opioid and non opioid and adjuvant analgesics

Question 1

MOE of opioids ?

Answer 1

inhibition of excitation of transmission of neuron ( inhibit glutamate )
inhibition of postsynaptic neurone
inhibition of descending inhibitory pathways

Question 2

MOE of NSAIDS ?

Answer 2

inhibition of release of mediators of inflammation

Question 3

what kind of receptors are opioid receptors ?

Answer 3

gi/go protein coupled receptors

Question 4

effects of opioids including analgesia, euphoria and respiratory depression are due to the action of what type of receptor ?

Answer 4

μ receptors

Question 5

sign of opioid overdose ?

Answer 5

miosis

Question 6

what type of opiod is associated with cough suppression ?

Answer 6

codeine

Question 7

what CVD effect do opioids induce ?

Answer 7

bradycardia except with meperidine - causes tachycardia

Question 8

effect of opioids on the GIT

Answer 8

decrease tone and motility and cause constipation

Question 9

effect of opioids on the biliary tract ?

Answer 9

biliary colic

Question 10

effect of opioid on the renal system

Answer 10

antidiuretic effect
decreases renal function

Question 11

effeect of opiods on the uterus ?

Answer 11

may prolong labour

Question 12

side effects of chronic frequent use of opioids

Answer 12

tolerance
addiction
physical dependence

Question 13

what are thee clinical uses of opioids in terms of their analgesic effect ?

Answer 13

pain associated with cancer
obstetrics labor
management of severe pain of renal and biliary colic
used in surgeries

Question 14

what is the best next step in management in GI disturbances that prevent the administration of oral sustained release morphine ?

Answer 14

fentanyl transdermal system ( fentanyl patches )

Question 15

what is the problem with using opioids in labour and how is this problem solved ?

Answer 15

opioids can cross the placental barrier and cause neonatal respiratory depression
managed by using naloxone

Question 16

what type of opioid is more commonly used in obstetrics practice ?

Answer 16

Phenylpiperidines

Question 17

what are the indications of opioid uses in acute pulmonary oedema ?

Answer 17

pulmonary oedema associated with LVHF
painful myocardial ischaemia with pulmonary oedema

Question 18

what opiodd is used for shivering ?

Answer 18

meperidine

Question 19

what is thee absorption of opioids ?

Answer 19

well oral absorption
but has 1st pass effect

Question 20

how are opioids metabolized and excreted ?

Answer 20

metabolized in the liver
excreted by thee kidneys

Question 21

what is morphine metabolized into ?

Answer 21

more potent form of morphine

Question 22

what type of interaction occurs between opioids and sedatives/hypnotics ?

Answer 22

increased CNS depression
especially respiratory depression

Question 23

what is the effect of using both opioids and antipsychotics together ?

Answer 23

increased sedation
accentuation of CVD effect

Question 24

what is the absolute contraindicated drug to be used with opioids ?

Answer 24

monamine oxidase inhibitor (anti depressant )
due to high incidence of hyperprexic comas

Question 25

what are the specific uses for methadone ?

Answer 25

1- racemic mixture blocks NMDA receptors
2- used when morphine fails to control pain
3- opioid rotation with morphine

Question 26

true or false , methadone tolerance develops quickly

Answer 26

false

Question 27

give an example of a synthetic opioid analogue

Answer 27

fentanyl

Question 28

what must partial agonists not be administered with ?

Answer 28

pure agonists associatedd with abstinence syndrome

Question 29

examples of partial agonists ?

Answer 29

buprenorphine
nalbuphine

Question 30

effect of naloxone on buprenorphine ?

Answer 30

resistant to the antagonist

Question 31

what is the contraindicated class of drugs that should not be used alongsidde buprenorphine ?

Answer 31

any CYP3A4
any azoles
macrolides
HIV protease inhibitors

Question 32

MOE of tramadol

Answer 32

blocks serotonin and norepinephrine

Question 33

what is the absolute contraindication to tramadol use ?

Answer 33

history of seizures

Question 34

what is the risk of thee co-administration of SSRIs with tramaddol ?

Answer 34

incidence of serotonin syndrome

Question 35

what is the effect of tramadol on respiration ?

Answer 35

no significant effect

Question 36

what is the optimal method of administration of naloxone ?

Answer 36

usually given by injection due to complete metabolization by the liver - parenteral or inhalation

Question 37

what are the clinical uses of naloxone ?

Answer 37

treating acute opioid overdose
low dose naloxone for treating SE of IV or epidural opioid induced constipation

Question 38

how is a diagnosis of opioid overdose confirmed with naloxone ?

Answer 38

If IV or nasal insufflation of naloxone shows prompt sign of recover→confirms opioid overdose diagnosis

Question 39

absolute contraindications generally when it comes to the use of opioids ?

Answer 39

1. Use of pure agonists with weak partial agonists
2. Use in patients with head injuries
3. Use during Pregnancy
4. Use in patients with impaired pulmonary function
5. Use in patients with impaired hepatic or renal function
6. Use in patients with reduced blood volume → more susceptible to vasodilation
7. Histamine release by morphine → exacerbate asthmatic attack or evoke allergic reaction
8. Use in patients with endocrine disease

Question 40

NSAID associated with highest GI safety ?

Answer 40

COX-2 inhibitor

Question 41

how is paracetamol different from NSAIDs ?

Answer 41

no anti inflammatory effect
does not induce gastric ulceration or bleeding

Question 42

metabolization of paracetamol vs ibuprofen

Answer 42

paracetamol in the liver
ibuprofen in the kidneys