Pharmacology: Narcotics

Question 1

nociceptive pain can be divided into ___ or __ pain

Answer 1

somatic or visceral pain.

Question 2

visceral pain

Answer 2

contant, aching squeezing, harder to localize, can be referred

Question 3

somatic pain/parietal pain

Answer 3

constant or intermitten, gnawing, aching, usually well localized. Sharper.

Question 4

neuropathic pain can be ___ or ___

Answer 4

dysesthetic or neuralgic.
overall, neuropathic pain is due to damage to nervous system and causes the sharp nerve pains. due to destruction, infiltration, compression of nerve tissue.

Question 5

neuralgic pain

Answer 5

lancinating, sharp shooting pain.

Question 6

dysesthetic pain

Answer 6

burning, contant allodyniec pain.

Question 7

acronym for assessing pain

Answer 7

WWQQAAAT: Where, when, quality (peritonitic or diffuse), quantity (1-10), aggravating, alleviating, associated symptoms, timeline/disease progression

Question 8

T/f neuropathic pain is harder to treat

Answer 8

true. it’s resistant to treatment and there are limited surgical interventions.

Question 9

opiates vs opioids

Answer 9

opiates= naturally present in opium– morphine, codeine, thebaine

opioids= manufacture- semisynthetic are derived from an opiate (heroin from morphine)

• some opioids are 100% man made like fentanyl and methadone.

Question 10

what factors affect pharcokinetics vs pharmacodynamic

Answer 10

kinetics: absorption, distribution, metabolism, excretion
dynamics: receptor binding, signal messaging, physiological effects.

Question 11

why is the effect of a given dose less after oral rather than parenteral administration

Answer 11

due to significant first pass metabolism

Question 12

bioavailability =

Answer 12

fraction of the administered dose of a drug that reaches the systemic circulation in an active form

Question 13

specificity of a test

Answer 13

probability that the test will be negative for someone who doesn’t have the disease

Question 14

sensitivity of a test

Answer 14

the ability of a test to correctly identify those with the disease (true positive rate),

Question 15

ppv

Answer 15

positive predictive value; the is the probability that subjects with a positive screening test truly have the disease.

Question 16

morphine gets conjugated with ___ acid to form a pharmacologically inactive metabolite, ____

Answer 16

conjugates with glucoronic acid to form 3-glucuronide. forms the principal metabolite. (6- glucuronide form is more active than morphine)
 has a longer half life
 Systemically it is about 2X as potent as morphine
 Intrathecally, it is about 100X more potent than morphine

Question 17

primary method of morhphine excretion

Answer 17

morphine is excreted by the kidney in the form of 3-glucuronide.

Question 18

morphine causes PEAR:

Answer 18

P = physical dependence
E= euphoria
A= analgesia
R= respiratory depression

Question 19

examples of full agonists, partial agonists, antagonists to Mu receptor

Answer 19

full agonist: morphine, hydromorphone, oxycodone, fentanyl

partial agonist: buprenorphien

antagonist: naloxone or naltrexone.

Question 20

T/F you should use a long acting formulation for opioid naive patients

Answer 20

false. to avoid dependence, opioid naive patients should receive short-acting formulations

Question 21

T/F opioids should be given IM

Answer 21

no. never!

preferred route is oral. When unable to swallow, IV or transdermal.

Question 22

what is breakthrough analgesia

Answer 22

done usually in chronic pain patients when schedule dosing (ex/ every 4 hours) is required, then as per needed (PRN) dosing for episodes of increasing pain.

Question 23

by how much should you titrate the opioid dose if the original dose is not giving pain control?

Answer 23

increase the dose by 25-50% if the patient is not achieving adequate pain control.

Question 24

neurotoxicity of opioids

Answer 24

anxiety, agitation, restlessness, delirium. Not reversible with naloxone.

Question 25

T/F narcosis is reversible with nalozone

Answer 25

true. narcosis is deep sedation, hypotension and decreased ventilation which can be reversed.

Question 26

T/F neurotoxicity is reversible with naloxone

Answer 26

false. the anxiety and agitation and delirium opioids can cause are not reversible with naloxone.