Neuro S6 L3 Pain Managment

Question 1

Weak COX2 selective inhibitors( the non selective )

Answer 1

diclofenac, piroxicam)

Question 2

Moderate COX2 selective

Answer 2

Celecoxib

Question 3

Weak COX1 selective

the non selective

Answer 3

aspirin, ibuprofen, naproxen

Question 4

Highly COX1 selective

Answer 4

Ketorolac

Question 5

Opioids

1. Pure agonists. uR

Answer 5

Peptides eg endorphin: Non-peptides such as Fentanyl, and methadone.

Question 6

Partial agonists. Of opioids

Answer 6

Morphine is a partial agonist at μR similar to pethidine.

Codeine and tramadol are weak agonists

Question 7

Mixed agonist-antagonists. Of opioids

Answer 7

Nalorphine and pentazocine, combined effect of κ agonist (dysphoria) and μ antagonist

Question 8

Antagonists of opiods

Answer 8

Naloxone and naltrexone.

Question 9

(4) Neuropathic pain relieving drugs

Answer 9

Amitryptiline, venlafaxine, citalopram, gabapentin, carbamazepine, lidocaine, ziconotide Ca Ch (-), NMDAR (-) ketamine, D-methorphan, corticosteroids.

Question 10

Opioids side effects

Morphine

Pethidine

Tramadol

Answer 10

Morphine: Sedation, Respiratory depression,, Itching (histamine release) tolerance and dependence, euphoria constipation, nausea and vomiting Pethidine :morhine like + Anticholinergic effects, Risk of excitement and convulsions Tramadol: May cause convulsions, Dizziness,NE reuptake inhibition, no resp. depr.

Question 11

Causation of NSAIDs gastric ulcer in sequence

Answer 11

Ketoprofen > piroxicam > naproxen > diclofenac > aspirin > fenoprofen

Question 12

What are the steps in treating pain

Answer 12

Step 1 : paracetamol, aspirin, NSAIDs ,propoxyphene
Step 2 : codeine , tramadol
Step 3 : stronger opiods such as morphine, oxycodone

Question 13

Tricyclic antidepressants TCA give example

Answer 13

amitriptyline

Question 14

Anti seizures enhancement of GABA action give examples

Answer 14

Benzodiazepine (clonazepam )

Valproate & phenobarbitone

Question 15

Inhibit Na channel function anti epileptics give examples

Answer 15

Phenytoin
Carbamazepine
Lamotrigine

Question 16

GABA mimetics

Give examples

Answer 16

gabapentin, pr

Gabapentin is frequently a first choice as levels do not need monitoring

Question 17

Benzodiazepines

When it used& give examples

Answer 17

Used when anxiety complicates pain management Clonazepam particularly useful in neuropathic pain

Question 18

Venlafaxine is similar to imipramine
What is the class of these drugs

Answer 18

5- SSRI when TCA side effects limit utility May be treating depression Venlafaxine is similar to imipramine in painful neuropathy

Question 19

Antispasmodics

Answer 19

Skeletal muscle spasm, myoclonic jerks

sedative effects more than direct muscle effect eg carisoprodol, baclofen

• Smooth muscle spasms eg ureteric and biliary colick relaxed by hyoscine butyl bromide

Question 20

Neuronal Membrane stabilizers

Answer 20

• Ketamine, a dissociative anaesthesia
• Memantine blocks NMDA receptors in dorsal horn
• Ziconotide, blocks N-type Ca ch analgesic agents.
• Botulinum toxin for back pain and spasticity
• Retigabine, K channel opener, inhibits C and Aδ-fibre
• Epibatidine frog alkaloid has NnR+ and analgesic eff.
• Neuropeptides, such as somatostatin and calcitonin

Question 21

What is Ketamine

Answer 21

a dissociative anaesthesia

Question 22

Memantine

Answer 22

blocks NMDA receptors in dorsal horn

Question 23

Ziconotide

Answer 23

blocks N-type Ca ch analgesic agents.

Question 24

Botulinum toxin

Answer 24

for back pain and spasticity

Question 25

Retigabine

Answer 25

K channel opener, inhibits C and Aδ-fibre

Question 26

Epibatidine

Answer 26

frog alkaloid has NnR+ and analgesic eff.

Question 27

Neuropeptides

Answer 27

such as somatostatin and calcitonin