Pharm- Pain

Question 1

What is the general MOA of aspirin?

Answer 1

Irreversibly inhibits COX

Question 2

What are the 4 actions of aspirin; relate to MOA

Answer 2

Inhibit cox1/2- suppress inflammation, relieve pain, reduce fever
Inhibit cox1- prevent MI (men) and stroke (women)

Question 3

What are the AE of aspirin?

Answer 3

Ulcer, bleeds in pt taking anticoags, renal dysfunction, asthma

Question 4

How do you prevent ulcers when taking aspirin?

Answer 4

Test and treat H pylori and give PPI

Question 5

What is a potential AE of long term use of aspirin?

Answer 5

Papillary necrosis

Question 6

Who does reye syndrome affect?

Answer 6

Children who take aspirin to relieve fever caused by viral infection

Question 7

Why should you avoid aspirin during labor and delivery?

Answer 7

Prevents contractions, inc uterine bleeding, and can cause premature closure of ductus arteriosus

Question 8

What are the differences between aspirin and other NSAIDs?

Answer 8

Other NSAIDs reversibly inhibit COX and inc risk of MI and stroke

Question 9

What is a selective COX2 inhibitor? How does it differ from other NSAIDs with regards to AE?

Answer 9

Coxib

Doesn’t inc risk of bleeds

Question 10

What are CI to NSAIDs?

Answer 10

Chronic kidney disease, active ulcers, HF, HTN, and pt taking anticoags

Question 11

What are the 7 NSAIDs? Which are topical and which can be given IV/IM? Which is preferred if pt has CV problem?

Answer 11

Aspirin
Coxib
Ibuprofen 
Diclofenac (topical)
Indomethacin
Ketorolac (IM/IV)
Naproxen- preferred if pt has CV problem

Question 12

Acetaminophen
Actions and how they compare to NSAIDs
AE (how do you treat one of them)

Answer 12

Acetaminophen
Suppresses pain and fever but not inflammation; doesn’t cause ulcers, renal dysfunction, and doesn’t suppress platelet aggregation
AE- hepatic necrosis due to OD depleting glutathione- treat w/ acetylcystein; inhibit metabolism of warfarin and inc risk of bleeds

Question 13

When do you use TCAs? For what type of pain? what is the example

Answer 13

TCA- amitriptyline

Use for chronic pain (neuropathic) and depression

Question 14

What are the SNRIs used for neuropathic pain and when do you use them

Answer 14

SNRI
Duloxetine and venlafaxine
Use in pt w/ concurrent depression

Question 15

Pregabalin
MOA
Uses

Answer 15

Pregabalin
GABA analog inhibits NT release by binding a2delta subunit of VGCaC
Use for neuropathic pain assoc w/ diabetic neuropathy, post-herpetic neuralgia, partial seizure, and fibromyalgia

Question 16

Gabapentin
MOA
Uses

Answer 16

Gabapentin
GABA analog inhibits NT release by binding a2delta subunit of VGCaC
Use for seizures, post-herpetic neuralgia, diabetic neuropathy, migraines, and fibromyalgia

Question 17

What are the 1st line treatments for neuropathic pain?

Answer 17

TCAs, SNRIs, and GABA analogs

Question 18

What are the 2nd line treatments for neuropathic pain?

Answer 18

Tramadol
Tapentadol
Opioids

Question 19

Tramadol
MOA
Uses

Answer 19

Tramadol
Weak mu agonist blocks NE and 5-HT reuptake and activates monoaminergic spinal inhibition of pain
Use for mod to severe pain

Question 20

Tapentadol

MOA

Answer 20

Tapentadol

Mu agonist blocks NE reuptake

Question 21

What are the 3rd line agents for neuropathic pain?

Answer 21

Ketamine
Dexmed
Clonidine
Ziconotide

Question 22

Ketamine
MOA
Uses

Answer 22

Ketamine
NMDA antag
Anesthesia and post-op pain

Question 23

Dexmed and Clonidine
MOA
Uses
Differences in how they are given

Answer 23

Dexmed and Clonidine
a2 agonists
Dexmed- analgesia and sedation- give IV
Clonidine- HTN and severe pain

Question 24

Ziconotide
MOA
Use

Answer 24

ziconotide
N type CaC antag
Use for chronic severe pain