PAIN- Partial Agonist and CAM

Question 1

Buprenorphine is this typer of receptor?

Answer 1

Mu receport partial agonist 1. activates receptor at lower level 2. less abused, less reinforcing

Question 2

What is bupprenorphine affinity so important?

Answer 2

Affinity is strength to receport. It binds so strong that it will displace heorin and methadone off. NOT same as receptor activtion

Question 3

How is dissociation affected with Bup?

Answer 3

stays on receport for a long time

Question 4

How is BUp important in platue at High does?

Answer 4

Low dose inc activity 2. Hig does plaute at lowe receptor activity

Question 5

How should BUp be used?

Answer 5

Avoid combo with opioid. Wil knock it off. SE similar to opioid, WD in chronic

Question 6

Pt has body aches, lacrimation, rhinorrhea, puplis dialted,sweating, NVD, insomina, yawing (craving O2) What is the patient experinecing?

Answer 6

Opiod W/D- Common w/ dependence, and High dose

Question 7

What is spontaneous W/D syndrome?

Answer 7

Sudden stop or dec in opiods. Less w/ longer t1/2 drugs. WD sx- Heroin severe, Bup mild severe mild duration. Methodone mild sever long duration of sx

Question 8

What drug will kick someone in WD w/in minutes and last 20min, dose may need adjustment?

Answer 8

Opiod antaganist-Naloxone. BUP less WD when kickin opiod off. Would need High dose of BUP to start WD

Question 9

Why does heroin and methoadone have higher abuse?

Answer 9

1. Shorter half life 2. Multiple fast routes 3. BBB high lipophilicty

Question 10

What can decrease abuse potential with partial agonist?

Answer 10

Naxolone + Bupprenorphine DEC potentioal. 4:1. DONT inject INC WD for opioid dependent

Question 11

Naloxone is what type of fx at a receptor?

Answer 11

1. occupies w/o activating receptor 2. Not reinforcing 3. Blocks agonist at mu receptor. NOT DOSE dependent

Question 12

Nalxone and Naltrexone are sued for what?

Answer 12

1. OD-naloxone 2. Alcoholism- naltrexone

Question 13

What are warning with opioid antagonists?

Answer 13

1. reverses OD, N/V, INC HR, INC BP, trembling. 2. AVOID opioid depend, preg, CVD

Question 14

How are drugs graded in classes?

Answer 14

Class I-V. Lower the number higher the abuse and less medical use-LSD. V-Lomotil, codeine

Question 15

Which classes have refills?

Answer 15

1. CIII-CV 5 refills 2. CII no refills(morphine

Question 16

Which opioid can be used for pain or addiction?

Answer 16

Medtahdone- MUST descirbe purpose on outpatient RX

Question 17

When do we refer to CURES?

Answer 17

CII-CIV pt. W/in 24hrs of 1st time RX. Check Q4m

Question 18

What is Opioid induced Hyperalgesia?

Answer 18

Pt pain threshold is lowered. Pain worsen despite inc. dosage. Abnormal pain response to non painful stimuli. Allodynia

Question 19

What is Breakthrough pain therapy ?

Answer 19

Spikes in pain 1. Malignant pain 2. Use same agent for LTC but fast onset is goal

Question 20

How are safety measures applied with PCA?

Answer 20

1. Single standard {} 2. Read label, Capnography 3. Pt ed 4. RARELY used, AVOID

Question 21

What are some monitoring objective tools?

Answer 21

1. Pain scales 2. RASS, POSS 3. RR- count 30s if less 12, count min

Question 22

If pt is Scored at Level 3 POSS, drifts off during convo, what should you do?

Answer 22

DEc next dose 50% or withhold, until they are back ot LEVEL 2- droswy

Question 23

How should you convert to PCA to PO?

Answer 23

CHeck amount of adminstration

Question 24

Which opioid has the most itching pruritic effect?

Answer 24

Meperidine and Least Fentanyl. 1. Meperidine 2. Cdeine 3. Morphine 5. Hydrocone(vicodine) 6. oxycodone 7 Hydormorphone 8. Fentanyl

Question 25

If SE of opioids itching is too much, what can be used?

Answer 25

Ideal Loratadine (claritin) less sedation

Question 26

Instead of methylnaltrexone, what is preferred?

Answer 26

Laxatives. Lactulose

Question 27

Which drugs have been used in combo with other opiods?

Answer 27

TCA- amitriptyline, nortriptyline 2. SSRI, NRI 3. Steroids 4. Topicals 5. CNS depressans cyclobenzaprine 6. Alpha 2 Adrengi Agoins-clonidine

Question 28

What are expectation for neuropathic pain?

Answer 28

Neves hold grude, 6wk + for diff. #1Gabepenitin, Carbamazepine, lamotrigine, pregabaline. SLOW titration

Question 29

Which drug is avoided in Elderly?

Answer 29

TCA- anticholingeric.

Question 30

Due to cycle of depressionn and pain, which drug is used?

Answer 30

Amitriptyline and SSRI- 4-6wk trial w/ titration. NO SUDDEN STOP

Question 31

Which muslce relaxants are good?

Answer 31

NONne- baclofen,dantrolene. Cyclbenzaprine-similar to amitriptyline.

Question 32

What is Dana favorite topical?

Answer 32

Lidocaine patch- post hepetic neurolagia, back pain

Question 33

When you stub you toe, what happens?

Answer 33

Smile, it release endorphins. We grin when in pain, body natural