Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro > Pain Meds > Flashcards

Pain Meds Flashcards

1
Q

Which group of pain meds inhibit COX?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What inflammatory mediator causes inflammation–>pain?

A

prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does COX 1 and 2 do?

A

use arachidonic acid to produce prostaglandins during inflammation

physiologic role in renal function

COX 1 in all tissues, COX2 induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drug irreversibly binds COX 1 and 2 to decrease prostaglandin and thromboxane A2?

A

aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What to use aspirin for?

A 
pain
fever
inflammation
stroke
MI prevention (via - Cox1 in platelets)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Side effects of aspirin

A

ulcer

bleeding risk

multiple drug interactions

Reye syndrome in kids with flu or chicken pox

increased serum creatinine d/t loss of prostaglandin effects in kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drug reversibly binds COX 1 and 2 to decrease prostaglandin synthesis?

A

ibuprofen

pain, fever, inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference between naproxen and ibuprofen?

A

same MOA

naproxen has longer half-life (2 vs 12 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Side effects of ibuprofen

A

fetal renal dysfunction–> oligohydraminos after 20 weeks

closure of ductus arteriosus after 30 weeks

increased risk MI and stroke
–> DONT USE IN CABG

increased risk of GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drug inhibits prostaglandin synthesis via COX2?

A

celecoxib

pain, arthritis, dysmenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Side effects of celecoxib

A

fetal renal dysfunction–> oligohydraminos after 20 weeks

closure of ductus arteriosus after 30 weeks

increased risk MI and stroke
–> DONT USE IN CABG

increased risk of GI bleeding (less with COX2 vs 1 and 2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do you take aspirin 2 hours before other NSAIDS?

A

non-aspirin NSAIDS interfere with antiplatelet effects–> decrease protection against MI and stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why d/c high dose aspirin 1 week before surgery/pregnancy?

A

increase risk of bleeding with warfarin, heparin, other anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOA of non-aspirin NSAIDS

A

inhibit COX1 and 2

pain, fever, inflammation

increased risk gastric ulcer, renal impairment, bleeding

different from aspirin:

  • reversible effects
  • increases risk of MI/CVA

use lowest effective dose for shortest possible time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Coxibs vs aspirin or non-aspirin NSAIDs

A

less gastric ulceration

selectively blocks COX2

doesn’t inhibit platelet aggregation–> no risk for bleeding

increased risk MI and stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Commonly used NSAIDs

A 
aspirin
celecoxib (celebrex)
diclofenac
ibuprofen (motrin)
indomethacin
ketorolac (toradol)
naproxen (aleve, naprosyn)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What NSAID is recommended is a patient has cardiovascular risk?

A

naproxen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Contraindications for NSAIDs

A 
CKD
gastric or duodenal ulcer
heart failure
uncontrolled HTN
allergy
ongoing anticoagulant tmt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When to use acetaminophen

A

pain and fever

DOES NOT treat inflammation

20
Q

Side effects of acetaminophen

A

med error/overdosing–> hepatotoxicity (depletes glutathione)

no GI, bleeding or renal risk

21
Q

Suspected MOA of acetaminophen

A

activate descending serotonergic inhibitor pathways in CNS

22
Q

tmt for acetaminophen toxicity

A

acetylcysteine

substitutes depleted glutathione

23
Q

Increased risk of bleeding with acetaminophen and ____

A

warfarin

inhibits its metabolism

24
Q

First line agents for neuropathic pain

A

calcium channel ligands

serotonin-norepi reuptake inhibitor (SNRI)

tricyclic antidepressant

25
Q

amitriptyline

A

tricyclic antidepressant (inhibits NE and 5-HT reuptake)

treat neuropathic pain

26
Q

Side effects of amitriptyline

A

SI in kids and ya

anticholinergic effects

increased bleeding risk

27
Q

duloxetine

A

inhibitor of 5-HT and NE reuptake

weak dopamine reuptake inhibitor

treat neuropathic pain with concurrent depression

28
Q

Side effects of duloxetine

A

SI (main)

N, dizziness, sweating, sexual dysfunction, insomnia/agitation, increased BP

29
Q

pregabalin (Lyrica)

A

binds a2s subunit of CNS calcium channels (NOT GABA) to decrease excitatory AP

neuropathic pain a/w DM neuropathy, postherpatic neuralgia, fibromyalgia, partial seizures

gabapentin similar

30
Q

Second line tmt for neuropathic pain

A

antiepileptic

opioid

tramadol

31
Q

Second line for nociceptive pain

A

weak opioid, nonopioid and adjuvant (TCA, SNRI, anticonvulsant)

32
Q

Third line for nociceptive pain

A

strong opioid, nonopioid and adjuvant (TCA, SNRI, anticonvulsant)

33
Q

Third line for nociceptive pain

A

strong opioid, nonopioid and adjuvant (TCA, SNRI, anticonvulsant)

34
Q

tramadol

A

partial u-opiate receptor agonist

block NE and 5-HT reuptake

severe pain, premature ejaculation, RLS

35
Q

Side effects of tramadol

A

overdose/death via respiratory depression with med error

addiction, abuse

interact with CYP450 drugs

increase respiratory depression with use with benzo, other CNS depressants

36
Q

What to use for patients not effectively treated with opioids or non-opioids in neuropathic pain?

A

tapentadol

mod-strong opioid agonist, blocks NE reuptake

37
Q

Third/Fourth line tmt for neuropathic pain

A

3: NMDA antagonist, analgesic combo, baclofen/tizanidine
4: botox, intrathecal ziconotide

38
Q

ketamine

A

noncompetitive NMDA receptor antagonist

dissociation/anesthesia, analgesia

39
Q

dexmedetomidine

A

selective alpha 2 agonist in brainstem

– inhibit NE release

sedation, pain

40
Q

clonidine

A

alpha 2 agonist for HTN and severe pain

41
Q

ziconotide

A

N voltage calcium channel on dorsal horn afferent nerves–> block excitation to reduce sensitivity to pain

42
Q

Side effects of ziconotide

A

severe psych sx, neuro impairment

increased risk for patient harm when used in error

43
Q

When to use ziconotide

A

only for chronic severe pain

given intrathecal when refractory to other treatments

44
Q

lasmiditan

A

5-HT receptor agonist

decrease stimulation of trigeminal system, treat migraine

45
Q

ubrogepant

A

calcitonin antagonist

treat migraine with or without aura

46
Q

dihydroergotamine

A

ergot alkaloid

migraine

cluster headaches

orthostatic hypotension

pelvic congestion with pain

47
Q

Side effects of dihydroergotamine

A

contraindicated with potent inhibitors of CYP3A4

cerebral ischemia

ischemia of extremities

Neuro (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions