Pharmacology of pain control

Question 1

Examples of drugs prescribed for step 1 (mild pain) of the WHO analgesic pain ladder

Answer 1

Non-opioid analgesics such as paracetamol, NSAID’s

Question 2

Examples of drugs prescribed for step 2 (moderate pain) of the WHO analgesic pain ladder

Answer 2

Opioids (with or w/o non-opioid analagesic and adjuvant) such as codeine, dihydrocodeine, tramadol (+laxative)

Question 3

Examples of drugs prescribed for step 3 (severe pain) of the WHO analgesic pain ladder

Answer 3

Opioids (with or w/o non-opioid analagesic and adjuvant) such as morphine, diamorphine, fentanyl, + laxative, anti-emetic- at least “prn”

Question 4

Which of the following drugs is NOT an anti-inflammatory?
a. Celecoxib
b. Naproxen
c. Diclofenac
d. Acetaminophen

Answer 4

d. Acetaminophen

Question 5

Which drug can deplete glutathione levels in the liver, allowing toxic metabolite NAPQI to accumulate?

Answer 5

Paracetamol (Acetaminophen)

Question 6

Among NSAIDs, aspirin is unique because it ____________ inhibits its target enzyme

Answer 6

irreversibly

Question 7

Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action?
a. Acetaminophen
b. Celecoxib
c. Colchicine
d. Indomethacin
e. Probenecid

Answer 7

a. Acetaminophen

Question 8

What is the most likely cause of death in acetaminophen overdose?

Answer 8

Liver failure (hepatic necrosis)

Question 9

In paracetamol overdose, saturation of conjugation mechanisms leads to the depletion of glutathione stores and the buildup of the toxic metabolite __________

Answer 9

NAPQI

Question 10

Which two body systems are most affected in paracetamol overdose?

Answer 10

Hepatic (liver necrosis/fulminant liver failure)
Renal (acute renal failure)

Question 11

Treatment for paracetamol (acetaminophen) overdose/toxicity?

Answer 11

N-acetylcysteine (IV)

Question 12

Celecoxib should be avoided in patients with a history of ________ __________ as they are associated with causing arterial thrombotic events

Answer 12

myocardial infarction

Question 13

Morphine has active metabolites that can accumulate in ________ impairment, leading to clinically relevant effects.

Answer 13

renal

Question 14

A patient with which of the following conditions is the most appropriate candidate for use of acetaminophen to manage chronic pain associated with osteoarthritis?
A. Chronic malnutrition
B. Obesity
C. Alcoholism
D. Viral hepatitis

Answer 14

B. All of the conditions except obesity can increase risk of acetaminophen-related hepatotoxicity. Acetaminophen can deplete glutathione concentrations in the liver, allowing toxic accumulation of NAPQI to build up.