Neuro: Drugs for Pain

Question 1

What does tissue damage initiate the release of?

Answer 1

Prostaglandins (PGE2),
Bradykinin,
Histamine

Question 2

What causes secondary hyperalgesia?

Answer 2

Glutamate stimulation of spinal NMDA receptors

Question 3

MOA of aspirin

Answer 3

irreversible inhibits COX-1 and COX-2

Question 4

Clinical use for aspirin?

Answer 4

Immediate release as analgesic, antipyretic, and anti-inflammatory

Extended-release: reduce stroke

Question 5

Off label uses for aspirin?

Answer 5

Colon cancer, to prevent atherosclerosis

Question 6

Adverse effects of aspirin?

Answer 6

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

Question 7

What is nociceptive pain?

Answer 7

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

Question 8

What is neuropathic pain?

Answer 8

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

Question 9

MOA of ibuprofen and naproxen

Answer 9

reversible inhibits COX-1 and COX-2

Question 10

Black box warning in all NSAIDs

Answer 10

Increase risk of MI and stroke

Increase risk of bleeding

Question 11

Who should avoid NSAIDs

Answer 11

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

CABG pts

Question 12

Celecoxib MOA

Answer 12

selective reversible COX-2 inhibitor

Question 13

Adverse effects of celecoxib?

Answer 13

Thrombotic events (from sketchy)

Question 14

What conditions is aspirin especially useful for?

Answer 14

Chronic pain conditions, such as rheumatoid arthritis

Question 15

What should you do when prescribing nonasparin NSAIDs

Answer 15

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

Question 16

Does celecoxib increase risk of bleeds?

Answer 16

No, does not inhibit platelets

-does increase risk for thrombosis though

Question 17

MOA of acetaminophen

Answer 17

TRPV1 and TRPA activation (possibly?)

Question 18

Clinical applications of acetaminophen

Answer 18

temporary relief for aches and pains, and headache

-only for mild to moderate pains

Question 19

Black box warning of acetaminophen?

Answer 19

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

Question 20

Does acetaminophen suppress inflammation?

Answer 20

Nope, only pain and fever

Question 21

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

Answer 21

No, does not inhibit COX1/2

Question 22

How do you treat acetaminophen overdose?

Answer 22

N-acetylcystine can replenish reduced glutathione stores

Question 23

MOA of morphine

Answer 23

binds opiod receptors in brain

Question 24

Black box waring for morphine

Answer 24

respiratory and CNS depression, especially with other drugs

Question 25

What are three firstline drug classes for neuropathic pain?

Answer 25

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

Question 26

MOA of amitriptyline

Answer 26

tricyclic antidepressant | -increases NE and 5-HT in cleft

Question 27

Black box warning for amitriptyline

Answer 27

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

Question 28

MOA of duloxetine

Answer 28

Potent Serotonin and NE Reuptake Inhibitor Great for depression and neuropathic pain

Question 29

Black box warning for duloxetine

Answer 29

increases risk of suicidal thoughts and behaviors

Question 30

MOA of pregabalin

Answer 30

α2δ Ca voltage gated channels blockers (in CNS)

Question 31

Uses for pregabalin and gabapentin

Answer 31

Neuropathic pain and focal (partial) seizures

Question 32

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

Answer 32

Neuropathic pain | -post-herpetic neuralgia, diabetic neuropathic, fibromyalgia

Question 33

Second-line treatment for neuropathic pain?(3)

Answer 33

1. Valproate 2. Opiods 3. Tramadol

Question 34

MOA of tramadol

Answer 34

partial agonist at μ opiate receptors | -also blocks NE and 5HT reuptake

Question 35

Black box warnings for tramadol

Answer 35

overdose, addiction, abuse CYP450 interaction Withdrawls Respiratory and CNS depression

Question 36

Adverse effects of tramadol

Answer 36

sedation, dizziness, headache, dry mouth, and constipation

Question 37

MOA of ketamine

Answer 37

noncompetitive NMDA receptor antagonist

Question 38

Clinical use of ketamine

Answer 38

analgesia, acute and chronic pain | -including neuropathic

Question 39

Dexamedetomidine MOA

Answer 39

selective alpha2-adrenoreceptor agonist | -sedative and anesthetic

Question 40

Clinical applications of dexamedetomidine

Answer 40

Short term sedation of ill patients who are intubated | sedation prior to procedures

Question 41

Clinical use of clonidine

Answer 41

a2 agonist for HTN and pain

Question 42

MOA of ziconotide

Answer 42

N-type voltage gate Ca channel

Question 43

Black box warning for ziconotide

Answer 43

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

Question 44

Clinical applications of ziconotide

Answer 44

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

Question 45

MOA of capsaicin and camphor

Answer 45

Topical TRPV1 "hot"

Question 46

MOA of menthol

Answer 46

Topical TRPM8 "cold"

Question 47

MOA of sumatriptan

Answer 47

selective 5-HT1B/D agonsit

Question 48

Clinical applications of the triptans

Answer 48

migraines

Question 49

MOA of lasmiditan

Answer 49

highly selective 5-HT1F receptor

Question 50

MOA of ubrogepant

Answer 50

calcitonin gene-related peptide receptor antagonist

Question 51

MOA of dihydroergotamine (DHE)

Answer 51

ergot alkaloid agonist for 5-HT receptors

Question 52

What drugs is dihydroergotamine contraindicated with?

Answer 52

CYP3A4 inhibitors -azoles, macolides Leads to vasospasm and cerebral ischemia