Unit 9: Analgesia

Question 1

Name some of the body’s responses to pain

Answer 1

bradykinin
serotonin
histamine
K+ ions
acids
prostaglandins
substance P

Question 2

Arachadonic Acid is a precursor to what? (Think: pain modulation)

Answer 2

prostaglandins

leukotrienes

Question 3

Name the cyclooxygenase enzymes

Answer 3

COX-1

COX-2

Question 4

Where are COX-1 receptors typically found?

Answer 4

CNS
mucosa
kidney
endothelium
bronchi
GI Tract
PLT

Question 5

Where are COX-2 receptors typically found?

Answer 5

bone
brain
kidneys
GI tract
female reproductive system

Question 6

What is the main function of COX-1?

Answer 6

housekeeping

protective effects

Question 7

Name some effects of COX-1

Answer 7

decrease in gastric acid secretion
increase in mucous secretion
regulate blood circulation
regulate vascular tone and PLT function

Question 8

What typically induces COX-2?

Answer 8

trauma

inflammatory chemical mediators causing pain

Question 9

What 2 prostanoids work together to regulate BP?

Answer 9

thromboxane

prostaciclin

Question 10

What do prostaglandins do?

Answer 10

regulate inflammatory mediation
construct vascular smooth muscle
regulate PLTs
induce labor

Question 11

Name 3 prostanoids

Answer 11

prostaglandins
thromboxane
prostacyclin

Question 12

What does prostacyclin do?

Answer 12

stop continual bleeding

Question 13

What does thromboxane do?

Answer 13

brings PLTs to the site of injury (PLT aggregation) to prevent bleeding

Question 14

What causes pain/edema in the body?

Answer 14

bradykinin/histamines in the inflammatory process

Question 15

How do the NSAIDs work?

Answer 15

inhibit prostaglandin synthesis by inhibiting COX-1 and COX-2

Question 16

Why are the NSAIDs good for joint pain?

Answer 16

all can be found in the synovial fluid after repeated dosings

Question 17

Benefit of newer NSAIDs

Answer 17

more selective for COX-2 –> do not inhibit PLT function

Question 18

Risk of children taking ASA

Answer 18

Reye’s Syndrome

Question 19

Symptoms of ASA Toxicity

Answer 19

increased heart rate
tinnitus
hearing loss
dimness of vision
headache
N/V/D
dizziness
confusion

Question 20

How is ASA toxicity treated?

Answer 20

charcoal + dialysis

Question 21

Only 2 COX-2 selective inhibitors on the US market

Answer 21

celecoxib (Celebrex)

meloxicam (Mobic)

Question 22

major risks of COX-2 selective inhibitors

Answer 22

increased risk of:
MI
stroke

Question 23

What is diclofenac?

Answer 23

non-selective COX inhibitor

Question 24

Advantages of diclofenac

Answer 24

older
cheaper
GI ulceration less frequent

Question 25

diclofenac dosing + caution with dosing

Answer 25

50-75mg QID

>150mg/day can cause renal impairment

Question 26

What is indomethacin (Indocin) used for?

Answer 26

drug of choice for gout
closure of PDA in children
arthritis
tendonitis
bursitis

Question 27

Adverse effects of indomethacin

Answer 27

GI ulceration
bone marrow depression
mental confusion
depression
psychosis

Question 28

Because ketorolac (Toradol) has a MAJOR RISK of GIB, how many times can it be given?

Answer 28

5x

Question 29

Drug classes used for Rheumatoid Arthritis

Answer 29

DMARDs

corticosteroids

Question 30

What does DMARD stand for?

Answer 30

Disease-Modifying Anti-Rheumatic Drugs

Question 31

Two classes of DMARDs

Answer 31

Biologics

Non-biologics

Question 32

Drug class of Azathioprine

Answer 32

non-biologic DMARD

Question 33

Drug glass of Chloroquine and Hydroxychloroquine

Answer 33

non-biologic DMARD

Question 34

Drug class of cyclosporine

Answer 34

non-biologic DMARD

Question 35

Drug class of methotrexate

Answer 35

non-biologic DMARD

Question 36

name a 1st line DMARD for RA

Answer 36

methotrexate

Question 37

major adverse effect of methotrexate…so monitor ____

Answer 37

hepatotoxicity

monitor LFTs