Pharmacology Of Pain

Question 1

Types of pain

Answer 1

Nociceptive
Acute
Chronic
Neuropathic

Question 2

Neuropathic pain

Answer 2

Chronic maladaptive pain after traumatic brain injury or spinal cord injury

Question 3

How long does chronic pain last

Answer 3

12wk+

Question 4

Which type of pain generally responds to analgesics and which doesn’t

Answer 4

Nociceptive responds
Neuropathic doesn’t

Question 5

Targets for pain medications

Answer 5

COX2
NOS
NMDA and nonNMDA glutamate receptors
NK1 receptors
Opioid receptors

Question 6

Factors influencing pain perception

Answer 6

Cognition - attention, distraction, control
Mood
Context - expectations, beliefs, placebo
Genetics
Chemical and structural - nerve dysfunction
Injury - sensitisation

Question 7

Opioid peptides involved in nociception

Answer 7

Leu enkephalin
Met enkephalin
Dynorphin A
Nociceptin

Question 8

What type of peptide is substance P

Answer 8

Tachykinin

Question 9

3 families of opioid receptors

Answer 9

Mu - μ1 μ2 μ3
Delta - δ1 δ2
Kappa k1 k2 k3

Question 10

Effects of opioids

Answer 10

Analgesia
Pupillary constriction
Sedation
Euphoria
Dysphoria
Respiratory depression
Reduced GI motility
Dependence
Drowsiness/legarthy
Nausea+vomiting
Hypotension
Itching

Question 11

Why do opioid agonists have a broad spectrum of effects

Answer 11

Widespread distribution of opioid receptors

Question 12

Mechanism of morphine

Answer 12

Activate potassium conductance and decrease calcium conductance causing decreased excitability and NT release

Question 13

Opioid drugs

Answer 13

Codeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Methadone
Oxycodone
Oxymorphone
Propoxyphene
Tramadol

Question 14

What drug is used to reverse opioid overdose

Answer 14

Naloxone

Question 15

Naloxone

Answer 15

Opiate antagonist used to reverse overdose

Question 16

Why should opiates not be underdosed

Answer 16

Risk of tolerance developing

Question 17

3 steps of the analgesic ladder

Answer 17

1 Non opioids + adjuvants
2 moderate efficacy opioids + non opioids + adjuvants
3 high efficacy opioids + non opioids - adjuvants

Question 18

Non opioid painkillers

Answer 18

Paracetamol - analgesic antipyretic
Aspirin - analgesic antipyretic anti inflammatory
Ibuprofen, diclofenac, ketoprofen - analgesic, anti inflammatory
Selective COX2 inhibitors
Anticonvulsants - neuropathic pain, trigeminal neuralgia
Tricyclic antidepressants - neuropathic pain, cancer pain
SSRI
TRPV1 receptor ligands
NMDA glutamate receptor agonists
GABA receptor agonists
Local anaesthesia

Question 19

Which drugs acts on COX 1 and 2

Answer 19

Paracetamol
Aspirin
Ibuprofen
Diclofenac
Ketoprofen
Selective COX 2 inhibitors

Question 20

Anticonvulsant drugs

Answer 20

Carbamazepine
Sodium valproate
Pregabalin

Question 21

What type of drug is Amitryptyline

Answer 21

Tricyclic antidepressant

Question 22

What channel do carbamazepine and sodium valproate act on

Answer 22

Sodium

Question 23

What channel does pregabalin act on

Answer 23

Calcium - alpha2delta subunit

Question 24

Tricyclic antidepressants mechanism

Answer 24

Inhibit amine reuptake
Block sodium and calcium channels

Question 25

What type of drug is capsaicin

Answer 25

TRPV1 receptor ligand

Question 26

What type of drugs are ketamine and dextromethorphan

Answer 26

NMDA glutamate receptor agonist

Question 27

What type of drug is baclophen

Answer 27

GABA receptor agonist

Question 28

1st line drugs for neuropathic pain

Answer 28

SSRI Tricyclic antidepressants Anticonvulsants

Question 29

Local anaesthetic drugs

Answer 29

Lignocaine Bupivacaine Prilocaine

Question 30

Local anaesthetic mechanism

Answer 30

Block sodium channels

Question 31

Effects of anaesthetic system toxicity

Answer 31

Hypotension Respiratory depression Bradycardia

Question 32

General anaesthetic mechanism

Answer 32

Activate inhibitory receptors or inhibit excitatory receptors

Question 33

Do general anaesthetics act as analgesics

Answer 33

No, except ketamine

Question 34

What type of drugs are halothane enflurane isoflurane and nitrous oxide

Answer 34

Inhalation all general anaesthetics

Question 35

What type of drugs are propofol thiopental etomidate ketamine and midazolam

Answer 35

IV General anaesthetics

Question 36

Trigeminal neuralgia

Answer 36

Sudden paroxysmal attacks of electric shock like/sharp/stabbing pain to the face lasting a few seconds to a few minutes

Question 37

Trigeminal neuralgia main cause

Answer 37

Compression distortion or stretching of Trigeminal nerve by a branch of AICA or PICA

Question 38

Trigeminal neuralgia treatment

Answer 38

Carbamazepine, baclofen, phenytoin, sodium valproate, clonazepam

Question 39

Benzodiazepine mechanism

Answer 39

Active GABAa receptors