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Neurology > Pharmacology of pain > Flashcards

Pharmacology of pain Flashcards

1
Q

What receptors are typically found on a C-fibre terminal?

A

NMDA receptors
u-, delta-, kappa- opioid receptors
EP (Prostaglandin E) receptors

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2
Q

What receptors are typically found on a dorsal horn neurone?

A

Non-NMDA receptors
Neurokinin 1 receptors
NMDA receptors
u-, delta-, kappa- opioid receptors

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3
Q

What NT is involved with NMDA and non-NMDA receptors?

A

Glutamate

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4
Q

What are opioids? Give examples of opioid peptides.

A

Endogenous peptides/endorphins

Examples: enkephalins, dynorphins, beta - endorphin

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5
Q

Name the 3 endogenous opioid systems.

A

Pro-opiomelanocortin derived
Pro-enkephalin derived
Prodynorphin derived
(also the pronociceptive system - cholecystokinin)

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6
Q

Describe the MOA of morphine.

A

Morphine attaches to its receptor (receptor has G1 and AC subunits)
Attachment of morphine causes a decrease in cAMP
This blocks calcium ion entry
Attachment also causes activation of potassium conductance and decreased calcium conductance
Overall, this causes a decrease in intracellular calcium
A decrease in intracellular calcium resulting in reduced excitability and reduced release of neurotransmitter

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7
Q

Give examples of opioid drugs.

A 
Morphine 
Pentazocine
Pethidine 
Fentanyl 
Methadone 
Sufentanil
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8
Q

What are the effects of activating mu opioid receptors?

A 
Analgesia 
respiratory depression 
pupillary constriction 
reduced gut motility 
sedation 
euphoria 
dependence
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9
Q

What are the effects of activating delta opioid receptors?

A

spinal analgesia
respiratory depression
reduced GI motility

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10
Q

What are the effects of activating kappa opioid receptors?

A 
spinal + peripheral analgesia 
respiratory depression 
reduced GI motility 
sedation 
dysphoria 
potentially dependence
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11
Q

What potential side effects are there of opioid drugs?

A 
hypotension 
delayed gastric emptying 
reduced biliary and pancreatic secretion 
urinary urgency 
itching
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12
Q

Describe the different steps in the analgesic ladder.

A
  1. non-opioids and adjuvant drugs
  2. moderate efficacy opioids, non-opioids and adjuvants
  3. high efficacy opioids, non-opioids and adjuvants
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13
Q

Which enzyme is rofecoxib a selective inhibitor for?

A

COX-2

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14
Q

What are the indications for NSAIDs?

A 
Rheumatoid arthritis 
Osteoarthritis 
Dysmenorrhea 
Gout 
Muscle spasm
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15
Q

What two drugs are often used in combination with paracetamol?

A

Codeine

Dihydrocodeine

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16
Q

What receptor/s do Ketamine and dextromethorphan act on?

A

NMDA glutamate receptors

17
Q

What class of drugs act on vanilloid receptors?

A

TRPV family ligands

18
Q

What are the first line drugs for neuropathic pain?

A 
SNRIs
Duloxetine 
Venlafaxine 
TCAs
Pregabalin, gabapentin, gabapentin extended release 
Enacarbil
19
Q

What are the second line drugs for neuropathic pain?

A

Tramadol
Capsaicin 8% patches
Lidocaine patches

20
Q

What are the third line drugs for neuropathic pain?

A

Strong opioids
Botulinum toxin A
(applies to all neuropathic pain EXCEPT trigeminal neuralgia)

21
Q

What are the first line drugs for trigeminal neuralgia?

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

22
Q

Give examples of general anaesthetics that can be inhaled.

A 
Halothane
Enflurane
Isoflurane
Seroflurane
Desflurane
Nitrous oxide
Xenon
23
Q

Give examples of general anaesthetics that can be given intravenously.

A

Propofol
Thiopental lutamine
Etomidate

24
Q

What is the most common cause of trigeminal neuralgia?

A

compression/distortion/stretching of nerve V root fibres by a branch of the anterior/posterior inferior cerebellar artery

25
Q

What treatment options are there for trigeminal neuralgia?

A 
Carbamazepine
Baclofen (or combined with Carbamazepine)
Phenytoin 
Valproate
Clonazepam

Neurology (46 decks)

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