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Pharmacology > Neuro: Drugs for Pain > Flashcards

Neuro: Drugs for Pain Flashcards

1
Q

What does tissue damage initiate the release of?

A

Prostaglandins (PGE2),
Bradykinin,
Histamine

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2
Q

What causes secondary hyperalgesia?

A

Glutamate stimulation of spinal NMDA receptors

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3
Q

MOA of aspirin

A

irreversible inhibits COX-1 and COX-2

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4
Q

Clinical use for aspirin?

A

Immediate release as analgesic, antipyretic, and anti-inflammatory

Extended-release: reduce stroke

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5
Q

Off label uses for aspirin?

A

Colon cancer, to prevent atherosclerosis

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6
Q

Adverse effects of aspirin?

A

ulcer and risks of bleeding
Increase serum creatinine
-loss off PG vasodilation of afferent arteriole

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7
Q

What is nociceptive pain?

A

perception of input from a nociceptor, which is a nerve fiber

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8
Q

What is neuropathic pain?

A

Abnormal neural activity secondary to disease, injury, or dysfunction of the nervous system

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9
Q

MOA of ibuprofen and naproxen

A

reversible inhibits COX-1 and COX-2

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10
Q

Black box warning in all NSAIDs

A

Increase risk of MI and stroke

Increase risk of bleeding

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11
Q

Who should avoid NSAIDs

A

Pregnant women (can lead to renal dysfunction and close ductus arteriosus)

CABG pts

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12
Q

Celecoxib MOA

A

selective reversible COX-2 inhibitor

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13
Q

Adverse effects of celecoxib?

A

Thrombotic events (from sketchy)

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14
Q

What conditions is aspirin especially useful for?

A

Chronic pain conditions, such as rheumatoid arthritis

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15
Q

What should you do when prescribing nonasparin NSAIDs

A

use lowest possible dose for shortest time due to increase risk of MI and stroke

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16
Q

Does celecoxib increase risk of bleeds?

A

No, does not inhibit platelets

-does increase risk for thrombosis though

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17
Q

MOA of acetaminophen

A

TRPV1 and TRPA activation (possibly?)

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18
Q

Clinical applications of acetaminophen

A

temporary relief for aches and pains, and headache

-only for mild to moderate pains

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19
Q

Black box warning of acetaminophen?

A

Risk of medication errors and overdose–>hepatotoxicity with acute liver failure

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20
Q

Does acetaminophen suppress inflammation?

A

Nope, only pain and fever

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21
Q

Is acetaminophen associated with the GI and anti-platelet side effects of NSAIDs?

A

No, does not inhibit COX1/2

22
Q

How do you treat acetaminophen overdose?

A

N-acetylcystine can replenish reduced glutathione stores

23
Q

MOA of morphine

A

binds opiod receptors in brain

24
Q

Black box waring for morphine

A

respiratory and CNS depression, especially with other drugs

25
Q

What are three firstline drug classes for neuropathic pain?

A
  1. α2δ Ca channels blockers (pregabalin, gabapentin)
  2. SNRIs (duloxetine)
  3. TCAs (amitriptyline)
26
Q

MOA of amitriptyline

A

tricyclic antidepressant

-increases NE and 5-HT in cleft

27
Q

Black box warning for amitriptyline

A

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

28
Q

MOA of duloxetine

A

Potent Serotonin and NE Reuptake Inhibitor

Great for depression and neuropathic pain

29
Q

Black box warning for duloxetine

A

increases risk of suicidal thoughts and behaviors

30
Q

MOA of pregabalin

A

α2δ Ca voltage gated channels blockers (in CNS)

31
Q

Uses for pregabalin and gabapentin

A

Neuropathic pain and focal (partial) seizures

32
Q

What is gabapentin used for most of the time (80%)? off-label

A

Neuropathic pain

-post-herpetic neuralgia, diabetic neuropathic, fibromyalgia

33
Q

Second-line treatment for neuropathic pain?

A
  1. Valproate
  2. Opiods
  3. Tramadol
34
Q

MOA of tramadol

A

partial agonist at μ opiate receptors

-also blocks NE and 5HT reuptake

35
Q

Black box warnings for tramadol

A

overdose, addiction, abuse
CytP450 interaction
Withdrawls
Respiratory and CNS depression

36
Q

Adverse effects of tramadol

A

sedation, dizziness, headache, dry mouth, and constipation

37
Q

MOA of ketamine

A

noncompetitive NMDA receptor antagonist

38
Q

Clinical use of ketamine

A

analgesia, acute and chronic pain

-including neuropathic

39
Q

Dexamedetomidine MOA

A

selective alpha2-adrenoreceptor agonist

-sedative and anesthetic

40
Q

Clinical applications of dexamedetomidine

A

Short term sedation of ill patients who are intubated

sedation prior to procedures

41
Q

Clinical use of clonidine

A

a2 agonist for HTN and pain

42
Q

MOA of ziconotide

A

N-type voltage gate Ca channel

43
Q

Black box warning for ziconotide

A

severe psychological impairment and has a high risk of patient harm (?)

44
Q

Clinical applications of ziconotide

A

chronic severe pain, intrathecally, for those who are refractory to other treatments

45
Q

MOA of capsaicin and camphor

A

Topical TRPV1 “hot”

46
Q

MOA of menthol

A

Topical TRPM8 “cold”

47
Q

MOA of sumatriptan

A

selective 5-HT1B/D agonsit

48
Q

Clinical applications of the triptans

A

migraines

49
Q

MOA of lasmiditan

A

highly selective 5-HT1F receptor

50
Q

MOA of ubrogepant

A

calcitonin gene-related peptide receptor antagonist

51
Q

MOA of dihydroergotamine (DHE)

A

ergot alkaloid agonist for 5-HT receptors

52
Q

What drugs is dihydroergotamine contraindicated with?

A

CYP3A4 inhibitors
-azoles, macolides

Leads to vasospasm and cerebral ischemia

Pharmacology (50 decks)

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