Pain OPTION 2-FINAL

Question 1

Aspirin (ASA)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 1

Mechanism of Action: Irreversibly inhibits COX-1 and COX-2, decreasing prostaglandin synthesis.

Uses: Anti-inflammatory, analgesic, antipyretic, antiplatelet.

Special Considerations: Avoid in children with viral infections (Reye’s Syndrome), can cause GI bleeding, take with food.

Contraindications: Children with viral infections (Reye’s Syndrome), active GI bleeding, severe kidney disease.

Pregnancy/Lactation: Avoid in pregnancy (3rd trimester: premature ductus arteriosus closure), lactation caution.

Question 2

Ibuprofen
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 2

Mechanism of Action: Reversibly inhibits COX-1 and COX-2, decreasing prostaglandin synthesis.

Uses: Pain relief, inflammation, fever reduction.

Special Considerations: Less GI risk than aspirin but still present, caution in kidney disease.

Contraindications: Severe renal impairment, history of GI bleeding, cardiovascular disease caution.

Pregnancy/Lactation: Avoid in 3rd trimester, caution in lactation.

Question 3

Acetaminophen (Tylenol)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 3

Mechanism of Action: Inhibits prostaglandin synthesis in CNS, weak peripheral COX inhibition.

Uses: Pain relief, fever reduction.

Special Considerations: Hepatotoxic in overdose, avoid in severe liver disease, antidote is N-acetylcysteine.

Contraindications: Severe liver disease, alcoholism, chronic high doses.

Pregnancy/Lactation: Considered safe in pregnancy, caution in high doses.

Question 4

Methotrexate
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 4

Mechanism of Action: Folic acid antagonist, inhibits cytokine production and purine synthesis.

Uses: RA, psoriasis, certain cancers.

Special Considerations: Monitor liver enzymes, contraindicated in pregnancy, give folic acid supplementation.

Contraindications: Pregnancy, liver disease, active infection, bone marrow suppression.

Pregnancy/Lactation: Contraindicated in pregnancy, avoid in lactation.

Question 5

Hydroxychloroquine (Plaquenil)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 5

Mechanism of Action: Unclear, but modulates immune response.

Uses: RA, lupus.

Special Considerations: Risk of ocular toxicity, requires regular eye exams.

Contraindications: Retinal disease, known hypersensitivity.

Pregnancy/Lactation: Use caution, potential fetal risks.

Question 6

Leflunomide (Arava)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 6

Mechanism of Action: Inhibits dihydroorotate dehydrogenase, preventing lymphocyte proliferation.

Uses: RA.

Special Considerations: Hepatotoxicity risk, contraindicated in pregnancy, long half-life.

Contraindications: Pregnancy, liver disease, immunosuppression.

Pregnancy/Lactation: Contraindicated in pregnancy and lactation.

Question 7

Celecoxib (Celebrex)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 7

Mechanism of Action: Selective COX-2 inhibitor, reducing inflammation.

Uses: RA, OA, pain relief.

Special Considerations: Lower GI risk but increased CV risk compared to NSAIDs.

Contraindications: History of CV disease, active GI bleeding.

Pregnancy/Lactation: Avoid in pregnancy (CV risk), lactation caution.

Question 8

Misoprostol (Cytotec)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 8

Mechanism of Action: PGE1 analog, protects gastric mucosa, decreases acid secretion.

Uses: Prevention of NSAID-induced ulcers, induction of labor, misscarriage, abortion

Special Considerations: Contraindicated in pregnancy, can cause diarrhea.

Contraindications: Pregnancy, history of uterine disorders, inflammatory bowel disease.

Pregnancy/Lactation: Contraindicated in pregnancy (uterotonic effects), lactation caution.

Question 9

TNF-α Inhibitors (Infliximab, Etanercept, Adalimumab)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 9

Mechanism of Action: Block TNF-α, reducing inflammation.

Uses: RA, Crohn’s disease, psoriasis.

Special Considerations: Risk of infections (TB, fungal), avoid live vaccines.

Contraindications: Active or latent TB, serious infections, history of malignancy.

Pregnancy/Lactation: Avoid in pregnancy (immunosuppression risk), lactation caution.

Question 10

Tofacitinib (Xeljanz)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 10

Mechanism of Action: Janus kinase (JAK) inhibitor, modulating immune response.

Uses: RA, psoriatic arthritis, UC.

Special Considerations: Monitor for infections, anemia, increased malignancy risk.

Contraindications: Serious infections, active TB, demyelinating disease.

Pregnancy/Lactation: Avoid in pregnancy, lactation safety unknown.

Question 11

Alprostadil (Caverject/Muse)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 11

Mechanism of Action: PGE1 analog, vasodilator.

Uses: Erectile dysfunction, maintains ductus arteriosus in neonates.

Special Considerations: Administered via injection or urethral suppository, risk of hypotension.

Contraindications: Serious infections, active TB, concurrent biologics.

Pregnancy/Lactation: Avoid in pregnancy, lactation safety unknown.

Question 12

Lubiprostone (Amitiza)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 12

Mechanism of Action: PGE1 derivative, activates Cl- channels increasing intestinal fluid secretion.

Uses: Chronic idiopathic constipation, opioid-induced constipation, IBS-C.

Special Considerations: Can cause nausea, take with food. Only approved for WOMEN.

Contraindications: Severe infections, TB, recent live vaccines.

Pregnancy/Lactation: Avoid in pregnancy, lactation safety unknown.

Question 13

Bimatoprost (Latisse/Lumigan)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 13

Mechanism of Action: Prostaglandin F2α analog, increases uveoscleral outflow.

Uses: Open-angle glaucoma, eyelash hypotrichosis.

Special Considerations: May cause iris pigmentation, increased eyelash growth.

Contraindications: Active TB, history of serious infections, lymphoma history.

Pregnancy/Lactation: Avoid in pregnancy, lactation safety unknown.

Question 14

Latanoprost (Xalantan)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 14

Mechanism of Action: Prostaglandin F2α analog, increases aqueous humor outflow.

Uses: Glaucoma, ocular hypertension.

Special Considerations: Can change iris color, cause eye irritation.

Contraindications: Severe COPD, serious infections, live vaccines.

Pregnancy/Lactation: Avoid in pregnancy, lactation unknown.

Question 15

Epoprostenol (Flolan/Veletri)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 15

Mechanism of Action: Prostacyclin (PGI2) analog, vasodilates pulmonary and systemic arteries.

Uses: Pulmonary arterial hypertension.

Special Considerations: Short half-life, continuous IV infusion required.

Contraindications: Serious infections, severe infusion reactions.

Pregnancy/Lactation: Avoid in pregnancy, lactation unknown.

Question 16

Iloprost (Ventavis)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 16

Mechanism of Action: Prostacyclin analog, vasodilates pulmonary arteries.

Uses: Pulmonary arterial hypertension.

Special Considerations: Inhalation formulation, may cause dizziness, headache.

Contraindications: Serious infections, neutropenia, liver disease.

Pregnancy/Lactation: Avoid in pregnancy, lactation unknown.

Question 17

Sulfasalazine (Azulfidine)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 17

Mechanism of Action: Unclear, modulates immune response.

Uses: RA, ulcerative colitis.

Special Considerations: Risk of GI upset, leukopenia, and anemia; monitor CBC.

Contraindications: Serious infections, hepatic impairment, GI perforation.

Pregnancy/Lactation: Avoid in pregnancy, lactation unknown.

Question 18

Adalimumab (Humira)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 18

Mechanism of Action: TNF-α inhibitor, reduces inflammation.

Uses: RA, Crohn’s disease, psoriasis.

Special Considerations: Risk of infection, avoid live vaccines.

Contraindications: Children with viral infections (Reye’s Syndrome), active GI bleeding, severe kidney disease.

Pregnancy/Lactation: Avoid in pregnancy (3rd trimester: premature ductus arteriosus closure), lactation caution.

Question 19

Certolizumab (Cimzia)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 19

Mechanism of Action: TNF-α inhibitor, neutralizes TNF-α.

Uses: RA, Crohn’s disease.

Special Considerations: PEGylated formulation extends half-life, increased infection risk.

Contraindications: Severe renal impairment, history of GI bleeding, cardiovascular disease caution.

Pregnancy/Lactation: Avoid in 3rd trimester, caution in lactation.

Question 20

Etanercept (Enbrel)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 20

Mechanism of Action: TNF-α receptor fusion protein, binds TNF-α.

Uses: RA, psoriasis, ankylosing spondylitis.

Special Considerations: Given subcutaneously weekly, increased risk of infections.

Contraindications: Severe liver disease, alcoholism, chronic high doses.

Pregnancy/Lactation: Considered safe in pregnancy, caution in high doses. (though research shows it crosses the placenta and has a small increase in risk of preterm birth)

Question 21

Golimumab (Simponi)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 21

Mechanism of Action: Monoclonal antibody against TNF-α.

Uses: RA, psoriatic arthritis.

Special Considerations: Monthly SQ injection, risk of infection and liver enzyme elevations.

Contraindications: Pregnancy, liver disease, active infection, bone marrow suppression.

Pregnancy/Lactation: Contraindicated in pregnancy, avoid in lactation.

Question 22

Infliximab (Remicade)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 22

Mechanism of Action: Chimeric monoclonal antibody against TNF-α.

Uses: RA, Crohn’s disease, psoriasis.

Special Considerations: Given IV, risk of infusion reactions, requires premedication.

Contraindications: Retinal disease, known hypersensitivity.

Pregnancy/Lactation: Use caution, potential fetal risks.

Question 23

Abatacept (Orencia)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 23

Mechanism of Action: Costimulation modulator, blocks T-cell activation.

Uses: RA.

Special Considerations: Given IV, increased risk of infections, avoid in severe COPD.

Contraindications: Pregnancy, liver disease, immunosuppression.

Pregnancy/Lactation: Contraindicated in pregnancy and lactation.

Question 24

Rituximab (Rituxin)
MOA
Uses
Special Considerations
Contraindications
Pregnancy

Answer 24

Mechanism of Action: Monoclonal antibody against CD20, depletes B cells.

Uses: RA, B-cell malignancies.

Special Considerations: Risk of infusion reactions, premedicate with steroids, APAP, and antihistamines.

Contraindications: History of CV disease, active GI bleeding.

Pregnancy/Lactation: Avoid in pregnancy (CV risk), lactation caution.

Question 25

Sarilumab (Kevzara) MOA Uses Special Considerations Contraindications Pregnancy

Answer 25

Mechanism of Action: Monoclonal antibody against IL-6 receptor. Uses: RA. Special Considerations: Given SQ, risk of neutropenia, increased LFTs. Contraindications: Pregnancy, history of uterine disorders, inflammatory bowel disease. Pregnancy/Lactation: Contraindicated in pregnancy (uterotonic effects), lactation caution.

Question 26

Tocilizumab (Actemra) MOA Uses Special Considerations Contraindications Pregnancy

Answer 26

Mechanism of Action: Monoclonal antibody against IL-6 receptor. Uses: RA, cytokine release syndrome. Special Considerations: Given IV or SQ, monitor for liver toxicity and infections. Contraindications: Active or latent TB, serious infections, history of malignancy. Pregnancy/Lactation: Avoid in pregnancy (immunosuppression risk), lactation caution.

Question 27

Meloxicam (Mobic) MOA Uses Special Considerations Contraindications Pregnancy

Answer 27

Mechanism of Action: Selective COX-2 inhibitor at low doses, inhibits prostaglandin synthesis. Uses: Osteoarthritis, rheumatoid arthritis. Special Considerations: Longer half-life allows once-daily dosing. Contraindications: History of GI bleeding, severe renal impairment. Pregnancy/Lactation: Avoid in third trimester, caution in lactation.

Question 28

Ketorolac (Toradol) MOA Uses Special Considerations Contraindications Pregnancy

Answer 28

Mechanism of Action: Non-selective COX inhibitor, strong analgesic effect. Uses: Moderate to severe pain, post-operative pain. Special Considerations: High risk of GI ulceration, limited to 5-day use. Contraindications: Active GI bleeding, severe renal impairment. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 29

Naproxen (Naprosyn) MOA Uses Special Considerations Contraindications Pregnancy

Answer 29

Mechanism of Action: Non-selective COX inhibitor, reduces inflammation and pain. Uses: Mild to moderate pain, arthritis, dysmenorrhea. Special Considerations: Longer half-life allows BID dosing. Contraindications: GI bleeding, cardiovascular disease. Pregnancy/Lactation: Avoid in third trimester, caution in lactation.

Question 30

Meperidine (Demerol) MOA Uses Special Considerations Contraindications Pregnancy

Answer 30

Mechanism of Action: Mu-opioid receptor agonist, inhibits pain transmission. Uses: Short-term pain relief. Special Considerations: Not recommended for chronic pain due to toxic metabolite (normeperidine). Contraindications: Renal failure, seizures. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 31

Codeine (CS III) MOA Uses Special Considerations Contraindications Pregnancy

Answer 31

Mechanism of Action: Weak mu-opioid receptor agonist, metabolized to morphine. Uses: Mild to moderate pain, cough suppression. Special Considerations: Metabolism varies between individuals, risk of respiratory depression. Contraindications: Children under 12, respiratory depression. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 32

Tapentadol (CS II/Nucynta) MOA Uses Special Considerations Contraindications Pregnancy

Answer 32

Mechanism of Action: Mu-opioid receptor agonist, inhibits norepinephrine reuptake. Uses: Moderate to severe acute pain. Special Considerations: Lower risk of respiratory depression than traditional opioids. Contraindications: Severe respiratory depression, MAOIs. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 33

Pentazocine (Talwin) MOA Uses Special Considerations Contraindications Pregnancy

Answer 33

Mechanism of Action: Mixed opioid agonist-antagonist. Uses: Moderate pain relief. Special Considerations: Can cause psychotomimetic effects. Contraindications: History of opioid dependence. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 34

Butorphanol (Stadol) MOA Uses Special Considerations Contraindications Pregnancy

Answer 34

Mechanism of Action: Partial opioid agonist, kappa receptor agonist. Uses: Migraine, moderate pain relief. Special Considerations: Can cause sedation and dizziness. Contraindications: Opioid dependence. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 35

Naratriptan (Amerge) MOA Uses Special Considerations Contraindications Pregnancy

Answer 35

Mechanism of Action: 5-HT1B/1D receptor agonist, causes vasoconstriction. Uses: Migraine abortive therapy. Special Considerations: Longer half-life than sumatriptan. Contraindications: Ischemic heart disease, uncontrolled hypertension. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 36

Almortriptan (Axert) MOA Uses Special Considerations Contraindications Pregnancy

Answer 36

Mechanism of Action: 5-HT1B/1D receptor agonist. Uses: Migraine abortive therapy. Special Considerations: Longer half-life, less recurrence. Contraindications: Cardiovascular disease, MAOIs. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 37

Eletriptan (Relpax) MOA Uses Special Considerations Contraindications Pregnancy

Answer 37

Mechanism of Action: 5-HT1B/1D receptor agonist. Uses: Migraine abortive therapy. Special Considerations: More potent than sumatriptan. Contraindications: Cardiovascular disease. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 38

Ergotamine Tartrate (Cafergot) MOA Uses Special Considerations Contraindications Pregnancy

Answer 38

Mechanism of Action: Non-selective 5-HT receptor agonist, vasoconstrictor. Uses: Migraine abortive therapy. Special Considerations: Can cause nausea, vasospasm. Contraindications: Pregnancy, cardiovascular disease. Pregnancy/Lactation: Category X, contraindicated in pregnancy.

Question 39

Dihydroergotamine (DHE) MOA Uses Special Considerations Contraindications Pregnancy

Answer 39

Mechanism of Action: 5-HT receptor agonist, vasoconstrictor. Uses: Refractory migraines. Special Considerations: Less nausea than ergotamine. Contraindications: Cardiovascular disease, pregnancy. Pregnancy/Lactation: Category X, contraindicated in pregnancy.

Question 40

Topiramate (Topamax) MOA Uses Special Considerations Contraindications Pregnancy

Answer 40

Mechanism of Action: Blocks voltage-gated Na+ channels, enhances GABA activity. Uses: Migraine prevention (can be used in children), epilepsy. Special Considerations: Can cause cognitive slowing, weight loss. Contraindications: Pregnancy (teratogenic effects). Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 41

Erenumab (Amovig) MOA Uses Special Considerations Contraindications Pregnancy

Answer 41

Mechanism of Action: Calcitonin gene-related peptide (CGRP) receptor antagonist. Uses: Migraine prevention. Special Considerations: SQ injection once monthly. Contraindications: Hypersensitivity reactions. Pregnancy/Lactation: Limited data, use with caution.

Question 42

Best Way to Treat Migraine

Answer 42

Mechanism of Action: Multimodal approach. Uses: Migraine management. Special Considerations: Acute treatment: NSAIDs, triptans; Prevention: Beta-blockers, antiepileptics. Contraindications: Varies by medication. Pregnancy/Lactation: Consult physician for safest option.

Question 43

Best Way to Treat Migraine in Children

Answer 43

Mechanism of Action: Pediatric-specific treatment approaches. Uses: Migraine management in children. Special Considerations: Acetaminophen, ibuprofen for acute; propranolol, topiramate for prevention. Contraindications: Avoid triptans in younger children.

Question 44

Indomethacin (Indocin) MOA Uses Special Considerations Contraindications Pregnancy

Answer 44

Mechanism of Action: Non-selective COX inhibitor, reduces inflammation. Uses: Acute gout attack, arthritis. Special Considerations: Preferred NSAID for gout, but can cause GI toxicity. Contraindications: GI bleeding, severe renal impairment, cardiovascular disease. Pregnancy/Lactation: Avoid in third trimester, caution in lactation.

Question 45

Colchicine (Colcrys) MOA Uses Special Considerations Contraindications Pregnancy

Answer 45

Mechanism of Action: Inhibits microtubule polymerization, reducing neutrophil activity. Uses: Acute gout attack, prophylaxis during urate-lowering therapy. Special Considerations: GI side effects common, dose adjust in renal/hepatic impairment. Contraindications: Severe renal or hepatic disease, pregnancy. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 46

Allopurinol (Zyloric/Uricto) MOA Uses Special Considerations Contraindications Pregnancy

Answer 46

Mechanism of Action: Xanthine oxidase inhibitor, reduces uric acid production. Uses: Chronic gout, tumor lysis syndrome. Special Considerations: Rash risk (including Stevens-Johnson syndrome), dose adjust in renal disease. Contraindications: Hypersensitivity, severe renal impairment. Pregnancy/Lactation: Use caution in pregnancy, limited data in lactation.

Question 47

Febuxostat (Uloric) MOA Uses Special Considerations Contraindications Pregnancy

Answer 47

Mechanism of Action: Selective xanthine oxidase inhibitor, reduces uric acid production. Uses: Chronic gout in patients intolerant to allopurinol. Special Considerations: Higher CV risk than allopurinol, requires liver function monitoring. Contraindications: History of cardiovascular disease, severe liver impairment. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 48

Probenecid (Probalan) MOA Uses Special Considerations Contraindications Pregnancy

Answer 48

Mechanism of Action: Uricosuric, increases renal excretion of uric acid. Uses: Chronic gout (alternative to xanthine oxidase inhibitors). Special Considerations: Not effective in renal impairment, can cause kidney stones. Contraindications: Renal impairment, history of nephrolithiasis. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 49

Pegloticase (Krystexxa) MOA Uses Special Considerations Contraindications Pregnancy

Answer 49

Mechanism of Action: Recombinant uricase, converts uric acid to allantoin. Uses: Chronic refractory gout. Special Considerations: Risk of infusion reactions, requires premedication with antihistamines/steroids. Contraindications: G6PD deficiency, severe hypersensitivity reactions. Pregnancy/Lactation: Avoid in pregnancy, caution in lactation.

Question 50

Drug of Choice for Acute Gout

Answer 50

Mechanism of Action: Suppresses inflammation in gouty joints. Uses: Rapid relief of acute gout attacks. Special Considerations: First-line: NSAIDs (Indomethacin preferred), colchicine if NSAIDs contraindicated, corticosteroids if NSAIDs/colchicine cannot be used. Contraindications: Varies by drug; NSAIDs contraindicated in renal disease, colchicine in severe hepatic/renal disease. Pregnancy/Lactation: Avoid NSAIDs in third trimester, colchicine with caution.

Question 51

Gout Maintenance Drugs

Answer 51

Mechanism of Action: Reduce uric acid levels or increase excretion to prevent flare-ups. Uses: Prevent recurrent gout attacks, reduce complications. Special Considerations: Xanthine oxidase inhibitors (Allopurinol, Febuxostat) are first-line; Probenecid is an alternative if uric acid excretion is normal. Contraindications: Severe renal impairment, hypersensitivity. Pregnancy/Lactation: Use with caution, consult specialist.

Question 52

Special Considerations in Gout Treatment

Answer 52

Mechanism of Action: Key factors in managing gout effectively. Uses: Optimizing treatment strategy for individual patients. Special Considerations: Start prophylaxis (Colchicine/NSAIDs) when initiating urate-lowering therapy to prevent flares; lifestyle modifications (low-purine diet, reduced alcohol intake) recommended. Contraindications: N/A Pregnancy/Lactation: Discuss case-specific recommendations with a specialist.