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Anesthesia > 10. Analgesics > Flashcards

10. Analgesics Flashcards

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1
Q

Arachidonic acid is derived from

A

phospholipids in membranes. Enzyme phospholipase

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2
Q

Arachidonic acid can be broken down into two different pathways, what are they

A

cyclooxygenase and lipoxygenase pathway

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3
Q

What are the products of the cyclooxygenase pathway

A

-Prostaglandins and thromboxane

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4
Q

What are the products of the lipoxygenase pathway

A

-5-HETE and leukotrienes

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5
Q

What are the different peripheral analgesics

A
  • Acetaminophen

- NSAIDs

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6
Q

MOA of acetaminophen

A

-Inhibition of cyclooxygenase in different manner from NSAID

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7
Q

Clinical activities of acetaminophen

A
  • Analgesia
  • Antipyretic
  • No anti-inflammatory effects
  • No inhibition of platelet aggregation
  • No inhibition of platelet aggregation
  • no gastric irritation
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8
Q

T/F Acetaminophen crosses the placenta

A

t

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9
Q

Describe the toxicity of acetaminophen

A
  • Acute toxicity with as little as 6 g taken within a short period
  • Metabolite NAPQI binds to liver proteins injuring hepatocytes
  • Hepatotoxicity
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10
Q

How is hepatotoxicity induced by acetaminophen treated

A

gastric lavage

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11
Q

What is the daily max dose for Acetaminophen for adults

A

4 gm

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12
Q

Mechanisms of analgesia for NSAIDs

A
  • inactivation of cyclooxygenase

- Inhibition of bradykinin synthesis

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13
Q

Anti-inflammatory mechanism of NASIADs

A
  • Inactivation of cyclooxygenase
  • Inhibition of WBC migration
  • Inhibition of WBC lysosomal enzyme release
  • Inhibition of phosphodiesterase
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14
Q

Anti-pyretic mechanism of NSAIDs

A

-Inhibition of prostaglandin synthetase in hypothalamus

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15
Q

T/F NSAIDs don’t have a ceiling effect

A

f

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16
Q

Adverse effects of NSAIDs are

A
  • Allergy
  • Anemia
  • Bronchospasm
  • Increased risk of coronary and cerebrovascular thrombotic events
  • GI irritation/bleeding
  • Inhibits platelet aggregation
  • Hepatotoxic
  • Renal toxicity (renal papillary necrosis)
  • Mutagenic
  • Carcinogenic (leukemia possible with indomethacin, phenylbutazone)
  • Fetotoxicity
  • Reye’s syndrome (kids)
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17
Q

Describe the fetotoxic effects of NSAIDs in 1st, 2nd and 3rd trimesters

A

1st
-Teratogenic effects

2nd and 3rd

  • Premature closure of ductus arteriosis
  • Fetal pulmonary hypertension
  • Prolonged gestation
  • Decreased uterine contractions
  • Bleeding at delivery
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18
Q

NSAID drug interactions

A
  • Anticoagulations
  • Triamterene
  • Lithium
  • Phenytoin
  • Valproic acid
  • Digitalis
  • Cyclosporine
  • Fluoroquinolones
  • Imidazole antifungals
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19
Q

T/F NSAIDs should be taken on an empty stomach

A

f

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20
Q

Mixture of NSAIDs with _ increases risk of gastritis

A

alcohol

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21
Q

Contraindications for NSAIDs

A
  • Allergy
  • Alcoholism
  • Asthma
  • Gastritis/ peptic ulcers
  • Pregnant
  • Blood dyscrasia
  • Renal function impairment
  • Psychiatric illness
  • Recent coronary artery bypass graft (CABG)
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22
Q

Indomethacin belongs to what drug category

A

NSAIDs (Indoleacetic acid)

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23
Q

Incidactions for indomethacin

A
  • Osteoarthritis

- Rheumatoid arthritis

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24
Q

Indomethacin shouldn’t be used in what populations

A

pediatric and geriatric and pregnant

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25
Indomethacin may worsen what diseases
CNS diseases such as epilepsy and risk of leukemia
26
What drug class does Nabumetone belong to
NSAIDs (Naphthylakanones)
27
Nabumetone is primarily used for
osteoarthritis and rheumatoid arthritis and TMJ
28
Nabumetone is FDA class _
C
29
Other names for indomethacin and Nabumetone are
indocin and relafen
30
Primary in dication for piroxicam are
- OA - RA - Gout
31
Piroxicam may produce what types of symptoms
flu like
32
Diclofenac is indicated for
primarily arthritis but good for acute dental pain
33
T/F diclofenac has minimal effect on platelets
t
34
What risk does diclofenac have
risk of bone marrow suppression
35
Diclodenac is FDA class
B
36
What drug category does piroxicam fall under
NSAID (oxicam)
37
What drug class does diclofenac belong to
NSAID (phenylacetic acids)
38
What are the different NSAID propionic acids
- Ibuprofen - Fenoprofen - Fluribiprofen - Ketoprofen - Naproxen - Oxaprozin
39
Propionic acids are good for treating what kinds of pain
acute pain
40
Other names for ibuprofen are
motrin and advil
41
Indications for ibuprofen
mild to moderate pain
42
What are the doses for ibuprofen for analgesia and inflammation
- Analgesia= 200-400 mg 6hrs | - Anti-inflammation= 600-800mg 6hrs
43
T/F Ibuprofen has been associated with sedation
t
44
Other name for fluribprofen is
ansaid
45
Issues with flurbiprofen
* *not indicated for routine analgesic use | - Potentially fetotoxic and embryotoxic
46
Other names for naproxen
aleve and anaprox
47
Indications for naproxen
mild to moderate dental pain
48
Naproxen is associated with _ in young kids
rash
49
Avoid what form of naproxen in the elderly
Na+ salt form
50
What form of naproxen should be avoided for initial therapy
delayed release
51
Etodoloc belongs to what family of NSAIDs
pyranocarboxylic acid
52
Other name for etodoloc is .
lodine
53
Indications for Etodoloc
Mild to moderate pain
54
Etodoloc is associated with abnormal
fetal limb development and decreased fertility, testicular atrophy
55
Another name for aspirin is
acetylsalicylic acid
56
Other Salicylates are
Aspirin and diflunisal
57
All salicylates are associated with _ syndrome
reyes
58
Salicylates should be avoided in what population
children (avoid in treating fever due to viral illness --> reyes)
59
Diflunisal has a (greater/lesser) effect on platelets compared to ASA
lesser
60
Diflunisal shouldn't be used in combo with
acetaminophen
61
Celecoxib is what class of NSAID
COX2 inhibitor
62
Celecoxib is indicated for
RA and OA ONLY
63
Celecoxib has a (higer/lower) incidence of gi effects
lower
64
T/F Celecoxib is indicated for odontogenic pain
f
65
Celecoxib puts patients at (increased/decreased) risk of CV events, MI, storke, etc.
increased
66
T/F There is cross reactivity between celecoxib and other NSAIDs
t
67
FDA classification of celecoxib
C
68
Avoid celecoxib in patients with
- CVD - daily aspirin use - Hypersensitivity - Asthmatics - Pregnant
69
Metabolize of celecoxib is antagonized by
fluconazole and other agents metabolized via cytochrome p450 2C9
70
Prostaglandins are involved in
GI mucosal protection (mediate pain, fever and inflammation)
71
Thromboxanes are involved in
hemostasis

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