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Neuro Muscular Psych Block 2 > Pain Pharmacology > Flashcards

Pain Pharmacology Flashcards

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1
Q 
NSAIDs
Classic Indications (7) Contraindications (4)
A 
Osteoarthritis
Rheumatoid Arthritis
Bursitis
Gout
Ankylosing Spondylitis
Dysmenorrhea
Headache

Cardiovascular Disease (use naproxen)
Active Peptic/Gastric Ulcers
Chronic Kidney Disease (Cr clearance < 60)
Anticoagulant Drug Therapy

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2
Q

Aspirin

MOA, Uses (4) Adverse Effects (6)

A

Irreversible inhibition of COX-1 and COX-2

Inflammation
Pain
Fever
MI/Stroke Prevention

Reye syndrome (kids with flu or chicken pox)
Risk of bleeding
Edema
HTN
Papillary Necrosis
Suppress uterine contractions
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3
Q

Ketorolac

MOA, Indication, Adverse Effects (4)

A

Reversible COX-1 and COX-2 inhibition

Acute post-operative pain

Peptic ulcers
Risk of bleeding
Cardiovascular thrombotic events
Renal impairment

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4
Q

Indomethacin

MOA, Indications, Risks (2), Contraindication

A

Reversible COX-1 and COX-2 inhibition

Cardiovascular and GI risks

Classic NSAID indications

Coronary Artery Bypass Graft Surgery (CABG)

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5
Q

Ibuprofen

MOA, Indications, Contraindications (3) Cautions (3)

A

Reversible COX-1 and COX-2 inhibition

Classic NSAID indications

Active GI ulcers
Hepatic failure
Renal failure (renal toxic)

CHF, HTN or other conditions at risk of edema

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6
Q

Flurbiprofen

Indication, Warnings (2)

A

Opthalmic drops for inhibition of intra-operative miosis

Delays healing
Increased bleeding time

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7
Q

Meloxicam

MOA, Indications (3) Adverse Effects (4)

A

Reversible COX-1 and COX-2 inhibition

Rheumatoid Arthritis
Osteoarthritis
Juvenile Rheumatoid Arthritis

Upper Respiratory Infection
Dyspepsis
Diarrhea
Flu-like symptoms

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8
Q

Naproxen

MOA, Indications, Contraindications (2) Black Box Warning, Adverse Effects (2)

A

Reversible COX-1 and COX-2 inhibition

Classic NSAID indications

Asthma, urticaria or other allergy reactions with NSAIDs
CABG surgery

Risk of Thrombotic events

Hepatotoxic
Renal impairment

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9
Q

Diclofenac

MOA, Indications, Contraindications (2) Black Box Warning (2)

A

Reversible COX-1 and COX-2 inhibition

Classic NSAID indications

CABG surgery
Renal Failure

Increased risk of Stroke and MI

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10
Q

Celecoxib

MOA, Benefits (2) Adverse Effects (2)

A

Selectively blocks COX-2

Less GI ulcer risk
Less bleeding risk (no platelet aggregation block)

Increased risk of MI and Stroke

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11
Q

Acetaminophen

MOA, Effects (2) Benefits (2) Overdose Description (2) and Treatment

A

Prostaglandin inhibition in CNS but not periphery

Supresses pain and fever

Useful for patients with:
Gastric Ulcers
Renal failure (does not impair renal function)

Hepatotoxins accumulate due to depletion of glutathione during overdose

Treat OD with N-Acetylcysteine

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12
Q

Amitriptylline

Drug Class, Indication (2)

A

Tri-Cyclic Antidepressant

Depressive symptoms with associated Chronic Pain

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13
Q

Duloxetine

MOA, Indications (3) Contraindications (2) Black Box Warning

A

SNRI

Chronic MSK pain
Fibromyalgia
Diabetic Neuropathy

MAOI use
Narrow Angle Glaucoma

Increased risk of suicidality

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14
Q

Pregabalin

Indications (4) Warnings (2)

A

Fibromyalgia (first approved drug)
Post-Herpetic Neuralgia
Diabetic Neuropathy
Seizures

Pregnancy Category C
Depressants amplify depressant effects

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15
Q

Gabapentin

Indications (6) and Warnings (2)

A 
Broad Spectrum Anti-Seizure 
Fibromyalgia
Diabetic Neuropathy
Post-Herpetic Neuralgia
Migraines
Restless leg syndrome

Pregnancy Category C
Depressants amplify depressant effects

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16
Q 
Tramadol
MOA (2) Minor Side Effects (5) Serious Side Effects (3)
A

Weak mu agonist
SNRI (activates monoaminergic spinal pain inhibition)

Dizzy
Dry Mouth
Constipation
Headache
Sedation

Seizures in Epileptics
Hypertensive Crisis (if with MAOI)
Serotonin Syndrome

17
Q 
Tapentadol
MOA (2) Indication
A

Mu agonist
Blocks NE reuptake

Pain not effectively treated by other opioids and non-opioids

18
Q

Ketamine

MOA, Indications (2) Adverse Effects (2)

A

NMDA receptor antagonist

Anesthesia
Post-Operative pain

Psychological Reactions
Elevated BP

19
Q

Dexmedetomidine

MOA, Indications (2) Administration, Adverse Effects (2) Warning

A

alpha-2 Agonist

Analgesia
Short term anesthesia in critically ill patients

IV administration

Hypotension
Bradycardia

Pregnancy Category C

20
Q

Clonidine

MOA, Indications (2) Administration, Adverse Effects, Warning

A

alpha-2 Agonist

HTN
Severe cancer pain

Continuous epidural catheter infusion

Hypotension

Pregnancy Category C

21
Q

Ziconotide

MOA, Effect, Adverse Effects (2) Warnings (2)

A

Selective N-type voltage sensitive Calcium channel antagonist

Prevents pain signaling from periphery

Cognitive impairment
Muscle damage

Pregnancy Category C
Amplifies depressant effects of depressants

22
Q

Mixed Opioid Agonists/Antagonists
Pentazocine MOA
Butorphanol Administration and Contraindication
Buprenorphine: Indication, Warnings (2)

A

Pentazocine: kappa agonist, mu antagonist

Butorphanol
Nasal administration for migraines
Myocardial Infarction (increases cardiac work)

Buprenorphine
Opioid addiction treatment
Not readily reversed with Naloxone (tightly binds)
QT prolongation can cause fatal arrhythmias

23
Q 
Ergotamine
MOA (2), Indication, Overdose (3) Warnings (2)
A

Supresses CGRP to decrease inflammation in Trigeminal vascular system

Terminate Ongoing Migraines

Ergotism: Constriction of peripheral vasculature, can cause gangrene

Physical dependence
Pregnancy Category X

24
Q

Dihydroergotamine

MOA (2), Indication, Adverse Effect, Contraindications ()

A

Supresses CGRP to decrease inflammation in Trigeminal vascular system

Terminate Ongoing Migraines

Prominent Diarrhea

CAD
Peripheral vascular disease
Pregnancy
Hepatic/Renal Impairment

25
Q

Sumatriptan

MOA (3) Indication, Adverse Effect (5)

A

5-HT agonist
Suppress CGRP inflammatory neuropeptides
Constrict intracranial blood vessels

First line to terminate ongoing migraine

Serotonin Syndrome when combined with:
Ergot Alkaloids, SSRIs, MAOIs, SNRIs

Neuro Muscular Psych Block 2 (7 decks)

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