Pharmacology 4 analgesic agents

Question 1

pain

Answer 1

• an unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of tissue damage or both

Question 2

types of dental pain

Answer 2

infection
exposed nerve endings
swelling in confined space
fear and anxiety

Question 3

analgesic ladder

Answer 3

mild to moderate pain
- non opioids and adjuvant analgesics
step 2
- weak opioids and non opioids and adjuvant anagelsics
step 3 strong opioids and non opioids and adjuvant anaglesics

Question 4

non opiods

Answer 4

paracetamol

NSAID

Question 5

strong opiods

Answer 5

morphien

diamorhphine

Question 6

parcetamol

Answer 6

inhibitor of synthesis of prostaglandins
4g in 24 hrs
hepatoxicity contradicted in liver disease

Question 7

NSAIDS

Answer 7

irreversible inhibitor of cytlo oxygenate (COX1/2) enzyme

prostaglandins and thromboxanes not formed

Question 8

effects of NSAIDS on parts of the body

Answer 8

GI Tract:
- Occult GI blood loss from minor breaches in mucosa (loss of PGE).
Peptic ulceration. General GI upset, indigestion
Renal Function:
- Reduction in intrarenal blood flow can cause renal failure
Platelets:
- COX inhibition, bleeding tendency
Cardiovascular:
- altered renal function, fluid retention can precipitate heart failure

Question 9

CV disease and NSAIDS

Answer 9

increases risk of MI and stroke
absence of anti platelet effects
better for first generation analgesic for pt

Question 10

weak opiods

Answer 10

codeine
dihydrocodeiene
both metabolised to morhphine

Question 11

side effects of weak opiods

Answer 11

1) Cardiovascular
- reduced sympathetic outflow, increased vagal tone
- bradycardia
- hypotension
- excitation
2) Respiratory
- inhibit cough reflex
- respiratory depression
3) GI tract
- reduced gastric motility
- constipation
- nausea and vomiting

Question 12

opiods effects on the CNS

Answer 12

1) spinal cord
- reduced pain fiber transmission at kappa opiod receptors
2) brainstem
- reduced pain projection to higher centers eg thalamus

Question 13

reversal of opiods

Answer 13

nalaoxide (antagonist)

reversal of mu opiod receptors

Question 14

newer oral opoiods

Answer 14

tramadol
as effective as codeine

less constipation
usual opined effects

Question 15

weak opiod and parecetamol combinatiosn

Answer 15

co-codamol

co -proxamol

Question 16

strong opids

Answer 16

morhphine
dimorhpnine
fentanyl patch

oral dose 3x IV dose for same efficacy

Question 17

co alalgesic

Answer 17

gabapentin
pregablin
used for chronic neurogenic pain

Question 18

placebo

Answer 18

anything administered which is pharmacologically and physiologically inhert
not effective therapeutically

Question 19

what does COX do

Answer 19

generates inflammatory mediaytors (via conversion of arachnid acid)
prostaglandins
thromboxanes

Question 20

withdrawal of opiods if tolerant/dependant

Answer 20

hypertension
tachycardia
diarrhoea
sweating 
anxiety

Question 21

adverse effects of gabapentin or pregalbalin

Answer 21

sedaton
dizziness
nausea