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Advanced Pharmacology > Pain > Flashcards

Pain Flashcards

1
Q

Arthropathies, ischemic disorders, myalgias, skin and mucosal ulcerations, superficial pain such as burns, and visceral pain such as appendicitis, pancreatitis, renal lithiasis, etc.
**Cuts or Surgical incision

A

Nociceptive Pain

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2
Q

Neuropathies as in alcoholism and diabetes, cancer-related pain, regional pain syndromes, HIV, multiple sclerosis, phantom limb pain, postherpetic neuralgia, trigeminal neuralgia, post-CVA pain
Shingles, neuropathy, fibromyalgia &raquo_space;>
Difficult to manage over time, may benefit from adjuncts such as anti-depressants

A

Neuropathic Pain

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3
Q

Chronic recurrent headaches, vasculitis

A

Mixed or Undetermined Etiology

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4
Q

NSAIDs inhibit _________ formation.

A

prostaglandin (PG)

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5
Q

__________ sensitize pain receptors to bradykinin and other biochemical mediators,causing vasodilation and increased vascular permeability.

A

prostaglandins (PG)

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6
Q

Triple A effect of NSAIDs

A

analgesic, antipyretic, and anti-inflammatory

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7
Q 
Ibuprofen
Diclofenac 
Ketoprofen 
Indomethacin
Meloxicam
Ketorolac (Toradol)...
are all COX \_\_ Inhibitors
A

1

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8
Q

Celecoxib (Celebrex) is a COX __ Inhibitor

A

2

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9
Q

Celecoxib (Celebrex) as a COX-2 Inhibitor has a better track record with ____ symptoms and ________

A

GI; bleeding

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10
Q

non-selective COX 1 + 2 Inhibitor intended for short-term use (<5 days) and used for moderate/severe pain; risks are GI bleed and renal deficiency

A

(Ketorolac) Toradol

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11
Q

the drug most commonly used for chronic pain in persons with past history of bleeding or GI problems, or ASA hypersensitivity

A

Acetominophen

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12
Q

drug class used for mild to moderate pain and soft tissue injury

A

NSAIDs

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13
Q

6 Items that must be on written Rx for scheduled drug

A 
Date of Issue
Patient’s name &amp; Address
NP Name, Address &amp; DEA #
Drug Name
Drug Strength
Dosage Form
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14
Q

No refills + No telephone orders unless true 911 (electronic orders OK) on Schedule ____ drugs

A

II

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15
Q

Up to 6 months or 5 refills + telephone/fax/electronic orders OK on Schedule ___ or ___

A

III or IV

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16
Q

Schedule ___ is same as Rx drugs

A

V

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17
Q

Schedule ___ Drugs:
Narcotics: oxycodone, meperidine, methadone
Stimulants: cocaine, methamphetamine, methylphenidate
Depressants: pentobarbital, secobarbital

A

II

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18
Q

Schedule ___ Drugs:
Narcotics: Codeine in combination w/ non-narcotic ingredients not to exceed 90 mg/day, Hydrocodone not to exceed 15 mg/tab
Stimulants: benzphetamine, chlorpheniramine, diethylpropion
Depressants: butabarbital
Anabolic Steroids
Testosterone

A

III

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19
Q 
Schedule \_\_\_\_ Drugs:
Pentazocine
Phentermine
Benzodiazepines
Meprobamate
A

IV

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20
Q 
Schedule \_\_\_ Drugs:
Loperamide
Diphenoxylate
Cough medications w/ <200 mg/100 mL
Pregabalin
A

V

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21
Q

type of opioid that binds to mu opioid receptors in the brain. This produces endorphins and gives pain relief. Remember mu stimulation produces:
Analgesia
Respiratory Depression
Euphoria

A

Full Agonists

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22
Q 
Examples of \_\_\_\_\_\_ Agonists:
Morphine (Kadian)
hydromorphone
oxymorphone
heroin
meperidine (Demerol)
methadone (Dolophine)
fentanyl (Sublimaze)
sufentanil (Sufenta)
A

Strong

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23
Q 
Examples of \_\_\_\_\_\_ Agonists:
Codeine (Tylenol with Codeine)
propoxyphene (Darvon)
oxycodone
hydrocodone
A

Moderate

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24
Q

type of opioid that binds primarily to muopioidreceptors and cause them to produce endorphins, but to a much lesser extent than full agonists. Increasing the dose of these results in much smaller increase in endorphin release, if any. This is why it is harder to abuse these than full agonists: they have a greater affinity for the receptor sites than full agonists so giving to someone who is addicted and using full agonistcan trigger withdrawal.When used in the treatment of addiction do not begin these until withdrawal from the opioid has begun.

A

Partial Agonists

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25
Q

Examples of _______ Agonists:
Buprenorphine (Subutex)
Buprenorphineplus naloxone (Suboxone)

A

Partial Agonists

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26
Q

type of opioid that act weakly on the mu receptor but strongly at the kappa receptor. Therefore, the effect seen is analgesia with less respiratory depression than seen with the drugs that bind preferentially to Mu receptors. These drugs binds to muopioidreceptors and cause them to produce endorphins, but to a much lesser extent than full agonists and ALSO have antagonist effects. Because of the antagonist effects, they should be used with caution in opioid addicted patients as they could cause withdrawal symptoms.

A

Mixed Agonist-Antagonists

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27
Q

Examples of ________:
Butorphanol (Stadol)
nalbuphine (Nubain)

A

Mixed Agonist-Antagonists

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28
Q

drugs that bind to the muopioidreceptors but don’t stimulate the production of endorphins. They prevent other opioids from stimulating the mu receptors.

A

Opioid Antagonists

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29
Q

Examples of ________:
Naloxone (Narcan)
Naltrexone (Reviva)

A

Opioid Antagonists

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30
Q

World Health Organization’s (WHO) step-wise treatment of pain:
Give ________ ______ first.

A

oral analgesics

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31
Q

World Health Organization’s (WHO) step-wise treatment of pain:
Give analgesics at ________ intervals and adjust the ________ until the patient is comfortable.

A

regular; dosage

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32
Q

World Health Organization’s (WHO) step-wise treatment of pain:
Prescribe analgesics according to pain __________ as evaluated by a _______ of intensity of pain.

A

intensity; scale

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33
Q

World Health Organization’s (WHO) step-wise treatment of pain:
Dosing of pain medication should be adapted to the ________–the correct dose is one that will allow adequate pain relief.

A

individual

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34
Q

World Health Organization’s (WHO) MODIFIED step-wise treatment of pain:
_______ is found in step 3 and is very useful in the treatment of cancer pain, chronic noncancer pain, and refractory neuropathic pain nonresponsive to traditional treatment.

A

Methadone

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35
Q

World Health Organization’s (WHO) MODIFIED step-wise treatment of pain:
________ meds suggested include steroids, anxiolytics, antidepressants, hypnotics, anticonvulsants such as gabapentin & pregabalin, and NMDA receptor antagonists for neuropathic pain. Cannabinoids can also be included in this group.

A

Adjunctive

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36
Q

This includes a fourth step for treatment of crises in chronic pain

A

World Health Organization’s (WHO) MODIFIED step-wise treatment of pain:

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37
Q

Changes in _______ as related to pain management:
Renal and liver mass decrease leading to decrease in blood flow
Decrease in saliva may affect swallowing
Decrease GI motility = constipation

A

Elderly

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38
Q

Max dose of Acetominophen per day= ____ grams

Reduce to ____ grams for elderly, frail, pt w/ decreased liver fxn

A

4; 3

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39
Q

The liver produces ________ which is a Queen antioxidant that enhances detoxifying effects of the liver. It is limited and when it’s gone, it’s gone.

A

Glutathione

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40
Q

Tylenol w/ _______ decreases the detoxifying action of the liver

A

alcohol

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41
Q

Unilateral, throbbing, pulsatile headache that lasts 4-72 hours, includes nausea and vomiting, light sensitivity, may have auras, more common in women, and genetically linked. There are variants that include focal neurologic findings.

A

migraines

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42
Q

most common headache that responds well to NSAIDs

A

tension HA

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43
Q

“Ice pick headache”, unilateral, severe pain behind one eye, nasal congestion with rhinorrhea, occur in groupings over weeks to months, often at night, more common in men and blacks.

A

cluster HA

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44
Q

combination of cluster and migraine HA

A

mixed HA

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45
Q

HA that occur due to overuse of medications to treat headache pain. The medication causes worsening of the pain. Treatmententails discontinuing all pain medications.

A

Rebound HA

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46
Q

Ergots and Triptans are vaso_________.

A

constrictors

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47
Q

MOA of ________:

constrict intracranial blood vessels and suppress inflammatory neuropeptides

A

Ergots and Triptans

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48
Q

Ergots are contraindicated in _________!!!!

A

pregnancy

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49
Q

Triptans Contraindicated in _________

A

(IHD) ischemic heart disease

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50
Q

data indicates that Sumatriptan (Imitrex) for headaches does not increase the rate of __________ above baseline

A

birth defects

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51
Q

Pregnant patient presenting with HA should cause the provider to consider the MOA of _________ of HA medications, and the provider needs to evaluate and consider __________ and ___________.

A

vasoconstriction

coronary artery disease and HTN

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52
Q

Level ____ Evidence for Migraine Treatment:
>Antiepileptic Drugs: Divalproex Sodium, Sodium, valproate, Topiramate
>Beta Blockers: Metoprolol + Propranolol
>Triptan: Frovatriptan

A

A

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53
Q

Level ____ Evidence for Migraine Treatment:
>Antidepressants:Amitriptyline (TCA), Venlafaxine (SNRI)
>Beta Blockers: Atenolol, Nadolol
>Triptans: Naratriptan, Zolmitriptan

A

B

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54
Q

FDA-approved drug for preventive treatment of chronic migraines that is injected in 31 sites across head and neck muscles repeated q12 weeks

A

Botox

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55
Q

Botox is Pregnancy Category ___

A

C

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56
Q

Contraindication of ________:

Intradetrusor (bladder wall) injection with UTI or Urinary Retention

A

Botox

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57
Q

Adverse Effect of ________:

Mostly related to spread of the toxin to unwanted areas

A

Botox

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58
Q

Drug Interactions of ________:
Anticholinergics- may potentiate effects
Muscle relaxants- may lead to exaggerated weakness if given before/after injection

A

Botox

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59
Q

Indications for __________ Treatment for Migraines:
Attacks last >24 hrs
Duration >2 months
Major disruption of ADLs >3 days
Abortive therapy fails or is overused
Symptomatic meds are contraindicated or ineffective
Use of abortive meds > twice/week
Migraine variants produce profound neurological effects

A

Prophylactic

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60
Q

_________ Treatments for Migraines:
Triptans (Selective Serotonin Receptor Agonists (5-HTI)
Egort alkaloids (ergotamine + dihydroergotamine (DHE)
Analgesics
NDAIDs
Antiemetics
Combination products

A

Abortive

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61
Q

3 FDA-approved drugs for fibromyalgia:

A

milnacipran (Savella), duloxetine (Cymbalta), pregabalin

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62
Q

_____________, Amitriptyline for fibromyalgia is Evidence Level A

A

Tricyclic Antidepressant

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63
Q

_____ for fibromyalgia are Evidence Level A:
Duloxetine (Cymbalta)-also indicated for concmitant depression
Milnacipran (Savella)- been shown to decrease pain, fatigue, and improve fxn
Pregabalin

A

SNRIs

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64
Q

______ for fibromyalgia are Evidence Level:
Citalopram= Grade D NOT effective
Fluoxetine= Grade B found to decrease pain
Paroxetine= Grade B found to improve fibromyalgia impact scores

A

SSRIs

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65
Q

_________ for fibromyalgia are Evidence Level:
Gabapentin= GradeB found to decrease pain and improve fibromyalgia pain scores
Pregabalin= Grade A improves pain/sleep/overall wellbeing, reduces fatigue

A

Anticonvulsants

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66
Q

________ for fibromyalgia are Evidence Level B:

Cyclobenzaprine- similar to TCAs which might explain its ability to improve sleep, stiffness and fatigue

A

Muscle Relaxants

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67
Q

________ for fibromyalgia is Evidence Level C:
conflicting reports
use in caution w/ pt taking SNRI or SSRI
lowers seizure threshold so caution in epileptics

A

Tramadol

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68
Q

Opioids, benzodiazepines, NSAIDs, magnesium, guaifenesin, DHEA, melatonin and calcitonin have not demonstrated effectiveness in treating __________ =Grade:C

A

fibromyalgia

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69
Q

not knowing what is in a supplement; some are contaminated with things like mercury or other harmful substances

A

supplement contamination

70
Q

This new lawexpanded the authority of APRNs to treat opioid addictionswith buprenorphine in office-based settings.This is an expansion of APRN ability to be on the front line in drug treatment

A

Comprehensive Addiction and Recovery Act (CARA) of 2016

71
Q

System used nationwide to record when a scheduled drug is prescribed; what is prescribed & quantity that helps prescribers to identify drug seeking behavior
Downside: all systems nationwide are not linked so you may not be able to see all use by patients if they are using in multiple unlinked systems

A

Prescription Drug Monitoring Program (PDMP)

72
Q

Women whouse opioids in the peri-conceptual period have a _____-fold increase in fetal risk of neural tube defects

A

2.2

73
Q

Weaning pregnant women with __________ has become more popular due to its accessibility and association withbetter neonatal outcomes.

A

Buprenorphine

74
Q

Opiateantagonist that blocks or reverses opioids by competitively occupying the receptor site that the narcotic occupied.
Use/Indication: Reversal of opioid depression

A

Naloxone (Narcan)

75
Q

Naloxone half-life is _____ minutes, shorter than opioid half-life so watch for respiratory depression after it wears off

A

30-81

76
Q

__________ during breastfeeding results in difficulty w/ temp regulation, hydration, feeding, seizures, and SIDS

A

Chronic opioid use

77
Q

____ receptors demonstrate the classic effects of:
Analgesia
Euphoria
Respiratory Depression
(EX: morphine, meperidine , fentanyl, sufentanil, hydromorphone)

A

Mu

78
Q

______ receptor stimulation results in:
Analgesia
Sedation
(EX: Stadol, Nubain)

A

Kappa

79
Q

Suboxone is made up of:
buprenorphine = __________ (class)
naloxone = __________ (class)

A

partial agonist

antagonist

80
Q

Tramadol is a ___drug so be careful w/ poor or ultra metabolizer

A

pro

81
Q

BBW for Tramadol

A

lowers seizure threshold, respiratory depression

82
Q

SE of Toradol

A

GI bleeds, kidney issues

83
Q

Do not give NSAID to someone in renal failure because it:

A

decreases renal blood flow

84
Q

opioid use preconceptually can cause ________

A

neural tube defects

85
Q

codeine turns into morphine after metabolized so a __________ may harm breastfed infant

A

ultra-rate metabolizer

86
Q

Do not use NSAIDs in pt w/ severe kidney problems because NSAIDs block ________ which vasodilate to keep blood flowing to kidneys- NSAIDs vasoconstricts kidneys and decreases GFR

A

prostaglandins

87
Q

Do not use acetominophen in pt w/ liver damage because it gets rid of _________ (antioxidant)

A

gluthathialone

88
Q

these sensitize pain receptors to bradykinin + other biochemical mediators causing vasodilation and increased vascular permeability
>they protect gastric mucosa by increasing mucous production + inhibiting gastric acid production
>ensure renal blood flow via vasodilation

A

prostaglandins

89
Q

_________ irreversibly blocks the production of the prostaglandin thromboxane in platelets

A

ASA

90
Q

how many days after stopping ASA would it take to see platelets that can clot?

A

7-10 days

91
Q

increases risk of cardiovascular event with NSAID use

A

COX-2 selective

higher dose/longer use

92
Q

NSAIDs w/ higher CV risk

A

celebrex, vulcaran

93
Q

NSAID w/ lower CV risk

A

naproxen

94
Q

risk of GI bleed w/ NSAID use

A

higher dose/longer use

longer-acting product

95
Q

NSAID w/ higher GI bleed risk

A

felvene, ketoralac (Toradol)

96
Q

NSAID w/ lower GI bleed risk

A

ibuprofen, celebrex

97
Q 
Use cytotec or PPI w/ \_\_\_\_\_\_\_ if:
long-term use
age>65,
daily ASA
previous uncomplicated ulcer
A

NSAIDs

98
Q

1 cause of liver failure in the US

A

acetominophen

99
Q

____% of patients prescribed opioids in primary care setting are struggling w/ addiction

A

25

100
Q

acute post-surgical pain should be treated w/ ___ days of opioids

A

3 (no more than 7)

101
Q

topical NSAIDs can still cause ________

A

GI bleed

102
Q

be aware of _________ with pain management in elderly

A

drug to drug

103
Q

hypersensitivity that occurs as a result of ASA use that is rare but common in patients w/ asthma, rhinitis, and nasal polyps- more common in women, similar reactions may occur with NSAIDs, so avoid nonselective (1st generation)

A

Aspirin-exacerbated Respiratory Disease (AERD)

104
Q

DO NOT give ASA to any patient under age ___ during __________ illness due to correlation between taking ASA with viral illness and Reye’s Syndrome

A

19; fever-inducing

105
Q

condition that occurs due to ASA use during fever-inducing viral illness characterized by continuous vomiting listlessness, somnolence, delirium, LOC, and death

A

Reye’s Syndrome

106
Q

The use of high doses of _____ greater than 150 mg per day in pregnancy is associated with prolonged gestation and labor, maternal and neonatal bleeding, fetal growth restriction, and increased mortality during the perinatal period.

A

ASA

107
Q

NSAIDs and ASA can cause premature closure of ______________ if taken at the end of pregnancy

A

the ductus arteriosus (DA)

108
Q

Avoid _____ with breastfeeding although some guidelines allow use with caution.

A

ASA

109
Q

All NSAIDs reduce PG synthesis with differences in the extent of inhibition of _______ and ______ (enzymes)

A

COX1 and COX2

110
Q

Selective ______ Inhibitors are more likely to cause cardiovascular events

A

COX2

111
Q

Less _________ COX1 + COX2 Inhibitor ________ are more likely to cause GI bleeds

A

selective; NSAIDs

112
Q

Nonselective NSAIDs increase GI bleed risk x___

COX2 Inhibitors increase GI bleed risk x____

A

4

3

113
Q

Rx of NSAIDs w/ ____________ increases bleeding risk ____x

A

12

114
Q

Rx of NSAIDs w/ Spironolactone increases bleeding risk ____x

A

11

115
Q

Rx of NSAIDs w/ SSRI increases bleeding risk ____x

A

7

116
Q

COX2 Inhibitors have higher _______ risks and lower _______ risks

A

higher cardiovascular risks

lower GI risks

117
Q

_________ is contraindicated in patients who drink > 3 drinks per day or take other liver-toxic drugs

A

Acetominophen

118
Q

Advantages of _________:

minimal GI irritation, non-interference with bleeding times, and no effect on uric acid levels or respiratory rates

A

Acetominophen

119
Q

Avoid ________ in:

hepatitis, dehydration, liver disease, cirrhosis, or those who are heavy drinkers

A

Acetominophen

120
Q

acetylcysteine is the antidote for _________

A

Acetominophen

121
Q

ASA should not be used as the primary treatment for _______ due to lack of net benefit

A

ASCVD

122
Q

ASA is recommended to patient post-___ to prevent reoccurrence

A

MI

123
Q

Do not use _____ in children under 19 w/ viral fever

A

ASA

124
Q

Avoid using _____ long-term if also using ASA for prophylaxis as it interferes w/ ASA cardioprotective effects

A

NSAIDs

125
Q

Caution using _______ with concurrent use of corticosteroids, anticoagulants, ASA, and alcohol as this furthers risk for UGI bleed

A

NSAIDs

126
Q

Use of high-dose ______ for long periods in pregnancy also increases the risk of bleeding in the brain of premature infants.

A

ASA

127
Q

Exposure to _______ after 30 weeks’ gestation is associated with an increased risk of premature closure of the fetal ductus arteriosus and oligohydramnios

A

NSAIDs

128
Q

fetal adverse effects of ______ use in pregnancy include brain, kidney, lung, skeleton, gastrointestinal tract and cardiovascular system

A

NSAIDs

129
Q

________ are no more effective in the treatment of low back pain than acetaminophen or NSAIDs and they carry the risk of drowsiness and dependence

A

Muscle relaxants

130
Q

__________ muscle relaxants may cause CNS sedation and increase the risk of falls and injury, particularly in the elderly

A

Centrally Acting

131
Q

With __________ use, consider additive effects of concomitant medications (anticholinergics and other CNS depressants) and alcoho

A

Muscle relaxants

132
Q

Ergots are contraindicated in ________ and while there is not enough data on all of the triptans, data indicates that Sumatriptan (Imitrex) does not increase the rate of __________ above baseline.

A

pregnancy; birth defects

133
Q

a long-acting opioid used as a substitution to gradually taper a client off other opioids or given in the long-term management of opioid addiction (tapered down)

A

methadone

134
Q

use of __________ in the treatment of drug addiction is restricted to Substance Abuse Mental Health Service Administration (SAMHSA) and state-certified programs.

A

methadone

135
Q

a partial-agonist opioid that can be used to facilitate detoxification or as maintenance therapy for addiction

A

Buprenorphine

136
Q

a law that expanded the authority of APRNs to treat opioid addictions with buprenorphine in office-based settings which is an expansion of APRN ability to be on the front line in drug treatment.

A

Comprehensive Addiction and Recovery Act (CARA) of 2016.

137
Q

__________ have a greater affinity for the receptor sites than full agonists, so giving it to someone who is addicted and using full agonists can trigger withdrawal

A

partial agonists

138
Q

opioid antagonist that works in the brain to block opioid-induced pleasurable effects and is not initiated until complete withdrawal of opioids has occurred.

A

Naltrexone

139
Q

drug indicated for the maintenance of abstinence from alcohol by reducing alcohol cravings (does not eliminate or diminish withdrawal symptoms)

A

Campral (acomprasate calcium)

140
Q

___________ is not known to cause alcohol aversion and does not cause a disulfiram-like reaction…it just reduces cravings

A

Campral (acomprasate calcium)

141
Q

Campral is contraindicated in patients w/ ___________ and use caution giving to __________ and __________

A

severe renal disease

depressed and elderly

142
Q

___________ is a potent alcohol dehydrogenase inhibitor that blocks the oxidation of alcohol, so if alcohol is ingested while this medication is in the body, the patient will experience unpleasant effects

A

Antabuse (disulfiram)

143
Q

___________ does not eliminate or diminish withdrawal symptoms from alcohol….contraindicated for patients with psychosis, severe myocardial disease, or recently used metronidazole (Flagyl)

A

Antabuse (disulfiram)

144
Q

COX that is s around all the time and is responsible for stimulating prostaglandin production in the stomach.

A

COX-1

145
Q

COX that is produced by gene transcription in the presence of tissue injury then produces the vasodilating prostaglandins that cause swelling, erythema, and pain.

A

COX-2

146
Q

Viox and Bextra (COX-2 Inhibitors) were removed from the market for causing _______ abnormalities

A

cardiac

147
Q

There are also concerns about cardiac problems with the remaining COX-2 inhibitor _________ as well as with the nonselective NSAID __________

A

celecoxib (Celebrex)

Naproxen (Aleve

148
Q

Level A Evidence for Migraine _________ Therapies:
Antileptic Drugs (Divalproex, Sodium Valproate, Topiramate)
Beta Blockers (Metoprolol, Propanolol)
Triptan
Fovatriptan

A

Preventative

149
Q

Level B Evidence for Migrain ___________ Therapy:
Antidepressants (TCA-Amitripyline, SNRI-Venlafaxin)
Beta Blockers (Atenolol, Nadolol)
Triptans
Zolmitriptan

A

Preventative

150
Q 
Drugs DO NOT have supportive evidence for treatment of \_\_\_\_\_\_\_\_\_\_\_:
Opioids
benzodiazepines
NSAIDs
magnesium
guaifenesin
DHEA
melatonin
calcitonin
citalopram (SSRI)
Conflicting data--tramadol
A

Fibromyalgia

151
Q

Pain meds to avoid in ___________:
Tramadol
Codeine

A

Children (Tramadol <18, Codeine <12)

152
Q

Pain meds to avoid in ___________:
NO ASA
NO CODEINE
**Can cause withdrawal or SIDS; can cause long-term self-destructive behavior, suicide, amphetamine, or opioid addiction

A

Breastfeeding

153
Q

People who abuse cocaine, opioids (e.g., morphine, heroin), and other drugs frequently abuse __________ as well. At high doses, it can cause subjective effects—euphoria, sedation, hallucinations—that some individuals find desirable. In addition, it can intensify the subjective effects of some abused drugs, including benzodiazepines, cocaine, and opioids. Because it costs less than these drugs, the combination allows abusers to get high for less money.

A

Clonidine

154
Q

Prescribe less than _____ days (ideally less than ___ days) of medication when initiating opioids”

A

7; 3

155
Q

drugs that bind primarily to mu opioid receptors and cause them to produce endorphins, but to a much lesser extent than full agonists. Increasing the dose of partial agonists results in much smaller increase in endorphins release if any.

A

partial agonists (“mixed”)

156
Q

drugs that bind to the mu opioid receptors in the brain. This produces endorphins & give pain relief. Remember mu stimulation produces:
● Respiratory Depression
● Analgesia
● Euphoria

A

full agonists

157
Q

drugs that bind to the mu opioid receptors but don’t stimulate the production of endorphins. They prevent other opioids from stimulating the mu receptors.

A

antagonists

158
Q

how much reaction we get from the drug

A

activation

159
Q

IF RECEPTOR SITES are full of drug (heroin) & you give them a ___________, we can put them into withdrawal

A

partial agonist

160
Q

Buprenorphine (Subutex only) is a partial agonist at the ____ sites and full antagonist at the ______ sites

A

mu; kappa

161
Q

Buprenorphine + Narcan = _________

A

Suboxone

162
Q

No suboxone in pregnancy because…..

A

the Narcan portion can send baby into withdrawal (death)

163
Q

_______ use in the periconceptional period appeared to be associated with a modest increased risk of neural tube defects
What should the provider do?

A

opioid…make sure they’re on folic acid/birth control

164
Q

If mother is ultra-rate metabolizer, _________ can be turned into morphine, transmitted to baby and kill

A

codeine

165
Q

COX-2 is ______selective

A

cardio

166
Q

Risk Factor that increases cardiovascular risk w/ NSAIDs

A

Hx of MI

167
Q

Which 2 NSAIDs have the highest CV risk?

A

celebrex & voltarin

168
Q

Which NSAID has the lowest CV risk?

A

Naproxen (nonselective COX-2)

169
Q

Which NSAID increases GI risk?

A

long acting (toradol, toradine)

170
Q

When do we Rx cytotec or PPI to NSAID users?

A

long term use for GI mucosal protection (>65yrs old)

171
Q

_______ NSAIDs are EXPENSIVE, only last 2wks, can still cause GI bleed! Higher concentrations.

A

Topical

Advanced Pharmacology (8 decks)

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