Week 9 Analgesia

Question 1

Pain is defined as an?

Answer 1

Unpleasant sensory and emotional experience associated with actual and potential tissue damage

Question 2

Mediators involved in the transmission or relief of pain include?

Answer 2

Endogenous opioids
Prostaglandins
Tachykinins

Question 3

Endogenous opioids, which are all……………………….include………………….?

Answer 3

Opioid peptides, include enkephalins, endorphins, dynorphans and nociceptin

Question 4

Nociceptive pain arises from?

Answer 4

Physiological pain, arising from stimulation of superficial and visceral nociceptors, by noxious stimuli such as tissue injury and or inflammation

Question 5

Neuropathic pain arises from?

Answer 5

A primary lesion or dysfunction in the somatosensory nervous system pathway, e.g nerve compression, amputation, inflammation, prolapsed intervertebral disc, trauma and or degeneration

Note: More examples are given in the textbook

Question 6

Neuropathic pain responds less well to?

Answer 6

Opioid analgesia or NSAIDs, often requires the addition of adjunct medication

Question 7

TRUE OR FALSE

Analgesia is associated only with DOR (opioid receptor subtype)?

Answer 7

FALSE

Subtypes of opioid receptors are classified by responses to different agonist and antagonist

Question 8

Constipation is associated with all opioid receptors? TRUE/ FALSE

Answer 8

TRUE

Most serious adverse affects of opioids is respiratory depression, excessive sedation, dysphoria, CONSTIPATION, nausea, vomiting, tolerance and dependency

Question 9

Euphoria is associated only with MOR? TRUE/ FALSE?

Answer 9

TRUE

MOR response include Supraspinal analgesia, EUPHORIA, respiratory depression, sedation, constipation, miosis, drug-dependence

Question 10

Dysphoria is associated only with KOR? TRUE/ FALSE

Answer 10

TRUE

Response include; spinal and peripheral analgesia, sedation, miosis, DYSPHORIA, respiratory depression

Question 11

Miosis is associated with MOR and KOR? TRUE/ FALSE

Answer 11

TRUE

Both MOR and KOR Opioid receptor responses include MIOSIS

Question 12

Sedation is associated with all opioid receptors? TRUE/ FALSE?

Answer 12

FALSE

Sedation is associated with MOR and KOR Opioid receptors

Question 13

Respiratory depression is associated with only DOR? TRUE/ FALSE?

Answer 13

FALSE

Respiratory depression is associated with DOR, KOR and MOR opioid receptors

Question 14

Dependence is associated with only MOR? TRUE/FALSE

Answer 14

TRUE

Drug or opioid dependence is associated with only MOR opioid receptors

Question 15

Which of the following effects is NOT associated with opioids? (Select all that apply)

a) Delirium
b) Diuresis
c) Hypotension
d) Nausea and vomiting
e) Diarrhoea
f) Cough
g) Itch
h) Hyperglycaemia
i) Hypethermia

Answer 15

a) delirium
b) Diuresis
e) diarrhoea
f) cough
g) itch
h) hyperglycaemia
i) hyperthermia

Question 16

Which of the following opioids are prodrugs?

a) heroin
b) codeine
c) pethidine
d) tramadol
e) Fentanyl

Answer 16

b) codeine

d) Tramadol

Question 17

Morphine (select all that apply)

a) use is associated with dependence but not tolerance
b) may cause histamine release and bronchoconstriction
c) has high hepatic extraction
d) forms an active metabolite
e) should be avoided in patients with severe hepatic or renal impairment

Answer 17

All of the above a) b) c) d) e)

Question 18

With respect to opioids (Select all that apply)

a) Fentanyl is administered via the dermal and sublingual route
b) pethidine is only administered orally
c) oxycodone is combined with naloxone to reduce GI adverse effects
d) codeine is used as a cough suppressant
e) seizures are most common cause of death following opioid overdose

Answer 18

c) d)

Question 19

Buprenorphine (Select all that apply)

a) may precipitate withdrawal symptoms in dependent people taking other opioids
b) has a low affinity for opioid receptors
c) patches have a prolonged onset and duration of action
d) is not recommended for the treatment of acute pain
e) is associated with more severe withdrawal syndrome than morphine

Answer 19

a) c) d)

Question 20

Naloxone (select all that apply)

a) has little or no effect in a person who has not taken an opioid
b) has a long duration of action
c) is contraindicated in neonates
d) has a high oral bioavailability
e) is used as a diagnostic aid for opioid intoxication

Answer 20

All of the above

NOTE: naloxone is used to reverse the effects of opioids. Naloxone is short acting if given parenterally, however long acting if given orally. It is also contraindicated in neonates whose mother is known to be dependent on opioids

Question 21

Aspirin (select all that apply)

a) inhibits COX-1
b) Has anti-inflammatory and analgesic, but not antipyretic actions
c) Reversibly inhibits the formation of thromboxane A2 in platelets
d) increases the synthesis of mucoprotective prostaglandin E2
e) has a short half-life
f) is metabolised to salicylic acid
g) is indicated in low doses for the primary prevention of stroke and myocardial infarction and for secondary prevention in ischaemic heart disease

Answer 21

e) f) g)

Question 22

With respect to the adverse effects of aspirin (select all that apply)

a) commonly cause GI adverse effects
b) may cause renal dysfunction
c) may increase the risk of bleeding in patients receiving other anti platelet agents or anticoagulants
d) Chronic use is associated with tolerance
e) Causes Reye’s syndrome in elderly people

Answer 22

a) b) c)

Question 23

Paracetamol (select all that apply)

a) has anti-inflammatory, antipyretic and analgesia actions
b) has very few adverse effects at therapeutic doses
c) is contraindicated in pregnancy
d) has low oral bioavailability
e) clearance is reduced in patients with renal dysfunction

Answer 23

a) b) e)

NOTE: Paracetamol is effective as a analgesic and antipyretic, has anti-inflammatory properties however very minimal

Question 24

Four characteristic signs of inflammation are?

Answer 24

Erythema (redness), oedema (swelling), pain and heat

Question 25

Mediators of inflammation include the?

Answer 25

3 basic steps

1. Blood vessel vasodilation and increased capillary permeability
2. Cellular infiltration and
3. Tissue repair

Question 26

Primary types of immunity are?

Answer 26

Cell-mediated immunity

and humoral or antibody mediated immunity

Question 27

The four different types of allergic reactions are?

Answer 27

Type I: immediate or anaphylactic reaction
Type II: anti-body-dependent cytotoxic reaction
Type III: Arthus, or complex-mediated reaction
Type IV: cell-mediated or delayed hypersensitivity reaction

Question 28

Therapeutic properties of NSAIDs include?

Answer 28

Analgesic, antipyretic and anti-inflammatory actions

Question 29

The anti-inflammatory action of NSAIDs is related to?

Answer 29

The inhibition of prostaglandin synthesis which is involved inflammation and pain, and contributes inflammatory erythema and pain

Question 30

Tumour necrosis factor alpha ( TNF-a) produced by macrophages, is a?

Answer 30

Is a cytokine that plays an important role in normal inflammatory and immune responses

Question 31

Immunosuppressant drugs decrease or?

Answer 31

Prevent a immune response

Question 32

Histamine is a chemical mediator that is present in……..and when liberated from cells……………….?

Answer 32

In almost all body tissue, highest concentrations in skin, lungs and gastrointestinal tract. When liberated from cells play an early transient role in the inflammatory process

Question 33

Antihistamines block the action of………….and are primarily used………….?

Answer 33

Histamine receptors and are primarily used to treating allergies

Question 34

Gout is a disease associated with?

Answer 34

A genetically determined error of Uric acid metabolism that increases its production

Question 35

Gout is characterised by………….and manifests as………….?

Answer 35

Defective purine metabolism and manifests itself by attacks of acute pain

Question 36

Proper administration of an ordered narcotic?

a) can lead to addiction
b) Should be done promptly to prevent increased pain and the need for larger doses
c) would include holding the drug as long as possible until the person really needs it
d) should rely on the person request for medication

Answer 36

b) should be done promptly to prevent increased pain and the need for larger doses