Pain

Question 1

What are the most commonly used analgesics?

Answer 1

Tylenol and NSAIDs

Question 2

What is the MOA of tylenol?

Answer 2

Unclear, may inhibit COX-3 (centrally located)

Question 3

Tylenol is not an NSAID, so which effects does it NOT have?

Answer 3

Anti-inflammatory and Anti-platelet

Question 4

What is the dose limited adverse effect of acetaminophen?

Answer 4

Hepatotoxicity

Question 5

What are the effects of NSAIDS?

Answer 5

Anti-inflammatory
Anti-pyretic
Analgesic

Question 6

What type of NSAID would you chose in a patient with risk of GI bleed?

Answer 6

COX-2 selective

Question 7

What is the biggest concern with prescribing NSAIDs?

Answer 7

Bleeding (specifically GI bleeding)

Question 8

What type of patients should avoid NSAIDs besides those at risk for bleeding?

Answer 8

Renal insufficiency
CHF
HTN

Question 9

What areas of the body can Voltaren gel be used for?

Answer 9

elbows, hands, knees

Question 10

What joint would not be appropriate for voltaren gel?

Answer 10

Hip

Question 11

Name a short acting systemic corticosteroid.

Answer 11

Hydrocortisone

Question 12

Name a long acting systemic corticosteroid.

Answer 12

Dexamethasone

Question 13

Name a two steroids with no minerocorticoid effect.

Answer 13

Methypredinosolone

Dexamethasone

Question 14

Name the systemic corticosteroid with the most minerocorticoid activity.

Answer 14

Hydrocortisone.

Question 15

What is the effect of minerocorticoid activity?

Answer 15

The ability of the medication to increase the reabsorption of sodium and excretion of potassium.

Question 16

Which of the following is not a known adverse effect of systemic corticosteroids? 
Hyperglycemia
Osteoporosis
Hypotension
Skin Atrophy
Pyschiatric Disturbance
Hypothalamic-pituitary axis supression

Answer 16

Hypotension

Question 17

What receptor are opioids active at?

Answer 17

Mu

Question 18

What is the primary risk for using opioids with other risks added such as use with benzos?

Answer 18

Respiratory Depression

Question 19

What prescriptions should you consider alongside opioids?

Answer 19

Narcan (naloxone)

Question 20

In addition to Mu receptor activity, what effect does Ultram have?

Answer 20

Inhibits reuptake of norepinephrine and 5-HT.

Question 21

What type of laxative should be prescribed for those using opioids?

Answer 21

Stimulant (bisocodyl or senna)

Question 22

What is the ideal way to stop opioid use?

Answer 22

Slowly, over time.

Question 23

What are the three medications approved for opioid use disorder?

Question 24

Full Mu agonist.
Partial Mu agonist.
Opioid antagonist.

… match with…

Methadone.
Buprenorphine.
Naltrexone.

Answer 24

Methadone: Full Mu Agonist (Access in methadone clinic only)
Naltrexone: Opioid antagonist (no benefit from using opioid)
Buprenorphine: Partial Agonist (relief but minimize resp. depression risk)

Question 25

Common treatments for neuropathic pain.

Answer 25

``` Duloxetine Gabapentin Pregabalin Tricyclinc Antidepressants Topical Lido ```

Question 26

What is the mechanism of action for triptans?

Answer 26

Stimulation of serotonin. This interrupts pain signals and causes vasoconstriction.

Question 27

What are injectable CGRP medications mostly used for?

Answer 27

Migraine prophylaxis

Question 28

What are some common adverse effects of triptans?

Answer 28

Paresthesia Dizziness Chest Pressure

Question 29

Which triptan may be effective for patients that have not responded to other triptan?

Answer 29

Eletriptan

Question 30

Which triptan has fewest side effects?

Answer 30

Axert (almotriptan)

Question 31

Which triptan is the longest acting?

Answer 31

Frova (frovatriptan)

Question 32

Which triptans are available as nasal spray?

Answer 32

zolmitriptan (Zomig) | sumatriptan (Onzetra)

Question 33

What is the core treatment for fibromyalgia?

Answer 33

Norepinephrine reuptake suppression (SNRI, tricyclic antidepressants, cyclobenzaprine) Balance with non-pharm interventions.