Pharmacological Approaches to Pain (Wolff) Flashcards
What does aspirin irreversibly inhibit?
Via what mechanism?
What effect does aspirin have?
1) Cyclooxygenase-1 and 2 (COX-1 and 2) enzymes
2) Acetylation
3) Decreases prostaglandin and thromboxane A2
What are potential toxicities of aspirin?
1) Ulcer
2) Increased risk of bleeding
What does ibuprofen reversibly inhibit?
What effect does ibuprofen have?
1) COX-1 and 2 enzymes
2) Inhibits prostaglandin synthesis
What black box warning do NSAIDs have with pregnancy?
May cause fetal renal dysfunction leading to oligohydramnios
What other black box warnings do NSAIDs have?
1) Increased risk of MI and stroke
2) Increased risk of GI bleed
What does celecoxib inhibit?
What effect does it have?
1) COX-2
2) Inhibits prostaglandin synthesis
Why should aspirin not be used by children with chicken pox or influenza?
Increases risk of Reye syndrome
Why does celecoxib not pose a risk of bleeding?
Because it doesn’t inhibit platelet aggregation
Where NSAID therapy is required for patients at risk of cardiovascular complications, what is recommended as the NSAID of choice?
naproxen
How does acetaminophen differ from NSAIDs in terms of effect?
Acetaminophen does not suppress inflammation
Because of risk of medication errors and overdosage, what black box warning does acetaminophen have?
Hepatotoxicity with acute liver failure
Overdosage of acetaminophen is treated with?
Acetylcysteine
What does morphine bind to in the CNS?
Opioid receptors
Morphine has multiple black box warnings related to?
Respiratory depression
Amitriptyline is a tricyclic antidepressant with analgesic effects that inhibits the reuptake of?
NE and Serotonin
What blackbox warning does amitriptyline have in children, adolescents, and young adults?
Increased risk of suicidal thinking and behavior
Duloxetine is an antidepressant with analgesic effects that inhibits the reuptake of?
NE and Serotonin
What blackbox warning does duloxetine have?
Increased risk of suicidal thinking and behavior
Pregabalin and gabapentin which are GABA analog, does not bind to GABA receptors but instead exerts its effects b binding to?
Alpha2-delta subunit of voltage-gated calcium channels
What are the clinical applications for pregabalin?
1) Neuropathic pain associated with diabetic neuropathy
2) Seizures
Tramadol is an agonist for?
What does it block the reuptake of?
1) μ-opiate
2) NE and serotonin
What black box warning is associated with tramadol due to medication errors/overdose?
Respiratory depression
Ketamine is a noncompetitive antagonist for?
What does it block?
1) NMDA receptor
2) Glutamate
What is the clinical application for ketamine?
Sub-anesthetic doses for
analgesia, acute and chronic pain
