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Pain Boards > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

After nerve injury, gaba and glycine receptor activation become paradoxically excitatory

A

True

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2
Q

Opioid activate post synaptic —- channels

A

K+
This allows K to leave and hyperpolarize the neuron

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3
Q

Opioids block these presynaptic channels

A

Ca2+
This reduces presynaptic release of activating neurotransmitters such as substance P

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4
Q

Opioids and PAG

A

Opioids inhibit GABA activity
Inhibition of these inhibitory neurons increases output from PAG (leading to more serotonin and NE outflow to the limbic forebrain

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5
Q

Opioid receptor for chemical visceral pain

A

Kappa

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6
Q

Mechanical and inflammatory opioid receptor

A

Delta

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7
Q

2D6 opioids (3)

A

Codeine
Oxycodone
Hydrocodone

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8
Q

3A4 converts these two opioids to inactive forms

A

Fentanyl
Methadone

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9
Q

Erythromycin
Azithromycin
Clarithromycin

A

Inhibit P450

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10
Q

Baclofen mechanism

A

GABA B

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11
Q

Decreased NK cell activity
Opioid receptor

A

Mu

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12
Q

Do opioids reduce testosterone and estrogen?

A

Yes both
Low estrogen in women can cause depressions, dysmenorrhea, osteoporosis

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13
Q

Quinidine
Paroxetine
Fluoxetine
Buproprion

A

Inhibit p450 and prevent codeine -> morphine conversion

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14
Q

M3G vs M6G

A

M6G is analgesic and acts like any other opioid
M3G produces opposite effects(hyperalgesia, myoclonus, seizures, alloys is)

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15
Q

Active metabolite of oxycodone

A

Oxymorphone

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16
Q

Normeperidine

A

Seizures in renal insufficiency

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17
Q

Hydromorphone can cause seizures?

A

Yes hydromorphone 3 glucuronide

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18
Q

Methadone pharmacology

A

NMDA antagonist
Opioid agonist
SSRI

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19
Q

Methadone active metabolite

A

None

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20
Q

Methadone alpha elimination

A

8-12 hrs and this explains the 6-8 he analgesic effect

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21
Q

Methadone beta elimination

A

30-60 hrs

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22
Q

Does renal insufficiency affect methadone

A

No

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23
Q

TCA + methadone dangers

A

Both are serotonergic
Both prolong QT

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24
Q

Oxymorphone potency

A

2-5x higher than morphine

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25
Q

What percent of oxycodone metabolites are Oxymorphone

A

10%

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26
Q

Hydrocodone is —- x more potent than codeine

A

6-8

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27
Q

Hydrocodone metabolism

A

2D6
Hydromorphone

3A4
Noroxycodone

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28
Q

Does naloxone reverse tramadol

A

Partial blockade with naloxone

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29
Q

Which antidepressant most likely to be implicated in serotonin syndrome

A

Venlafaxine

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30
Q

Toxic Tylenol metabolite

A

NAPQI

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31
Q

What metabolismzes NAPQI

A

Glutathione

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32
Q

HIV and Tylenol

A

HIV may limit glutathione availability and make patients more susceptible to Tylenol liver toxicity

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33
Q

Is there good evidence to use TCA for HIV neuropathy

A

O

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34
Q

Duloxetine S vs NE reuptake inhibition

A

10x in favor of serotonin

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35
Q

FDA approval for duloxetine

A

Fibro
OsteoArthritis
Msk back pain
Painful diabetic neuropathy

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36
Q

Do tcas cause weight gain

A

Yes

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37
Q

Gabapentin and pregabalin bind to which receptor?

A

Alpha 2 delta

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38
Q

Can treat OIH with

A

Gabapentin

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39
Q

Adv of lyrica over Gabapentin

A

Shorter duration to pain relief
Less side effects

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40
Q

Pregabalin is fda approved for

A

PHN
PDN
SCI neuropathic pain

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41
Q

Ziconotide mechanism

A

N type Ca channel blocker in the spinal cord

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42
Q

Ziconotide side effects

A

Dizziness
Ataxia
Confusion
Hallucinations
Elevated CK

It does not cause resp depression and it can be stopped abruptly

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43
Q

Carbamazepine side effects

A

Dizziness
Nausea vomiting
Sedation

Pancytopenia
Stevens johnson
TEN

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44
Q

Frequency of blood monitoring for carbamazepine

A

2-4 months

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45
Q

Monitoring for oxcarbazepine

A

Monitor for hypoNa in the first 3 months and when initiating therapy

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46
Q

Topiramate mechanisms

A

Increases gaba activity
Inhibits voltage sensitive Na channels
Inhibitory modulator of glutamate at the glutamate receptor
Decreases activity of L type Ca channels
Carbonic anhydrase inhibitor

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47
Q

Albumin and nsaids

A

Hypoalbuminemia can increase free fraction of otherwise highly protein bound NSAIDs

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48
Q

Most nsaids are metabolized

A

By the liver, p450

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49
Q

Cardioprotective effects of aspirin are antagonized by

A

Ibuprofen

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50
Q

You cannot use this nsaid with sulfa allergies

A

Celebrex

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51
Q

Does celebrex affect platelet function

A

No

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52
Q

Which nsaid is safest in patients at risk for cardiovascular thrombosis

A

Naproxen

Long term administration of cox2 inhibitors is bad

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53
Q

Risks factors for gastric ulceration when patient is also taking an NSAID

A

Increased age
History of ulceration
Higher NSAID doses
Multiple nsaids being used
Concurrent anticoagulation use
Tobacco use
Etoh use
H pylori infection

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54
Q

Cox — inhibitors should be avoided in patients with history of cardiovascular disease

A

Cox2

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55
Q

I’m patients with cardiovascular risk and GI risk factors, how to prescribe NSAIDs?

A

Non selective NSAID with PPI

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56
Q

Sodium retention and edema is primarily driven by cox — inhibition

A

Cox2

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57
Q

Do cox1 and cox2 inhibition both cause HTN and edema

A

Yes

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58
Q

Does CHF increase NSAID kidney risk?

A

Yes
As does dehydration, Perioheral vasc disease, SLE, liver disease, and advanced age

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59
Q

Smallest particulate

A

Betamethasone

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60
Q

Why does buprenorphine block out the effects of other opioids?

A

Highest affinity for mu opioid receptor

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61
Q

Bioavailability of Gabapentin and lyrica

A

Gabapentin 30-60%
Lyrica 90%

62
Q

What makes carisoprodol addictive

A

It’s metabolite meprobamate

63
Q

Tizanidine mechanism

A

A2 agonist

64
Q

Chlorzoxazone mechanism

A

Muscle relaxant
Unclear mechanism
It is not an alpha2 agaonist

65
Q

Which CYP is most important for methadone metabolism in humans

A

2B6 > 3A4

66
Q

NMS

A

Fever
Rigidity
Tachycardia
AMS
High CK
Leukocytosis
Elevated LFTs
Renal impairment
ekg abnormalities

67
Q

Nav1.7

A

Specific Na channel blockade for mexilitine

68
Q

Incidence of SJS when starting lamotrigine

A

1/1250 or 0.08%

69
Q

Ziconotide mechanism

A

N type calcium channel blocker

70
Q

Cyclobenzaprine is structurally similar to

A

TCAs

71
Q

Which two steroids have high glucocorticoid activity

A

Betamethasone
Dexamethasone

72
Q

CYP 2D6 takes care of

A

Codeine
Hydrocodone
Oxycodone
TCAs

73
Q

2C9 takes care of

A

Nsaids

74
Q

NR2B
What is this?

A

NMDA receptor subunit that modulates pain

75
Q

Fibro symptom severity score is based on

A

Fatigue
Waking Unrefreshed
Cognitive
Plus the severity of somatic symptoms

76
Q

First line opioid induced pruritis

A

Antihistamine
Diphenhydramine is sedating but more effective

77
Q

Do children get opioid tolerance

A

Not really

78
Q

2 mo to 7 yes pain assessment

A

FLACC
First grade: faces scale
Once there is abstract thinking, VAS score is fine

79
Q

If a patient is in the action phase but struggling to follow through, discuss with him/her

A

Specific goals (avoiding soda, walking x miles)

80
Q

Least chondrotoxic local anesthetic

A

Ropi

81
Q

Pain assessment 3 years and older

A

Faces

82
Q

Enkephalins primarily bind to which opioid receptor

A

Delta

83
Q

Spinal opioid receptors are mostly

A

Kappa

84
Q

Antagonist to this opioid receptor can help with constipation

A

Mu2

85
Q

Medical illnesses that can cause trigeminal neuralgia

A

Lyme
Sarcoid
Multiple sclerosis

86
Q

Morphine to Hydrocodone conversion

A

1:1

87
Q

Morphine to oxycodone conversion

A

3:2

88
Q

How to dose fentanyl patch

A

Take oral morphine equivalents (daily, mg) and divide in half to get mcg per day of fentanyl. Reduce this dose by about another 25-50% when initiating fentanyl patch to account for cross tolerance

40mg OME/day -> 20mcg fent/day -> 10-15mcg/day as the starting fent dose

89
Q

Is morphine metabolized to hydromorphone

A

Yes

90
Q

Biceps is innervated by which nerve and which nerve roots

A

Musculocutabeous
C5 and C6

91
Q

Flexor carpi unpairs flexes the wrist and is innervated by which nerve and which nerve roots

A

Ulnar nerve
C7, C8, T1

92
Q

Dorsal and palmar interossei muscles and innervated by

A

Ulnar nerve
C7, C8, T1

93
Q

Meds that cause IIH

A

Retinoids
Vit A
Tetracycline
Lithium
OCPs

94
Q

What makes it less likely that SCS will work for fbss

A

Older age
Pain duration greater than 15 yrs
Catastrophizing thoughts

95
Q

Scs success rate for PHN

A

84%

96
Q

Proprionic acid derivative NSAIDs

A

Ibuprofen
Diclofenac

97
Q

Corticosteroids inhibit ——— activation

A

Phospholipase A2

98
Q

Least likely to cause OIH

A

Oxymorphone
Unclear why

99
Q

Tcas cause hypotension via

A

Alpha 1 antagonism

100
Q

5 metrics of the pain advanced dementia scale

A

Vocalization
Breathing
Consolability
Facial expression
Body language

101
Q

Abort cluster headache

A

Sumatriptan
Oxygen

102
Q

Prophylaxis cluster headache

A

Verapamil

103
Q

Tramadol and codeine are contraindicated for patients younger than

A

12 yes old

104
Q

TCA with little to no anticholinergic effects

A

Desipramine

105
Q

TCAs and their effects of the heart

A

Can promote sinus tachycardia via anticholinergic effect

PR, QRS, or QT prolongation (conduction block)

Can also worsen glaucoma

106
Q

Tapentadol mechanism

A

Mu opioid agonist
SNRI

107
Q

Hydrocodone in morphine equivalent

A

1:1

108
Q

Hydromorphone in morphine equivalents

A

4 times as potent as morphine

109
Q

Oxycodone in morphine equivalents

A

1.5 times as potent as morphine

110
Q

At johns wort

A

SSRI activity

111
Q

NSAID that concentrates more in synovial fluid

A

Meloxicam

112
Q

Serotonin syndrome drugs

A

MDMA/ecstasy
Amphetamines
Fentanyl
Dextromethorphan
sSRIs/snris
Cyclobenzaprine
Meperidine
Tramadol
Lithium
MAOIs
TCAs

113
Q

Can Ziconotide be stopped abruptly

A

Yes

114
Q

Alcohol neurolysis takes how long

A

3-5 days

115
Q

Which neurolytic agent is hyperbaric

A

Phenol

Alcohol is hypobaric

116
Q

Which neurolytic when injected has a painless warm feeling

A

Phenol

Alcohol has burning pain

117
Q

Obturator nerve arises from what levels

A

L3-4

118
Q

Unique heroin metabolite

A

6-MAM

119
Q

A trial of a lidocaine patch should be

A

About 1-2 weeks

120
Q

Because of this mechanism, topiramate causes kidney stones

A

Carbonic anhydrase inhibition

121
Q

Antiepileptic that causes parenthesis’s of the digits

A

Topiramate

122
Q

Antiepileptic that lowers OCP effectiveness

A

Topiramate

123
Q

Can triptans contribute to serotonin syndrome

A

Yes

124
Q

Contraindications for therapeutic ultrasound

A

Malignancy
Open epiphysis
Pacemaker
Near the heart, eyes, genitals, carotid sinus
Laminectomy site
Prosthetics with cement

125
Q

Indications for iontophoresis

A

Subacromial bursitits
Plantar fasciitis
Lateral epicondylitis
Achilles tendinitis
Patellar tendinitis
GT bursitis

126
Q

TENS contraindications

A

Malignancy
Pregnancy
Pacemaker
Active bleeding
Seizure disorder
Decreased skin sensation

127
Q

Contraindications for spine traction

A

AA subluxation
Active PUD
Vertebrobasilar insufficiency
Aortic aneurysm
Pregnancy
Restrictive lung disease
Cuaauda equina syndrome
Osteomyelitis or diskitis
Osteoporosis
Spine mets
Marfan/ehlers danlos

128
Q

This opioid should be avoided in patients taking class I and class III antiarrythmetics

A

Buprenorphine

129
Q

Meperidine is contraindicated with what drug class

A

MAOIs

130
Q

Myokymic discharges =

A

Post Radiation plexopathy

131
Q

Spinal and visceral analgesia opioid receptor

A

Kappa

132
Q

Ketamine acts on these receptors

A

NMDA
Opioid
Sodium channels

133
Q

Buprenorphine is x times more potent than morphine

A

50

134
Q

Nalbuphine mechanism

A

Kappa agonist
Mu antagonist

For itching

135
Q

Why is Buprenorphine less likely to be reversed with naloxone

A

Very high affinity for mu receptor

136
Q

Mononeuritis multiplex

A

Think about vasculitus
Small to medium blood vessel occlusion cause single peripheral nerve dysfunction (but multiple nerves affected)

137
Q

Small short motor unit potential =

A

Myopathic lesion

138
Q

Buproprion mechanism

A

NE and dopamine reuptake inhibitor
Lowers seizure threshold

139
Q

Which oral opioid is 1:1 with morphine

A

Hydrocodone

140
Q

Topiramate mechanism

A

Enhances GABA
Decreases glutamate activity
Na channel blocker

141
Q

Convert morphine to Oxymorphone

A

Divide by 3

142
Q

Convert Hydrocodone to morphine

A

Hydrocodone is 3/4 as potent

143
Q

Convert oral morphine total per day in mg to mcg/hr fentanyl patch

A

Divide total morphine per day by 2

60mg -> 30mcg/hr so use a 25mcg/hr patch

144
Q

Convert morphine oral to Hydromorphone oral

A

Divide morphine mg by 4

145
Q

Sympathetic block increases or decreases sweating?

A

Decreases - anhidrosis

146
Q

Convert oral methadone to any other route of administration

A

IM, IV
Divide by 2

147
Q

Tramadol plus TCA =

A

Seizure

148
Q

TCA prolongs qt?

A

Yes

149
Q

The presence of ——— can help indicate OIH over fibromyalgia

A

Alodynia

150
Q

Does baclofen cause seizures

A

Yes

Pain Boards (4 decks)

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