Midterm Questions Flashcards
THC is a
1. agonist at CB1 and 2
2. partial agonist at CB1 and 2
3. weak antagonist at CB2
4. weak antagonist at CB1
5. 3 and 4
2
which chemical binds to orphan GPCR55 and 5HT1A, inhibiting anandamide uptake and metabolism
1. tramadol
2. duloxetine
3. THC
4. CBD
4
which of the following is NOT a characteristic of cannabinoid hyperemesis syndrome
1. severe N/V
2. compulsory showering
3. anorexia
4. regular use for >1yr, at least weekly
3
which of the following is true
1. CBD is a CYP2C19 inhibitor
2. THC is a CYP 3A4 inhibitor
3. CBD is a CYP3A4 inhibitor
4. THC is a CYP 2C9 inducer
1
CBD is a CYP2C19 inhibitor and substrate, is also a CYP3A4 substrate
THC is a CYP2C9 and 3A4 substrate
match the following antidepressants with the CYP enzyme that inactivates them- either CYP2D6 or 2C19
- fluvoxamine
- sertraline
- citalopram/ escitalopram
- venlafaxine
- amitriptyline
fluvoxamine, venlafaxine = 2D6
sertraline, citalopram/ escitalopram = 2C19
amitriptyline = 2D6 and 2C19
define phenoconversion
when the observed phenotype doesn’t fit what was expected based on the genotype- may be due to nongenetic factors like inflammation, smoking, etc
3 red flags for chronic pain include
possibel fracture, possible tumor/ infection, possible cauda equina sx
which of the following is false
1. TCAs have a =>30% improvement in LBP
2. duloxetine sees a 30-50% improvement in LBP
3. pregabalin causes more weight gain, but less euphoria than gabapentin
4. topiramate is shown to improve chronic LBP in the short term
1- =>30% improvement in neuropathic pain
how often should gabapentinoid doses be titrated?
q3-7d
T or F: acetaminophen is not effective in chronic LBP and is generally not recommended for neuropathic pain
T
in regards to opioids…
1. dose increases should happen q2-14d
2. and adequate trial is 3-6mths
3. buprenorphine is a k receptor and mu agonist
4. fentanyl is a substrate for 3A4
5. 3 is false
6. 1+2
5- 1, 2, 3, 4, are true
_____ has more weight gain, and _____ are more euphoria/ abuse potential
1. pregabalin
2. gabapentin
pregabalin for weight gain
gabapentin for euphoria
what is a adequate trial for tramadol?
4wks
regarding bisphosphonates…
1. they may be used to treat hypercalcemia
2. use for bone pain is controversial
3. caution should be used in renal impairment
4. should not lay down after taking them to prevent esophagitis
5. all of the above
5
what is the CS of choice in cancer pain
dexamethasone
using dexamethasone with NSAIDs increases the risk of
1. flu like effects
2. kidney damage
3. fluid retention
4. gastric ulceration
4
T or F: carbamazepine, valproic acid, and phenytoin may be used for adjuvants in cancer pain
F- no longer first line
dex dose must be tapered if taking for more than ____
2wks
after the failure of traditional cancer pain adjuvants, ____ may be used
ketamine
which of the following is false about methadone
1. there is biphasic elimination, and may result in delayed overdose
2. renal elim depends on urinary pH
3. may prolong QTc interval
4. has a short half life
5. may be used as a coanalgesic
6. has less neurotoxicities
4- long half life
select all of tramadol’s MOAs
1. mu opioid receptor
2. dopamine receptor
3. 5HT reuptake inhibition
4. NE reuptake inhibition
1,3,4
T or F: NSAIDs are as effective as weak opioids, thsi is why step 2 of the WHO analgesic ladder is sus
T
WHO analgesic ladder was made for
1. cancer pain
2. noncancer pain
1
which of the following opioids must be compounded if it’s not an oral tablet? how many days is it good for in the fridge?
1. hydromorphone, methadone- 2 days
2. fentanyl, methadone - 3 days
3. fentanyl, oxycodone - 2 days
4. oxycodone, methadone - 3 days
4
which of the following is not a long acting opioid
1. methadone
2. fentanyl
3. hydrocodone
4. codeine
3
codeine, morphine, hydromorphone, fentanyl, oxycodone, tramadol, methadone
what is first line treatment for severe pain from shingles?
tramadol, strong opioids, topical lidocaine
consider adjuvant with gabapentinoid or TCAs
+ prednisone if severe
which condition can use capsacin cream?
1. painful diabetic neuropathy
2. postherpetic neuralgia
3. shingles pain
4. trigeminal neuralgia
2
how long is an adequate trial of meds for NeP
1. 2wks
2. 4wks
3. 2mths
4. 6wks
2
what should be prescribed along with TCAs
1. artificial saliva spray
2. bowel regimen
3. naloxone
4. topical analgesics
5. 1, 2
5
what is the drug of choice for TGN
1. phenytoin
2. baclofen
3. duloxetine
4. carbamazepine
5. amitriptyline
6. pregabalin
4
what is the least effective adjuvant for acute pain
1. cannabinoids
2. gabapentinoids
3. skeletal muscle relaxants
4. NSAIDs
1- may actually increase pain
skeletal muscle relaxants usually
1. works best after 2 weeks of use for acute pain
2. are indicted for painful diabetic neuropathy
3. has decreased benefit after 1 week for MSK injuries
4. may be used as an adjuvant for shingles pain with opioids
3
which of the following is false: using validated tools for a pain assessment (SPOT, RASS) …..
1. improves pain management
2. decreases use of sedatives
3. decreases length of ventilation and ICU stay
4. increases use of opioids in noncommunicative pts
4- decreases
____ has the least hemodynamic and histamine effects while ____ is the safer option in renal dysfunction
1. morphine, fentanyl
2. fentanyl, hydromorphone
3. hydromorphone, fentanyl
4. fentanyl, morhine
2
