Pharmacology Flashcards
1
Q
After nerve injury, gaba and glycine receptor activation become paradoxically excitatory
A
True
2
Q
Opioid activate post synaptic —- channels
A
K+
This allows K to leave and hyperpolarize the neuron
3
Q
Opioids block these presynaptic channels
A
Ca2+
This reduces presynaptic release of activating neurotransmitters such as substance P
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
5
Q
Opioid receptor for chemical visceral pain
A
Kappa
6
Q
Mechanical and inflammatory opioid receptor
A
Delta
7
Q
2D6 opioids (3)
A
Codeine
Oxycodone
Hydrocodone
8
Q
3A4 converts these two opioids to inactive forms
A
Fentanyl
Methadone
9
Q
Erythromycin
Azithromycin
Clarithromycin
A
Inhibit P450
10
Q
Baclofen mechanism
A
GABA B
11
Q
Decreased NK cell activity
Opioid receptor
A
Mu
12
Q
Do opioids reduce testosterone and estrogen?
A
Yes both
Low estrogen in women can cause depressions, dysmenorrhea, osteoporosis
13
Q
Quinidine
Paroxetine
Fluoxetine
Buproprion
A
Inhibit p450 and prevent codeine -> morphine conversion
14
Q
M3G vs M6G
A
M6G is analgesic and acts like any other opioid
M3G produces opposite effects(hyperalgesia, myoclonus, seizures, alloys is)
15
Q
Active metabolite of oxycodone
A
Oxymorphone
16
Q
Normeperidine
A
Seizures in renal insufficiency
17
Q
Hydromorphone can cause seizures?
A
Yes hydromorphone 3 glucuronide
18
Q
Methadone pharmacology
A
NMDA antagonist
Opioid agonist
SSRI
19
Q
Methadone active metabolite
A
None
20
Q
Methadone alpha elimination
A
8-12 hrs and this explains the 6-8 he analgesic effect
21
Q
Methadone beta elimination
A
30-60 hrs
22
Q
Does renal insufficiency affect methadone
A
No
23
Q
TCA + methadone dangers
A
Both are serotonergic
Both prolong QT
24
Q
Oxymorphone potency
A
2-5x higher than morphine
25
What percent of oxycodone metabolites are Oxymorphone
10%
26
Hydrocodone is —- x more potent than codeine
6-8
27
Hydrocodone metabolism
2D6
Hydromorphone
3A4
Noroxycodone
28
Does naloxone reverse tramadol
Partial blockade with naloxone
29
Which antidepressant most likely to be implicated in serotonin syndrome
Venlafaxine
30
Toxic Tylenol metabolite
NAPQI
31
What metabolismzes NAPQI
Glutathione
32
HIV and Tylenol
HIV may limit glutathione availability and make patients more susceptible to Tylenol liver toxicity
33
Is there good evidence to use TCA for HIV neuropathy
O
34
Duloxetine S vs NE reuptake inhibition
10x in favor of serotonin
35
FDA approval for duloxetine
Fibro
OsteoArthritis
Msk back pain
Painful diabetic neuropathy
36
Do tcas cause weight gain
Yes
37
Gabapentin and pregabalin bind to which receptor?
Alpha 2 delta
38
Can treat OIH with
Gabapentin
39
Adv of lyrica over Gabapentin
Shorter duration to pain relief
Less side effects
40
Pregabalin is fda approved for
PHN
PDN
SCI neuropathic pain
41
Ziconotide mechanism
N type Ca channel blocker in the spinal cord
42
Ziconotide side effects
Dizziness
Ataxia
Confusion
Hallucinations
Elevated CK
It does not cause resp depression and it can be stopped abruptly
43
Carbamazepine side effects
Dizziness
Nausea vomiting
Sedation
Pancytopenia
Stevens johnson
TEN
44
Frequency of blood monitoring for carbamazepine
2-4 months
45
Monitoring for oxcarbazepine
Monitor for hypoNa in the first 3 months and when initiating therapy
46
Topiramate mechanisms
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
47
Albumin and nsaids
Hypoalbuminemia can increase free fraction of otherwise highly protein bound NSAIDs
48
Most nsaids are metabolized
By the liver, p450
49
Cardioprotective effects of aspirin are antagonized by
Ibuprofen
50
You cannot use this nsaid with sulfa allergies
Celebrex
51
Does celebrex affect platelet function
No
52
Which nsaid is safest in patients at risk for cardiovascular thrombosis
Naproxen
Long term administration of cox2 inhibitors is bad
53
Risks factors for gastric ulceration when patient is also taking an NSAID
Increased age
History of ulceration
Higher NSAID doses
Multiple nsaids being used
Concurrent anticoagulation use
Tobacco use
Etoh use
H pylori infection
54
Cox — inhibitors should be avoided in patients with history of cardiovascular disease
Cox2
55
I’m patients with cardiovascular risk and GI risk factors, how to prescribe NSAIDs?
Non selective NSAID with PPI
56
Sodium retention and edema is primarily driven by cox — inhibition
Cox2
57
Do cox1 and cox2 inhibition both cause HTN and edema
Yes
58
Does CHF increase NSAID kidney risk?
Yes
As does dehydration, Perioheral vasc disease, SLE, liver disease, and advanced age
59
Smallest particulate
Betamethasone
60
Why does buprenorphine block out the effects of other opioids?
Highest affinity for mu opioid receptor
61
Bioavailability of Gabapentin and lyrica
Gabapentin 30-60%
Lyrica 90%
62
What makes carisoprodol addictive
It’s metabolite meprobamate
63
Tizanidine mechanism
A2 agonist
64
Chlorzoxazone mechanism
Muscle relaxant
Unclear mechanism
It is not an alpha2 agaonist
65
Which CYP is most important for methadone metabolism in humans
2B6 > 3A4
66
NMS
Fever
Rigidity
Tachycardia
AMS
High CK
Leukocytosis
Elevated LFTs
Renal impairment
ekg abnormalities
67
Nav1.7
Specific Na channel blockade for mexilitine
68
Incidence of SJS when starting lamotrigine
1/1250 or 0.08%
69
Ziconotide mechanism
N type calcium channel blocker
70
Cyclobenzaprine is structurally similar to
TCAs
71
Which two steroids have high glucocorticoid activity
Betamethasone
Dexamethasone
72
CYP 2D6 takes care of
Codeine
Hydrocodone
Oxycodone
TCAs
73
2C9 takes care of
Nsaids
74
NR2B
What is this?
NMDA receptor subunit that modulates pain
75
Fibro symptom severity score is based on
Fatigue
Waking Unrefreshed
Cognitive
Plus the severity of somatic symptoms
76
First line opioid induced pruritis
Antihistamine
Diphenhydramine is sedating but more effective
77
Do children get opioid tolerance
Not really
78
2 mo to 7 yes pain assessment
FLACC
First grade: faces scale
Once there is abstract thinking, VAS score is fine
79
If a patient is in the action phase but struggling to follow through, discuss with him/her
Specific goals (avoiding soda, walking x miles)
80
Least chondrotoxic local anesthetic
Ropi
81
Pain assessment 3 years and older
Faces
82
Enkephalins primarily bind to which opioid receptor
Delta
83
Spinal opioid receptors are mostly
Kappa
84
Antagonist to this opioid receptor can help with constipation
Mu2
85
Medical illnesses that can cause trigeminal neuralgia
Lyme
Sarcoid
Multiple sclerosis
86
Morphine to Hydrocodone conversion
1:1
87
Morphine to oxycodone conversion
3:2
88
How to dose fentanyl patch
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
Is morphine metabolized to hydromorphone
Yes
90
Biceps is innervated by which nerve and which nerve roots
Musculocutabeous
C5 and C6
91
Flexor carpi unpairs flexes the wrist and is innervated by which nerve and which nerve roots
Ulnar nerve
C7, C8, T1
92
Dorsal and palmar interossei muscles and innervated by
Ulnar nerve
C7, C8, T1
93
Meds that cause IIH
Retinoids
Vit A
Tetracycline
Lithium
OCPs
94
What makes it less likely that SCS will work for fbss
Older age
Pain duration greater than 15 yrs
Catastrophizing thoughts
95
Scs success rate for PHN
84%
96
Proprionic acid derivative NSAIDs
Ibuprofen
Diclofenac
97
Corticosteroids inhibit ——— activation
Phospholipase A2
98
Least likely to cause OIH
Oxymorphone
Unclear why
99
Tcas cause hypotension via
Alpha 1 antagonism
100
5 metrics of the pain advanced dementia scale
Vocalization
Breathing
Consolability
Facial expression
Body language
101
Abort cluster headache
Sumatriptan
Oxygen
102
Prophylaxis cluster headache
Verapamil
103
Tramadol and codeine are contraindicated for patients younger than
12 yes old
104
TCA with little to no anticholinergic effects
Desipramine
105
TCAs and their effects of the heart
Can promote sinus tachycardia via anticholinergic effect
PR, QRS, or QT prolongation (conduction block)
Can also worsen glaucoma
106
Tapentadol mechanism
Mu opioid agonist
SNRI
107
Hydrocodone in morphine equivalent
1:1
108
Hydromorphone in morphine equivalents
4 times as potent as morphine
109
Oxycodone in morphine equivalents
1.5 times as potent as morphine
110
At johns wort
SSRI activity
111
NSAID that concentrates more in synovial fluid
Meloxicam
112
Serotonin syndrome drugs
MDMA/ecstasy
Amphetamines
Fentanyl
Dextromethorphan
sSRIs/snris
Cyclobenzaprine
Meperidine
Tramadol
Lithium
MAOIs
TCAs
113
Can Ziconotide be stopped abruptly
Yes
114
Alcohol neurolysis takes how long
3-5 days
115
Which neurolytic agent is hyperbaric
Phenol
Alcohol is hypobaric
116
Which neurolytic when injected has a painless warm feeling
Phenol
Alcohol has burning pain
117
Obturator nerve arises from what levels
L3-4
118
Unique heroin metabolite
6-MAM
119
A trial of a lidocaine patch should be
About 1-2 weeks
120
Because of this mechanism, topiramate causes kidney stones
Carbonic anhydrase inhibition
121
Antiepileptic that causes parenthesis’s of the digits
Topiramate
122
Antiepileptic that lowers OCP effectiveness
Topiramate
123
Can triptans contribute to serotonin syndrome
Yes
124
Contraindications for therapeutic ultrasound
Malignancy
Open epiphysis
Pacemaker
Near the heart, eyes, genitals, carotid sinus
Laminectomy site
Prosthetics with cement
125
Indications for iontophoresis
Subacromial bursitits
Plantar fasciitis
Lateral epicondylitis
Achilles tendinitis
Patellar tendinitis
GT bursitis
126
TENS contraindications
Malignancy
Pregnancy
Pacemaker
Active bleeding
Seizure disorder
Decreased skin sensation
127
Contraindications for spine traction
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
This opioid should be avoided in patients taking class I and class III antiarrythmetics
Buprenorphine
129
Meperidine is contraindicated with what drug class
MAOIs
130
Myokymic discharges =
Post Radiation plexopathy
131
Spinal and visceral analgesia opioid receptor
Kappa
132
Ketamine acts on these receptors
NMDA
Opioid
Sodium channels
133
Buprenorphine is x times more potent than morphine
50
134
Nalbuphine mechanism
Kappa agonist
Mu antagonist
For itching
135
Why is Buprenorphine less likely to be reversed with naloxone
Very high affinity for mu receptor
136
Mononeuritis multiplex
Think about vasculitus
Small to medium blood vessel occlusion cause single peripheral nerve dysfunction (but multiple nerves affected)
137
Small short motor unit potential =
Myopathic lesion
138
Buproprion mechanism
NE and dopamine reuptake inhibitor
Lowers seizure threshold
139
Which oral opioid is 1:1 with morphine
Hydrocodone
140
Topiramate mechanism
Enhances GABA
Decreases glutamate activity
Na channel blocker
141
Convert morphine to Oxymorphone
Divide by 3
142
Convert Hydrocodone to morphine
Hydrocodone is 3/4 as potent
143
Convert oral morphine total per day in mg to mcg/hr fentanyl patch
Divide total morphine per day by 2
60mg -> 30mcg/hr so use a 25mcg/hr patch
144
Convert morphine oral to Hydromorphone oral
Divide morphine mg by 4
145
Sympathetic block increases or decreases sweating?
Decreases - anhidrosis
146
Convert oral methadone to any other route of administration
IM, IV
Divide by 2
147
Tramadol plus TCA =
Seizure
148
TCA prolongs qt?
Yes
149
The presence of ——— can help indicate OIH over fibromyalgia
Alodynia
150
Does baclofen cause seizures
Yes
