Pain medications

Question 1

What meds can act on peripheral nociceptors

Answer 1

TRANSDUCTION SITES:
Locas anesth.
NSAIDs, COX-1 and COX-2 inhibitors 
Acetaminophen
Capsaicin

Question 2

What meds can act on peripheral nerve

Answer 2

local anesth.

opioids

Question 3

What meds can act on Dorsal horn

Answer 3

Local anesth.
Opioids
NSAIDs

Question 4

What meds can act on descending modulation

Answer 4

OPIOIDS:
Serotonin drugs
Neuropeptides

Question 5

What meds can act on the brain

Answer 5

Opioids
Glutamine/GABA (Ultram)
Antidepresants (5HT/NE)

Question 6

What are possible side effects of COX-2 inhibitors

Answer 6

Interfers with renal function

Reduces prostaglandin mediated vasodilation–> heart attacks and strokes.

Question 7

COX-1 and 2 inhibitors are

Answer 7

Analgesic
anti-inflammatory
anti-pyretic

Question 8

Acetaminophen (Tylenol) properties

Answer 8

Non NSAID
Non COX-1 or 2 inhibitor
Might block COX-3 and/or block 5HT
Analgesic: dental, headache, muscle, bone pain
anti-pyretic (children); interaction with seratonin–>sedative
Stable in solution

Question 9

What are examples of NSAIDs

Answer 9

non-selective COX-1 and 2 inhibitors
Salicylates
Ibuprofen-like
Selective COX-2 inhibitors (Celebrex)

Question 10

What are the properties of Salicylates (Aspirin)

Answer 10

COX-1 and 2 inhibitor
Antipyretic; 300-600 mg
Analgesia; 600mg (plateau)
Anti-inflammatory; 1 gm 
Duration; 4 hrs 
Mild to mod somatic pain 
Often combined w; acetaminophen, caffeine, opioids

Question 11

What are side effects of salicylates

Answer 11

DO NOT USE ON CHILDREN up to 19yo; Reyes syndrome
GI irritation and erosion
Anti-clotting; damages platelets; two weeks to recover
Tinnitis at high doses
Acid; present in wart remover.

Question 12

What are the properties of Ibuprofen-type NSAIDs

Answer 12

COX-2 and 1 inhibitor
Antipyretic; 400 mg
Analgesia; 400 mg
Anti-inflammatory; 800 mg
Duration; 4 hrs 
Mild to mod pain relief ≥ aspirin

Question 13

What are the side effects of Ibuprofen-like NSAIDs

Answer 13

GI ulcers

Question 14

What are some Ibuprofen-type NSAIDs

Answer 14

Motrin
Advil
Naproxen (Alleve); longer-lasting but slower acting
Ketoprofen; Rx 50mg, more potent
Celebrex Rx; cox-2; no GI/anti-clotting action. poss CV effects.

Question 15

What are other Rx NSAIDs

Answer 15

Indomethacin; non-selective, serious side effects.
Meloxican; Preferential cox-2 inh = less GI problems
Diflunisal (Dolobid); related to salycilates, bone pain

Question 16

What are side effects of Acetaminophen

Answer 16

Liver toxin in high doses= 1 gm

Do not use on compromised liver patients

Question 17

What are some NSAID anticoagulant contraindications

Answer 17

Cuomadin ( warfarin/pradaxa)
Joint replacement
Heart attack/stroke
Major surgery
Atrial fibrillation
Hemophiliac

Question 18

What are some Ulcer NSAID contraindications

Answer 18

Ulcers;
Frequent upset stomach
Bleeding in stools 
takes antacids
Takes H2 blockers (Tagamet)
Already taking high doses; Arthritis 
History of allergies

Question 19

What are therapeutic uses of Opioids

Answer 19

Analgesia; somatic/visceral–> mild to severe
Antitussive; interferes with cough reflex
antidiarrheal
Causes drug dependance/withdrawals after 1 month

Question 20

Equipotent dosis

Answer 20

Fentanyl 0.1mg
Oxymorphone 1 mg
Hydromorphone 1.5 mg 
Morphine 10  mg 
Oxycodone (Oxycontin/Percodan) 20 mg
(Percoset) Oxycodone + acetaminophen 
Hydrocodone + acetaminophen (lortab/vicodin) 30 mg (dentist most com)
Codeine 200 mg

Question 21

What are other narcotic analgesics

Answer 21

Meperidine
Pentazocine; mod pain, mix ago/anta–> discourages abuse
Methadone/Buprenorphine; mod to strong, used to treat opioid addiction and as analgesic

Question 22

What are opioid agonist side effects

Answer 22

Mostly mu receptors
Respiratory depression/dec pulmonary reflex
Constipation/ slow bowel movement
Sedation/additive or synergistic with CNS depressants
Euphoria/dependency/addiction

Question 23

What is the tx for opioid OD

Answer 23

Naloxone (Narcan)

may precipitate withdrawals ( blocks endorphins)

Question 24

What are opioids contraindications

Answer 24

history of substance abuse
severe constipation
Respiratory problems 
Use of CNS depresants
History of allergies

Question 25

What is the Tx for neuropathic pain (trigeminal neuralgia)

Answer 25

Gabapentin/Lyrica (anti-seizure) GABA/glutamate
Duloxetine (antidepressant) NE/5HT uptake blocker
Nortriptyline (antidepressant) NE uptake
Next
Tramadol (non-opioid but can cause dependance sch 4)

Question 26

What is the def of misuse

Answer 26

Either not prescribed or clinically inappropriate

Question 27

What is dependence

Answer 27

persistent use resulting in adaptations typically accompanied by accommodation or tolerance and withdrawal.

Question 28

what is drug addiction

Answer 28

compulsive frug use tat consists of repetition to satisfy intense urges, despite severely negative consequences.

Question 29

What is use

Answer 29

Prescribed and clinically appropriate

Question 30

What schedule are opioids

Answer 30

II

Question 31

What is the addiction cycle for Rx drugs

Answer 31

Relieve medical condition
Causes reinforcing effects (↑ DA in brain)
induces physical dependence
Tolerance/withdrawal issue due to lengthy use
Often pts have pre existing abuse risk (mental/prexisting prob)
Use of various strategies to maintain supply

Question 32

How many americans are abusing Rx drugs

Answer 32

9 million at least once a year

4 million monthly

Question 33

Where do abused Rx drugs come from

Answer 33

Friend/relative= 66%
Buy drug = 21 %
Doctor Rx = 19%
Took/stole = 12%
Dealer = 8 %

Question 34

What is SBRIT

Answer 34

Screening
Brief interview
Intervention
Referral 
Treatment

Question 35

What is DOPL

Answer 35

Division of Occupational and Professional Licensing