HIGH YIELD

Question 1

T/F, opiates are used for both acute and chronic pain?

Answer 1

true, for both

Question 2

what are the types of pain?

Answer 2

visceral
neuropathic
somatic

Question 3

what are the drugs used for neuropathic pain?

Answer 3

anticonvulsants
-gabapentin
-pregabalin
tricyclic antidepressants
-amitryptiline
SNRIs
-duloxetine

Question 4

this is a theory that involves using multiple agents w/ complementary mechanisms and allows for opioid sparing and fewer side effects

allows you to use smaller doses of opioid

Answer 4

multimodal pain therapy

Question 5

what are the first line non opioids for mild-moderate pain?

Answer 5

acetaminophen and NSAIDs

Question 6

types of opiates for mild, moderate and severe pain?

Answer 6

non opioid
weak opioid + adjuvant therapy
strong opioid + non opioid + adjuvant therapy

Question 7

morphine, codeine is an example of?

Answer 7

opiates

Question 8

opiates can affect what pathways?

Answer 8

ascending pathway
-opioids bind to the mu opioid receptor

descending pathway
-mu receptor inhibits GABA activating this pathway sending out descending inhibiting NTs (GABA) decreasing pain

Question 9

what are the opioid agonists? (which ones are full or partial)

Answer 9

methadone, full agonist
buprenorphine, partial agonist

• partial agonist
• plateau
• can be an antagonist to a full agonist

Question 10

what are the routes of admin?

Answer 10

oral and parenteral (common)
patient controlled analgesia
spinal delivery
rectal, oral transmucosal, transdermal

Question 11

what are the organ system effects of opioids?

cautions in therapy?

Answer 11

respiratory depression
sedation
GI (constipation, N/V, biliary tract)
Hypogonadism
adrenal insufficiency
Others
-pruritis
-euphoria
-urinary retention
-seizures

head injuries
pregnancy
respiratory disorders

Question 12

to avoid respiratory depression, we must carefully consider opiates for what patient types?

Answer 12

pulmonary diseases
elderly
meds that depress resp drive
-alcohol, anesthetics, sedatives, hypnotics

tolerance can occur

Question 13

what receptor is affected that causes constipation?

does tolerance develop?

Answer 13

Mu receptor

no, tolerance does not develop

*can be prevented with laxatives (docusate, senna, cathartics)

Question 14

absorption of opiates can happen in what ways?

distribution occurs how?

Answer 14

oral
transdermal
parenteral
transmucosal

• crosses the BBB for analgesic effect
• lipophilic drugs cross BBB and accumulate in fatty tissue; placenta and into fetus