Pharmacology of Pain II

Question 1

Describe mechanism of Ibuprofen, diclofenac, ketoprofen [1]

Answer 1

COX-1 and COX-2 inhibition plus additional mechanisms

Question 2

Celecoxib is a selective COX-2 inhibitor, but has a significant risk of what? [1]

Answer 2

significant risk of cardiovascular events

Question 3

carbamazepine, sodium valproate, pregabalin are what type of drugs? [1]

Answer 3

Anti-convulsant drugs

Question 4

Carbamazepine, sodium valproate, pregabalin treat what type of pain? [2]

Answer 4

Neuropathic pain; Trigeminal neuralgia

Question 5

Name a tricyclic antidepressant that is used to treaet neuropathic and cancer pain [1]

Answer 5

Amitriptyline

Question 6

Carbamazepine and sodium valproate act on what type of channels:

Ca2+
K+
Amines
Na+
NH3

Answer 6

Carbamazepine and sodium valproate act on what type of channels:

Ca2+
K+
Amines
Na+
NH3

Question 7

Pregabalin acts on the α2δ subunit of what type of channels

Ca2+
K+
Amines
Na+
NH3

Answer 7

Pregabalin acts on the α2δ subunit of what type of channels

Ca2+
K+
Amines
Na+
NH3

Question 8

Explain the mechanism of action of tricylic anti-depressants [2]

Answer 8

Tricylic antidepressants inhibit the reuptake of amines (dopamine, norepinephrine, adrenaline, noradrenaline histamine, and serotonin) and also block sodium and calcium channels

Question 9

Name a drug used to treat migraines [1]

Describe its MoA [1]

Answer 9

Sumatriptan: vasoconstriction of cerebral arteries reducing inflammatory response and trigeminal activation

Question 10

Pain management for complex pain types

Describe MoA of ketamine [1]

Answer 10

NMDA glutamate receptor antagonist

Question 11

Pain management for complex pain types

Name two calcium channel ligands [2]

Answer 11

gabapentin, pregabalin [2]

Binds α2δ 1 and 2 in voltage gated calcium channels to reduce calcium currents

Question 12

Pain management for complex pain types

What is the MoA of baclofen? [1]

What type of pathologies is it used to treat? [2]

Answer 12

GABA receptor agonists

It’s used to relieve muscle spasms, cramping or tightness caused by conditions such as MS, cerebral palsy

Question 13

Pain management for complex pain types

Describe the MoA of tramadol & tapentadol [2]

Answer 13

Oopioid receptors AND amine reuptake inhibition

Question 14

What are the first three firstline drug classes recommended for neuropathic pain? [3]

Answer 14

• SNRIs (duloxetine)
• tricyclic antidepressants (amitrypyline)
• calcium channel blockers (gabapentin, pregabalin)

Question 15

Local anaesthetics

Name 3 examples [3]
MoA? [1]

Answer 15

lignocaine, bupivacaine, prilocaine (all end in -caine)

Block Na channels

Question 16

Local anaesthetics

Mode of administration? [3]

Risks of systermic toxicity include? [3]

Answer 16

Mode of administration: surface, infiltration, epidural

Risk of systemic toxicity: hypotension, respiratory depression, bradycardia

Question 17

General anaesthetics

Mode of administration? [2]

Mechanism of action? [2]

Answer 17

Mode of administration: inhalational or intravenous

Mechanism of action: activation of inhibitory receptors or inhibition of excitatory receptors

Question 18

What do you need to remember with general anaesthetics? [1]

Answer 18

Most do not act as analgesics, instead they induce a loss of conciousness

Question 19

Which drug acts as a general anaesthetic AND acts as an analgesic? [1]

Answer 19

ketamine

Question 20

Name some inhaled anaesthetics [2] and IV anaesthetics [2]

Answer 20

Inhaled: [end with -ane]
Halothane
Enflurane
Isoflurane
Nitrous oxide

Intravenous anaesthetics:
Propofol
Thiopental
Etomidate
Ketamine
Midazolam

Question 21

Define trigeminal neuralgia [1]

Answer 21

is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums

Question 22

What is trigeminal neuralgia caused by? [1]

Answer 22

Compression, distortion or stretching of the nerve V
root fibres by a branch of the anterior or posterior inferior cerebellar artery

Question 23

Treatment for trigeminal neuralgia? [5]

Answer 23

carbamazepine (sodium channel blocker): 1st line
baclofen (GABAB agonist): 1st line if unresponsive
phenytoin (sodium channel blocker)
valproate (sodium channel blocker and other targets)
clonazepam (benzodiazepine)