Pain-FINAL Flashcards
What is the mechanism of action of NSAIDs?
They inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
What is the difference between COX-1 and COX-2 enzymes?
COX-1 regulates gastric protection, platelet aggregation, and kidney function, while COX-2 is upregulated in inflammation.
What are selective COX-2 inhibitors?
Drugs like Celecoxib that selectively inhibit COX-2 to reduce inflammation with fewer GI side effects.
What is the primary function of aspirin (ASA)?
It irreversibly inhibits COX-1, reducing platelet aggregation and providing cardiovascular protection.
Why should aspirin be avoided in children with viral infections?
It can cause Reye’s syndrome, leading to liver damage and encephalopathy.
What are common NSAIDs used for pain and inflammation?
Ibuprofen, naproxen, diclofenac, ketorolac, and celecoxib.
What is the primary use of Acetaminophen (Tylenol)?
Pain relief and fever reduction without significant anti-inflammatory effects.
What is the antidote for acetaminophen overdose?
N-acetylcysteine (NAC), which replenishes glutathione stores in the liver.
What is the mechanism of action of Methotrexate?
It inhibits folic acid metabolism, reducing cytokine production and immune activation.
What are the major adverse effects of Methotrexate?
Mucosal ulcers, nausea, hepatotoxicity, and bone marrow suppression.
What is Hydroxychloroquine used for?
Treatment of early, mild rheumatoid arthritis and malaria.
What is a major adverse effect of Hydroxychloroquine?
Ocular toxicity, including irreversible retinal damage.
What is Leflunomide used for?
RA treatment via inhibition of pyrimidine synthesis, reducing autoimmune lymphocyte proliferation.
What are the adverse effects of Leflunomide?
Diarrhea, liver toxicity, weight loss, and teratogenicity.
What is the function of Sulfasalazine?
Treatment of rheumatoid arthritis and inflammatory bowel disease.
What are common side effects of Sulfasalazine?
GI upset, nausea, leukopenia, and headache.
What are TNF-alpha inhibitors used for?
They reduce inflammation in RA, Crohn’s disease, psoriasis, and ankylosing spondylitis.
What are examples of TNF-alpha inhibitors?
Adalimumab (Humira), Infliximab (Remicade), Etanercept (Enbrel), Golimumab (Simponi), Certolizumab (Cimzia).
What are risks associated with TNF-alpha inhibitors?
Increased infection risk, malignancy risk, and worsening heart failure.
What is Abatacept (Orencia) used for?
RA treatment by inhibiting T-cell activation via CD80/CD86 interaction blockade.
What is the mechanism of action of Rituximab?
It depletes B-cells by targeting CD20, reducing autoimmune response in RA and lymphoma.
What are IL-6 inhibitors used for?
Tocilizumab (Actemra) and Sarilumab (Kevzara) block IL-6 to reduce inflammation in RA.
What is the mechanism of action of Xeljanz (Tofacitinib)?
It is a Janus kinase (JAK) inhibitor that modulates immune cell activity in RA.
What are the risks of JAK inhibitors like Xeljanz?
Anemia, neutropenia, infection risk, and malignancies.
What are Prostaglandin analogs used for?
Treatment of open-angle glaucoma by increasing uveoscleral outflow.
What are examples of Prostaglandin analogs?
Latanoprost, Bimatoprost, Tafluprost, Travoprost.
What is the role of Prostacyclin analogs?
They act as potent pulmonary vasodilators used to treat pulmonary hypertension.
What are examples of Prostacyclin analogs?
Epoprostenol, Iloprost, Treprostinil.
What is the primary use of Misoprostol?
Prevent NSAID-induced gastric ulcers and induce labor (off-label).
What is the mechanism of action of Lubiprostone?
It activates chloride channels in the intestine, increasing fluid secretion and easing constipation.
What is the primary function of opioids?
To relieve severe pain, reduce anxiety before anesthesia, control coughing or diarrhea, and treat opioid addiction.
What are common weak opioid analgesics?
Codeine, Hydrocodone, Tramadol.
What are common strong opioid analgesics?
Morphine, Hydromorphone, Fentanyl, Methadone, Oxycodone.
What opioid is commonly used for opioid addiction treatment?
Methadone.
Which opioid has the highest potency relative to morphine?
Fentanyl (approximately 100 times more potent).
What is the antidote for opioid overdose?
Naloxone (Narcan).
Which opioid has a ceiling effect due to Tylenol combination?
Hydrocodone (Vicodin, Lortab).
Which opioid should be avoided due to toxic metabolite accumulation?
Meperidine (Demerol).
What opioid antagonist is used for opioid-induced constipation?
Methylnaltrexone (Relistor).
What are the key side effects of opioids?
Respiratory depression, constipation, sedation, nausea, urinary retention.
Which opioid has both opioid and NMDA receptor effects?
Methadone.
What is the mechanism of action of NSAIDs?
They inhibit COX-1 and COX-2 enzymes to reduce prostaglandin synthesis.
Which NSAID is a selective COX-2 inhibitor?
Celecoxib (Celebrex).
What is the major risk of NSAIDs in cardiovascular patients?
Increased risk of heart attack and stroke.
Which NSAID is used for acute migraine treatment?
Diclofenac (Cambia).
What is the first-line treatment for mild to moderate pain?
Acetaminophen (Tylenol).
What is the antidote for acetaminophen overdose?
N-acetylcysteine (Mucomyst).
Which medication is used to protect the stomach when taking NSAIDs?
Misoprostol (Cytotec).
Which triptan is the prototype for migraine treatment?
Sumatriptan (Imitrex).
Which migraine medication should not be used in patients with cardiovascular disease?
Ergotamine (Cafergot).
What medication is used for refractory migraines?
Dihydroergotamine (DHE).
What is the first-line prophylactic treatment for migraines?
Beta-blockers (Propranolol, Metoprolol).
What newer class of biologic drugs is used for migraine prevention?
CGRP inhibitors (Erenumab - Aimovig).
Which antidepressants are commonly used for chronic pain management?
Tricyclic antidepressants (Amitriptyline, Nortriptyline).
Which anticonvulsants are used for neuropathic pain?
Gabapentin, Pregabalin (Lyrica), Topiramate.
What medication is used for opioid withdrawal management?
Buprenorphine (Subutex, Suboxone).
Which opioid is commonly used in patient-controlled analgesia (PCA) pumps?
Morphine or Hydromorphone.
Which opioid is commonly used in transdermal patches for chronic pain?
Fentanyl (Duragesic patch).
What is the major contraindication for triptans?
Uncontrolled hypertension, coronary artery disease, recent stroke.
What drug is used to treat serotonin syndrome?
Cyproheptadine.
What is the primary cause of gout?
High levels of uric acid in the blood leading to sodium urate crystal deposits in tissues, joints, and kidneys.
What triggers acute gout attacks?
Excess alcohol consumption, purine-rich diet, renal disease.
What are the first-line treatments for acute gout?
NSAIDs (Indomethacin preferred), steroids, and Colchicine.
When should preventative therapy for gout be considered?
For patients with 2+ attacks per year, CKD, renal stones, or tophi.
What are the main types of chronic gout therapy?
Xanthine oxidase inhibitors (Allopurinol, Febuxostat) and uricosurics (Probenecid).
What is the mechanism of action of Colchicine?
It binds to tubulin, preventing neutrophil migration and reducing inflammation in gout.
What are the side effects of Colchicine?
Nausea, vomiting, diarrhea, myopathy, neutropenia, aplastic anemia, alopecia.
What is the mechanism of action of Allopurinol?
Xanthine oxidase inhibitor that decreases uric acid production.
What are the adverse effects of Allopurinol?
Skin rashes (higher risk in renal impairment), hypersensitivity reactions.
How does Febuxostat differ from Allopurinol?
It is a non-purine xanthine oxidase inhibitor with lower risk of hypersensitivity but higher CV risk.
What is the function of Probenecid?
A uricosuric agent that promotes uric acid excretion by inhibiting reabsorption in the kidneys.
Why is Pegloticase used for gout?
It is a recombinant uricase enzyme that converts uric acid into allantoin for excretion.
What are common side effects of Pegloticase?
Infusion reactions, anaphylaxis (patients should be premedicated with antihistamines and steroids).
Which medication is first-line for preventing recurrent gout attacks?
Allopurinol or Febuxostat.
What is the mechanism of action of muscle relaxants?
They reduce muscle spasms by acting on the CNS or directly on skeletal muscles.
Which muscle relaxant is commonly used for spasticity in MS?
Baclofen.
What is the primary treatment for drug-induced serotonin syndrome?
Cyproheptadine.
Which medications are commonly abused as stimulants?
Cocaine, amphetamines, MDMA, synthetic cathinones.
What are the effects of cocaine toxicity?
Psychiatric complaints, hyperthermia, convulsions, chest pain, and cardiac complications.
What is cocaethylene and why is it dangerous?
A cardiotoxic metabolite formed when cocaine is used with alcohol.
What is the primary treatment for stimulant toxicity?
Benzodiazepines (Lorazepam) for agitation, cooling measures for hyperthermia.
What are the risks of synthetic cannabinoids?
Severe hallucinations, psychosis, seizures, acute kidney injury, and death.
What is the mechanism of action of alcohol?
Enhances GABA inhibition, increases opioid release, and alters serotonin/dopamine levels.
What are symptoms of alcohol withdrawal?
Tachycardia, sweating, tremors, hallucinations, seizures, anxiety.
Which medications are used to treat alcohol dependence?
Disulfiram (Antabuse), Naltrexone (ReVia/Vivitrol), Acamprosate (Campral).
What is the role of Disulfiram in alcohol cessation?
It blocks aldehyde dehydrogenase, leading to unpleasant reactions if alcohol is consumed.
What is the role of Naltrexone in alcohol dependence?
It is an opioid antagonist that reduces cravings and reward response to alcohol.
What is the role of Acamprosate in alcohol cessation?
Regulates NMDA-mediated glutamate activity to reduce cravings.
Which opioid is most commonly abused?
Fentanyl and its derivatives.
What is the antidote for opioid overdose?
Naloxone (Narcan).
