neonatal abstinence syndrome, morphine and buprenorphine are linked with longer hospital stay than methadone

A

F (shorter)

44
Q

what do rubor, tumor, calor, dolor mean in the inflammatory response to pain?

A

redness, swelling, heat, pain

45
Q

three phases of inflammatory response to pain

A

acute -> vasodilation
subacute -> infiltration
chronic -> proliferation

46
Q

eicosanoids are _______ acid metabolites

A

arachidonic

47
Q

aspirin

a. reversible COX 1 inhibitor
b. irreversible COX 1 inhibitor
c. reversible COX1/2 inhibitor
d. irreversible COX1/2 inhibitor

A

d. irreversible COX1/2 inhibitor

48
Q

what does acetylation of COX2 do?

A

changes catalytic activity, turns off ability to generate prostaglandins

49
Q

aspirin, unlike other NSAIDs, _______ inhibits COX enzymes

A

irreversibly

50
Q

acetaminophen can cause dose-dependent, potentially fatal _____ _____

A

hepatic necrosis

51
Q

lidocaine, bupivacaine, and benzocaine are _____ channel blockers

A

sodium

52
Q

lidocaine’s structure has a ____ group while benzocaine has a _____ group

A

amide; ester (esters have higher allergy risk)

53
Q

off label peripheral neuropathy, migraine

a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran

A

a. lamotrigine

54
Q

trigeminal neuralgia

a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran

A

b. carbamazepine

55
Q

Post-herpetic neuralgia, polyneuropathy, fibromyalgia, visceral pain

a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran

A

c. amitriptyline

56
Q

diabetic pain, fibromyalgia, peripheral neuropathy

a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran

A

d. duloxetine

57
Q

off label diabetic neuropathic pain; also has non-selective opioid effects and cardiac toxicity

a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran

A

e. venlafaxine

58
Q

which 3 drugs can be used for fibromyalgia?

a. lamotrigine
b. carbamazepine
c. amitriptyline
d. duloxetine
e. venlafaxine
f. milnacipran

A

c. amitriptyline
d. duloxetine
f. milnacipran

59
Q

two SNRIs that lack sodium channel functionality

A

milnacipran
tapentadol

60
Q

tapentadol use

A

diabetic neuropathic pain

61
Q

SNRIs can increase _____ levels and act on _____ receptors in spinal cord

A

NE; alpha 2 adrenergic

62
Q

how do CCBs work as an analgesic?

A

reduced calcium influx will reduce glutamate release and reduced firing and depolarization of the neuron

63
Q

which of the following are CaV1,2 selective and have no drug-drug interactions? SELECT ALL THAT APPLY

a. levetiracetam
b. ziconotide
c. gabapentin
d. pregabalin

A

c, d

64
Q

half-life of gabapentin and pregabalin (range)

A

4-8 hours

65
Q

which CCB for pain is derived from snail toxin and used in opioid intolerant patients?

a. ziconotide
b. gabapentin
c. pregabalin
d. levetiracetam

A

a. ziconotide

66
Q

which CCB for pain may cause mood symptoms?

a. levetiracetam
b. ziconotide
c. gabapentin
d. pregabalin

A

a. levetiracetam

67
Q

opioids, cannabis, GHB

a. stimulants
b. depressants
c. psychedelics

A

b. depressants

68
Q

alcohol, inhalants

a. stimulants
b. depressants
c. psychedelics

A

b. depressants

69
Q

cocaine, amphetamine, meth

a. stimulants
b. depressants
c. psychedelics

A

a. stimulants

70
Q

bath salts, ecstasy, nicotine

a. stimulants
b. depressants
c. psychedelics

A

a. stimulants

71
Q

LSD, psilocybin, PCP, mescaline, ketamine

a. stimulants
b. depressants
c. psychedelics

A

c. psychedelics

72
Q

morphine

a. stimulants
b. depressants
c. psychedelics

A

b. depressants

73
Q

which of the following do NOT act DIRECTLY on GPCRs? SELECT ALL THAT APPLY

a. opioids
b. LSD
c. cocaine
d. alcohol
e. caffeine
f. marijuana
g. psilocybin
h. MDMA
i. GHB
j. amphetamine

A

c. cocaine
d. alcohol
h. MDMA
j. amphetamine

74
Q

what does incentive salience mean in regards to addiction? (from internet)

A

it’s an unconscious desire for a reward that triggers intense motivation; ex. If a recovering drug user has a cognitive desire to abstain from drugs, but still “wants” drugs. These cravings/desires can be triggered by “cues” such as smelling a drug or being around drug paraphernalia

salience = state or quality of an item that stands out relative to neighboring items

75
Q

how many criteria must be met for mild, moderate, and severe substance use disorder?

A

mild 2-3
moderate 4-5
severe > 6

76
Q

goose bumps and muscle spasms are examples of what kind of withdrawal sx?

a. emotional
b. physical
c. dangerous

A

b. physical

77
Q

headaches, anxiety, and insomnia are examples of what kind of withdrawal sx?

a. emotional
b. physical
c. dangerous

A

a. emotional

78
Q

know the diff between positive and negative reinforcement

A

ok

79
Q

what does LTP mean?

A

long term potentiation -> persistent inc in synaptic strength following intense stimulation

80
Q

rewarding substances cause relative inc in glutamatergic _____ receptors

A

AMPA

81
Q

“cold turkey” refers to what physical sx of withdrawal?

A

goose bumps

82
Q

“kicking the habit” refers to what physical withdrawal sx?

A

muscle spasms

PHRM 845 Therapeutics (34 decks)

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