Pain therapeutics

Question 0

Only FDA indication for lidocaine 5% patch

Answer 0

post herpetic neuralgia

Question 1

The normal processing of stimuli

Answer 1

nociceptive

Question 3

An inbalance of pro-nociceptive and anit-nociceptive stimuli

Answer 3

dysfunctional pain

Question 4

The drug of choice for trigeminal neuralgia

Answer 4

crbamazepine

Question 5

MOA of gabapentin and pregabalin

Answer 5

bind to alpha-2-delta subunit of N-type Ca channels and block them

Question 6

FDA approved used of gabapentin regarding pain

Answer 6

post herpetic neuralgia

Question 7

Abnormal processing of sensory input that is caused by direct damage to the nervous system or persistent stimulaton of the nervous system by another pain source

Answer 7

neuropathic pain

Question 8

Minimum effective dose of gabapentin

Answer 8

600 mg TID

Question 9

FDA approval of pregabalin regarding pain

Answer 9

post herpetic neuralgia, diabetic peripheral neuropathy and fibromyalgia

Question 10

Minimum effective dose of pregabalin

Answer 10

150 mg/day in 2-3 divided doses

Question 11

MOA of katamine

Answer 11

NMDA receptor antagonist

Question 12

MOA of TCAs

Answer 12

5HT/NE reuptake inhibition and Na channel block

Question 14

5 cautions with TCAs

Answer 14

1. BPH
2. arrhythmia (QT prolongation)
3. suicidal idealization
4. hepatic failure
5. renal failure

Question 15

Opioid that is the most useful in neuropathic pain

Answer 15

Methadone

Question 16

4 groups of 1st line agents for neuropathic pain

Answer 16

1. TCAs
2. Gabapentin and pregabalin
3. Lidocaine patch (post herpetic neurophathy)
4. SNRI (diabetic peripheral neuropathy)

Question 17

3 groups of second line agents for neuropathic pain

Answer 17

1. tramadol
2. opioids
3. capsaicin

Question 18

2 opioids that are the most common for a patient to have a true allergy to

Answer 18

codeine and morphine

Question 19

enzyme that metabolizes codeine to morphine

Answer 19

CYP2D6

Question 21

4 opioids that have a risk of serotonin toxicity

Answer 21

1. fentanyl
2. tramadol
3. meperidine
4. methadone

Question 23

the 4 A’s of pain

Answer 23

1. Analgesia
2. Adverse effects
3. Activities of daily living
4. Aberrant opioid-related behaviors

Question 25

Opioid that has the worst nausea side effects

Answer 25

Codeine

Question 26

enzyme that metabolizes hydrocodone to hydromophone

Answer 26

CYP2D6

Question 27

Toxic metabolite of meperidine that has a longer half-life and no analgesic action

Answer 27

normeperidine

Question 28

4 C’s of addiction

Answer 28

1. Loss of control
2. Continued use despite adverse consequences
3. Compulsion to use
4. Cravings

Question 30

MOA of meperidone

Answer 30

Strong mu agonist and NMDA agonist

Question 31

The gold standard for the treatment of moderate-severe pain

Answer 31

Morphine

Question 32

Neurotoxic metabolite of hydromorphone

Answer 32

H3G

Question 33

Enzyme that catalyzes conversion of oxycodone to noroxycodone, a non-active, non-toxic metabolite

Answer 33

CYP3A4

Question 34

Enzyme that catalyzes conversion of oxycodone to oxymorphone, an active metabolite

Answer 34

CYD2D6

Question 35

Sole route of metabolism of fentanyl

Answer 35

CYP3A4

Question 36

MEQ that is defined as non-opioid naive

Answer 36

>60 mg MEQ for the past 7 days

Question 37

Black box warning for methadone

Answer 37

cardiac toxicity and QT prolongation at >60 mg/day

Question 38

Abnormal behavior developing as a direct consequence of inadaquate pain management

Answer 38

Pseudoaddiction

Question 39

Any drug deviation from the medical plan

Answer 39

aberrant behaviors

Question 40

Patient population to avoid morphine in in order to decrease risk of opioid neurotoxicity

Answer 40

morphine

Question 41

2 opioids that have the lowest risk of neurotoxicity

Answer 41

methadone and fentanyl

Question 42

Damage to solid or hollow organs that is poorly localized and often associated with nausea and diaphoresis

Answer 42

Visceral pain

Question 43

NSAID that has the lowest CV risk

Answer 43

Naproxen

Question 50

Damage to bone, muscle, ligament or skin that is usually well localized

Answer 50

Somatic pain