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Pharmacology > Pain Relief > Flashcards

Pain Relief Flashcards

1
Q

Ketorolac, Oxaprozin, Flubiprofen, Ketoprofen, Naproxen, Ibuprofen and Fenoprofen

A

Pharmacodynamics: propionic acid COX - 1 selective blocker NSAID;
Indication for use: Anti - inflammatory pain relief.

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2
Q

Sulindac, Indomethacin and Tolmetin

A

Pharmacodynamics: acetic acid COX - 1 selective blocker NSAID;
Indication for use: Anti - inflammatory pain relief.

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3
Q

Piroxicam and Meloxicam

A

Pharmacodynamics: Oxicam COX - 2 selective blocker NSAID;

Indication for use: Anti - inflammatory pain relief.

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4
Q

Celecoxib, Diclofenac and Etodolac

A

Pharmacodynamics: COX - 2 selective blocker NSAID;

Indication for use: Anti - inflammatory pain relief.

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5
Q

Mecofenamate and Mefanamic acid

A

Pharmacodynamics: Fenamate NSAID affinity for COX-2;

Indication for use: Anti - inflmmatory pain relief;

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6
Q

Methyl salicylate, Salsalate, Aspirin, Diflunisal, Salicylate salt and Nabumetone

A

Pharmacodynamics: Salicylate NSAID affinity for COX-2;
Indication for use: analgesic at low dose, anti-inflammatory at high dose. As aspirin also inhibits COX-1 it also prevents the formation of PGH2 and subsequently Thromboxane A2 inhibiting clotting.

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7
Q

Acetaminophen (Paracetamol) (Doliprane 1000mg don’t take two or you’ll die)

A

Pharmacodynamics: COX inhibitor;

Indication for use: Pain relief and anti-pyretic.

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8
Q

Hydroxy - chloropquine (Plaquenil), Methotrexate (Rheumatrex), Sulfalazine, Abatacept, Adalimumab, Anakinra, Certolizumab (Cimzia), Etanercept (Enbrel), Golimumab (Simponi), Infiximab (Remicade), Leflunomide (Arava), Retuximab (Rituxan), Tocilizumab (Actemra) and Tofacitinib (Xeljanz).

A

Pharmacodynamics: immuno - suppressant reducing the autoimmune reaction that causes Rheumatoid arthritis (RA);
Indication for use: treatment of RA.

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9
Q

Allopurinol (Zyloprim), Febuxostat (Uloric), Colchicine

Colcrys) Pegloticase (Krystexxa) and Probenecid (Benemid

A

Pharmacodynamics: Effects uric acid production and reabsorption;
Indication for use: treatment of gout.

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10
Q

Alfentanil (Alfenta), Fentanyl (Abstral / Actiq), Meperidine (Demerol) and Sufentanil (Sufenta), loperamide, diphenoxylate, dextramorphan.

A

Pharmacodynamics: Strong opioid agonists (phenylpiperidines);
Indication for use: Analgesia, treatment of diarrhoea, cough relief, treatment of pulmonary oedema, anxiety, anaesthesia: systemic and spinal
anaesthesia as well as postoperative analgesia.

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11
Q

Heroin, Hydrocodone (Lortab / Vicodin), Hydromorphone (Dilaudid / Exalgo), Methadone (Dolophine), Morphine (Avinza / Kadian), Oxycodone (Oxycontin), Oxymorphone (Opana) and Remifentanil (Ultiva)

A

Pharmacodynamics: Strong opioid agonists;
Indication for use: Analgesia, treatment of diarrhoea, cough relief, treatment of pulmonary oedema, anxiety, anaesthesia: systemic and spinal
anaesthesia as well as postoperative analgesia.

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12
Q

Codeine

A

Pharmacodynamics: Moderate opioid agonists;
Indication for use: Analgesia, treatment of diarrhoea, cough relief, treatment of pulmonary oedema, anxiety, anaesthesia: systemic and spinal
anaesthesia as well as postoperative analgesia.

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13
Q

Buprenorphine (Buprenex / Subutex), Butorphanol, Nalbuphine (Nubain) and Pentazochine (Talwin)

A

Pharmacodynamics: Mixed agonist and antagonist (partial agonists) of opioid receptors;
Indication for use: Analgesia, treatment of diarrhoea, cough relief, treatment of pulmonary oedema, anxiety, anesthesia: systemic and spinal
anaesthesia as well as postoperative analgesia.

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14
Q

Naloxone (Narcan) and Naltrexone (Revia / Vivitrol)

A

Pharmacodynamics: competitive antagonists for kappa, mu and delta receptors;
Indication for use: Used to reverse opioid overdose.

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15
Q

Tapentadol (Nucynta) and Tramadol (Ultram)

A

Pharmacodynamics: Opioid agonists;
Indication for use: Analgesia, treatment of diarrhoea, cough relief, treatment of pulmonary oedema, anxiety, anaesthesia: systemic and spinal anaesthesia as well as postoperative analgesia.

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16
Q

Halothane

Fluothane

A

Pharmacodynamics: Suppress NT release in the CNS;

Indication for use: General anaesthetic (inhaled);

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17
Q

Isoflurane

Forane

A

Pharmacodynamics: Suppress NT release in the CNS;
Indication for use: General anaesthetic (inhaled);
Clinical features: Muscle relaxation, quick recovery, stable cardiac output, doesn’t’t raise intracranial pressure, doesn’t sensitise heart to epinephrine.

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18
Q

Sevoflurane

Ultane

A

Pharmacodynamics: Suppress NT release in the CNS;
Indication for use: General anaesthetic (inhaled);
Clinical features: Bronchial smooth muscle relaxation, rapid onset and recovery and no – irritating and can cause Renal toxicity at low flow.

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19
Q

Desflurane

Suprane

A

Pharmacodynamics: Suppress NT release in the CNS;
Indication for use: General anaesthetic (inhaled);
Clinical features: Requires a special vaporiser.

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20
Q

Nitrous Oxide

A

Pharmacodynamics: Suppress NT release in the CNS;
Indication for use: General anaesthetic (inhaled);
Clinical features: Is a good analgesic, has rapid onset and recovery, it is safe and non irritating. Incomplete anaesthesia; no muscle relaxation; must be used in conjunction with other SAs.

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21
Q

Pancuronium, Atracium, Rocuronium, Vecuronium, Cisatracurium and Succinylcholine

A

Pharmacodynamics: Neuro-Muscular blocker;

Indication for use: Used as a pre-anaesthetic to facilitate intubation.

22
Q

Bupivacaine (Marcaine), Lidocaine (Xylocaine), Mepivacaine (Carbocaine), Ropivacaine (Naropin), Prilocaine

A

Pharmacodynamics: local anaesthetics (Amides) block sodium ion channels;
Indications for use: causing dose based CNS depression for local anaesthetic.

23
Q

Chloroprocaine (Nesacaine), Procaine (Novocaine), Tetracaine (Pontocaine), Cocaine

A

Pharmacodynamics: local anaesthetics (Esters) block sodium ion channels;
Indication for use: causing dose based CNS depression for local anaesthetics.

24
Q

Benzodiazepine, Barbiturates, Opioids, Thiopental, Dexmedetomidine (Precedex), Etomidate (Amidate), Ketamine (Ketalar), Propofol (Diprivan)

A

Pharmacodynamics: General anaesthetics (Intravenous);

Indications for use: causing dose based CNS depression for general anaesthesia.

25
Q

Almotriptan (Axert), Eletriptan (Relpax), Frovatriptan (Frova), Naratriptan (Amerge), Rizatriptan (Maxalt), Sumatriptan (Imitrex, Alsuma), Zolmitriptan (Zomig)

A

Pharmacodynamics: binding to serotonin (5-hydroxy-tryptamine) receptors in the brain, where they act to induce vasoconstriction of extra-cerebral blood vessels and also reduce neurogenic inflammation;
Indications for use: Used to relieve symptoms in prodromal phase of migraine;
Clinical features: Triptans: rapidly and effectively reduce
severity in 80% of patients and are
serotonin agonists.

26
Q

Dihydro - ergotamine (Migranal)

A

Pharmacodynamics: binding to serotonin (5-hydroxy-tryptamine) receptors in the brain, where they act to induce vasoconstriction of extra-cerebral blood vessels and also reduce neurogenic inflammation;
Indications for use: Used to relieve symptoms in prodromal phase of migraine;
Clinical features: (contraindicated in pregnancy
and patients with vascular disease and
coronary artery disease).

27
Q

Amitriptyline, Verapamil, Propranalol, Nadolol, Divalproex

A

Pharmacodynamics: TCAs, Calcium channel blockers, beta-blockers and anti-convulsants;
Indication for use: Prophylactic agent to be used in the latent period of migraine.

28
Q

What are the common side effects of opioids?

A

Common side effects of opioids include: hypotension; dysphoria (anxiety, depression or unease); sedation; constipation; urinary retention; nausea; potential for addiction; respiratory depression.

29
Q

What are the contraindications of opioids?

A

Contraindication : MAO inhibitors such as Meperidine and other opioids as high incidence of hyperpyrexic coma; Sedatives / Hypnotics: Increased CNS depression (mainly
respiratory); TCAs and antipsychotic drugs: Increased sedation; variable effects on respiratory depression.

30
Q

What are the withdrawal effects of opioids?

A

Opioid withdrawal effects: occur in three stages. In the first 8 hours patient experiences anxiety and drug cravings; In the first 24 hours: anxiety, insomnia, GI disturbances, rhinorrhea, mydriasis, diaphoresis (sweating); Up to three days: tachycardia, nausea / vomiting, hypertension, diarrhoea, fever, chills, tremors, seizure, muscle spasms.

31
Q

Why is buprenorphine the drug of choice for heroin withdrawal?

A

Buprenorphine is used for heroin withdrawal as the severity of withdrawal symptoms and duration of symptoms is lower than methadone.

32
Q

What are the contraindication for drugs that treat gout?

A

Contraindicated in patients with renal impairment.

33
Q

What are the side effects of drugs that treat gout?

A

Can cause hypersensitivity syndrome and suppress bone marrow elements leading to anaemias.

34
Q

What are the side effects of salicylates?

A

Side effects of salicylates can be dependent on plasma concentration: < 10 mg/dL, experience gastric bleeding, impaired blood clotting and hypersensitivity reactions; 10 – 50 mg/dL patients experience tinnitus and central hyperventilation; > 50 mg/dL which is classed as intoxication patients experience vasomotor collapse, coma and dehydration.

35
Q

What are the contraindications of salicylates?

A

Interactions with salicylates: Heparin (any other anticoagulants) can increase risk of hemmorhage; Probenecid leads to decreased urate excretion; Bilirubin, Phenytoin, Valproic Acid, Thyroxine, Trilodothyronine can cause increased plasma concentration of salicylates –> prolonged half life, therapeutic effects and toxicity.

36
Q

What are the common side effects of NSAIDs?

A

The side effects include: GI related (dyspepsia, bleeding)
reduction in protective mucus and increase in gastric secretions; Increased risk of bleeding due to reduction of thromboxane; reduced renal blood flow and the retention of sodium can cause oedema; cardiac effects due to reduction of thromboxane and PGI2, may exacerbate asthma.

37
Q

What are the contraindications of NSAID use?

A

As NSAIDs are highly protein bound (80 – 90%) so can displace other highly protein bound drugs such as warfarin, valproic acid and phenytoin increased free concentrations. Should be avoided in the third trimester as may close the ductus arteriosus. Aspirin should be avoided in children under 16.

38
Q

By what mechanisms do NSAIDs exert their anti-inflammatory affect?

A

NSAIDs and COX-2 specific inhibitors inhibit the cyclooxygenase mediated conversion of arachidonic acid (from membrane phospholipids) to prostoglandins in the cyclooxygenase pathway. Glucocorticoids also inhibit this pathway by reducing mRNA transcription triggered by oxidative stress, injury, ischemia, seizures and neurodegenerative disease. Reduction of prostaglandins reduces inflammation; reduction of PGE2 (which usually sensitises nerves ending) produces an analgesic effect; PGE2 also elevates the set point of the anterior hypothalamic thermoregulatory centre, reducing PGE2 will reduce fever. The acetyl group is transferred from the NSAID to cyclooxygenase thereby inactivating it. This naturally occurs due to the reduction of Prostoglandin G2 to Prostoglandin H2.

39
Q

How do NSAIDs facilitate vasodilation in renal disease?

A

NSAID inhibition of prostaglandin mediated vasoconstriction: renal disease and cardiovascular disease cause decreased renal blood flow; cirrhosis, nephrosis, heart failure and diuretics cause decreased blood volume which leads to an increase in vasoconstrictors such as angiotensin II, catecholamines, vasopressin, however, prosotglandins would usually inhibit renal vasoconstriction; NSAIDs inhibit prostoglandin production and therefore, allow vasoconstriction to continue unfettered.

40
Q

Why are antacids used as a pre-anaesthetic?

A

Reduce acid levels in the stomach to reduce pulmonary complications if aspirated.

41
Q

Why are anticholinergic used as a pre-anaesthetic?

A

Prevent bradycardia and secretion of fluids into the respiratory tract.

42
Q

Why are antiemitics used as a pre-anaesthetic?

A

Prevent aspiration of stomach contents and post surgical nausea and vomiting.

43
Q

Why are antihistamines used as a pre-anaesthetic?

A

Prevent gastric acid secretion (H2) and prevent allergic reactions.

44
Q

Why are benzodiazepines used as a pre-anaesthetic?

A

Relieve anxiety.

45
Q

Why are opioids used as a pre-anaesthetic?

A

Analgesia.

46
Q

By what mechanism do opioids cause analgesia?

A

Opioids act on opioid receptors reducing the amount of excitatory NTs released from vesicles in the presynaptic neurone and increasing the efflux of potassium causing hyper-polarisation making excitatory neurotransmission difficult.

47
Q

What are the risks of Halothane?

A

Halothane carries an increased risk of arrhythmia and sensitivity to catecholamines as well as inhibiting respiratory reflex (sevoflurane as well) and some risk of hepatotoxicity.

48
Q

What are the risks of general anaesthetics (inhaled)?

A

All decrease cardiac output, lower blood pressure on a dose-dependent basis as well as risk of hepato / renal toxicity.

49
Q

Which general anaesthetic (inhaled) is most soluble?

A

Halothane

50
Q

Which general anaesthetic (inhaled) has the quickest induction and quickest recovery?

A

Nitrous Oxide

51
Q

Which general anaesthetic (inhaled) has the lowest minimum alveolar concentration?

A

Halothane

Pharmacology (11 decks)

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