Treatment of pain - Egleton

Question 1

class of drug: aspirin, acetaminophen, NSAIDS, COX-2 inhibitors

Answer 1

non-opioid analegesics

Question 2

class of drug: morphine, methadone, heroin, hydrocodone, oxycodone, hydromorphone

Answer 2

opioids

Question 3

class of drug: Clonodine

Answer 3

alpha 2 adrenergic agnoists

Question 4

class of drug: TCA- Amitriptyline
SNRI- Venlafaxine, Duloxetine

Answer 4

antidepressents

Question 5

class of drug: alpha 2 durgs

Answer 5

antiepiletpic

Question 6

class of drug: lidocaine, capsaicin

Answer 6

topical local analgesics

Question 7

class of drug: ketamine

Answer 7

NMDA antagonist

Question 8

class of drug: baclofen, diazepam, Carisoprodol

Answer 8

muscle relaxants

Question 9

non-opioid analgesics target what component of the pain cascade

Answer 9

inflammatory

Question 10

what is the number one cause of liver failure in the US

Answer 10

Acetaminophen

Question 11

what are side effects of NSAIDS, and Aspirin

Answer 11

gastric ulcers

inhibit platelet aggregation

Question 12

what are the two receptors opioid drugs target

Answer 12

mu and kappa

Question 13

Name the strong agonist opioids

Answer 13

Morphine
Methadone
Heroin
Fentanyl

Question 14

Name the moderate to low agonist opioids

Answer 14

codeine

Question 15

Name the mixed agonist/antagonist partial agonists opioids

Answer 15

Buprenorphine

Question 16

Name the antagonists of opioids

Answer 16

Naloxone

Naltrexone

Question 17

when are opioids prescribed to a patient

Answer 17

• not 1st line
• moderate-to-severe acute and chronic pain
• pulmonary edema
• preanesthetic medication

Question 18

MOA of opioids

Answer 18

act at Mu receptors with high affinity

Question 19

Opioids act on areas involved in

Answer 19

respiration
pain perceptor
mood emotion

Question 20

what are CNS effects of Morphine? more info

Answer 20

• analgesia without loss of consciousness
• Euphoria/Dysphoria –> promotes abuse potential
• Nausea and vomiting –> direction action on CTZ

Question 21

what is pathognomonic of opiate intoxication? what causes this

Answer 21

miosis - due to excitation at the Edinger-Westphal nucleus of oculomotor nerve

Question 22

what is the main cause of death in overdose of morphine

Answer 22

respiration

Question 23

what is the biggest GI side effect for using opioids

Answer 23

constipation

Question 24

name 2 antidiarrheal opioids with no CNS activity

Answer 24

Diphenoxylate

Loperamide

Question 25

when taking opioids, tolerance does not develop to what

Answer 25

moisis constipation respiratory effects

Question 26

How is opioid poisoning treated

Answer 26

ventilation | i.v. opiate antagonist

Question 27

the source of opioid, opium, contains several alkaloids, name them

Answer 27

morphine, codeine, papaverine

Question 28

what opioids are used for cough supression

Answer 28

codeine | hydrocodone

Question 29

what are two precursors for morphine

Answer 29

Codeine | Herion

Question 30

what converts codeine to morphine

Answer 30

CYP2D6

Question 31

what is Hydromorphone used for

Answer 31

severe pain

Question 32

what are predominant side effects of methadone

Answer 32

constipation | biliary spasms

Question 33

what opioid agonist is used for opioid withdrawal

Answer 33

methadone

Question 34

what forms of heroin have higher BBB penetration than morphine

Answer 34

Diacetylmorhpine | 6-monoacetylmorphine

Question 35

what is the specific heroin metabolite detectable in urine tests

Answer 35

6-monoacetylmorphine

Question 36

what is hydrocodon usually mixed with

Answer 36

acetaminiophen

Question 37

Oxycodone is usually mixed with what

Answer 37

non-opioid analgesics ibuprofen aspirin acetaminophen

Question 38

what about oxycontin ( oxycodone) gives it potential for abuse

Answer 38

delayed release formulation

Question 39

``` Miperidine Fentanyl Sufentanyl Alfentanil Remifantanil ```

Answer 39

Synthetic derivatives

Question 40

What causes excitement at toxic doses when using Meperidine

Answer 40

Normeperidine ( CNS stimulant)

Question 41

can you use naloxone to treat overdose of Meperidine

Answer 41

no

Question 42

Meperidine combined with other drugs can cause excitation, delirium, hyperpyrexia, convulsions, respiratory depression

Answer 42

MAO inhibitors

Question 43

how can Fentanyl be given to a patient

Answer 43

patch lozenge ( sucker) I.V. pre/post surgery

Question 44

Sufentanil Alfentanil Remifentanil are derivatives of what?

Answer 44

Fentanyl | mu opioid agonists

Question 45

slow metabolism of codeine results in

Answer 45

codeine ineffective analgesic

Question 46

fast metabolism of codeine results in

Answer 46

fast conversion to morphine - overdose

Question 47

Propoxyphene is an agonist to what

Answer 47

mu | moderate to low opioid agonist

Question 48

what drug is put into Pentazocine to prevent abuse

Answer 48

Naloxone

Question 49

what opioid is used for pregnant patients and how is this drug usually administered

Answer 49

Buprenorphine | sublingually

Question 50

MOA of Tramadol

Answer 50

inhibits NE and 5-HT reuptake | -not an opioid but binds opioid receptors

Question 51

in opioid-dependent subjects, antagonists can induce

Answer 51

withdrawal

Question 52

name 2 opiate antagnoists

Answer 52

Naloxone Nalmefene Naltrexone

Question 53

when is Dextromethrorphan (opioid) used? what is it found it? abuse potential

Answer 53

non-analgesic use cough syrup Robotripping in teens

Question 54

name an alpha 1 adrenergic agnoist

Answer 54

Clonodine

Question 55

what are Diphenoxylate and Leperamide used for

Answer 55

antidiarrheal

Question 56

what is MOA for Clonodine

Answer 56

NE inhibits pain by activation of pre and post alpha 2 receptors simulation in projection neurons of DORSAL HORN and primary afferents

Question 57

what is the most common TCA antidpressent that treats pain

Answer 57

amitriptyline

Question 58

MOA of TCA and SNRI

Answer 58

Ne and 5-HT reuptake inhibitors promote NE activation of pre and post alpha 2 receptors in projection neurons of dorsal horn and primary afferents - can alter perception of pain

Question 59

name antiepileptic drugs used for pain

Answer 59

alpha 2 delta | Carbamazepine

Question 60

name two alpha 2 delta drugs

Answer 60

gabapentin | pregabalin

Question 61

MOA of alpha 2 delta drugs

Answer 61

reduce activation of N and P/Q Ca2+ channels

Question 62

MOA of Carbamazepine

Answer 62

stabilized inactive state of voltage gated sodium channels

Question 63

which antiepileptic drugs decreases tolerances of opioids

Answer 63

gabapentin

Question 64

what is lidocaine used for

Answer 64

local anesthetic

Question 65

what is Capsaicin

Answer 65

chilli pepper alkaloid adjunctive

Question 66

what is MOA for ketamine

Answer 66

blocks NMDA | glutamate signaling

Question 67

what is Baclofen used for? any warnings

Answer 67

spasticity and hiccups | -avoid abrupt withdrawal, will result in sequelae

Question 68

what id Diazepam used for

Answer 68

IV/IM muscle spasms | oral - muscle relaxant

Question 69

what muscle relaxant is not recommended for use in elderly or children under 16, used cation in patients with drug abuse history

Answer 69

Carisoprodol

Question 70

``` Chorzoxazone Cyclobenzaprine Metaxalone Methocarbamol are used in care with who ```

Answer 70

elderly

Question 71

what is Cyclobenzaprine used for? Pharmacokinetics

Answer 71

acute muscle spasms TMJ -large half life -Cyp3A4

Question 72

what is the main side effect of Metaxalone

Answer 72

Jaundice

Question 73

what is Methocarbamol used for

Answer 73

muscle spasm tetanus

Question 74

what is Tizanadine used for

Answer 74

tension headaches | low back pain