Pain and Pharmacology

Question 1

What medications can make OCPs less effective? (6)

Answer 1

1. Phenytoin
2. carbamazepine
3. primidone
4. phenobarbital
5. rifampin
6. griseofulvin

Question 2

What is the pathophysiology associated with increased bleeding risk in patient on warfarin when given diclofenac?

Answer 2

Diclofenac displaces protein bound warfarin (increasing active warfarin)

Question 3

How long does it take a first order drug to reach steady state if no loading dose given?

Answer 3

5 half lives

example if half life is 6 hours, then 30 (5x6) hours

Question 4

What must be the same for 2 unrelated products to be considered bioequivalent?

Answer 4

rate of absorption

Question 5

what medications require an acidic environment for absorption (and should be therefore taken before food)? (3)

Answer 5

1. levothyroxine
2. iron
3. antifungals (azoles)

Question 6

What is the next best step in management for patient developing apnea after propofol administration?

Answer 6

perform chin lift/ jaw thrust followed by bag-mask ventilation

Question 7

Why is oral naloxone less effective than IV naloxone?

Answer 7

first pass effect (oral naloxone is metabolized in liver decreasing amount that reaches brain)

Question 8

What sedation medication is contraindicated in patient with soy or egg allergy?

Answer 8

Propofol

Question 9

What is the possible adverse effect if Precedex (dexmedetomidine) is given to patient on nifedipine?

Answer 9

hypotension (additive effect)

Question 10

What are two contraindication for Ketamine use?

Answer 10

1. not to be used in children under 3 months old (as well as relatively contraindicated in children less than 1 year old)
2. history of psychosis

Question 11

What medications can interfere with renal clearance of lithium?

Answer 11

ibuprofen