Week 5 - pain part 2

Question 1

opioid indication

Answer 1

analgesia

antitussive (codeine)

Question 2

opioid MOA

Answer 2

bind to opioid receptors in CNS to inhibit ascending pain pathway

Question 3

Main opioid receptors

Answer 3

mu, kappa, delta

Question 4

common AE with opioid

Answer 4

constipation

respiratory depression

Question 5

opioids contra indication

Answer 5

GI obstruction, respiratory depression, paralytic ileus

Question 6

strong mu agonist opioids

Answer 6

morphine 
fentanyl
hydromorphone
meperidine
methadone
oxycodone

Question 7

mid-moderate mu agonist (weak opioids)

Answer 7

codeine

Question 8

what is a prodrug

Answer 8

must convert to morphine through metabolic process to get effects

Question 9

what is the main effect of codeine

Answer 9

antitussive

Question 10

opioids agonist-antagonist (partial mixed agonist)

Answer 10

pentazocine
butorphanol
nalbuphine
buprenorphine

Question 11

most common opioids agonist-antagonist (partial mixed agonist)

Answer 11

buprenorphine

Question 12

buprenorphine

Answer 12

high affinity with mu receptors

antagonist at delta and kappa receptors

Question 13

tramadol

Answer 13

weak mu agonist
inhibit reuptake of norepinephrine and serotonin
increased risk of seizure
less risk of dependence

Question 14

first pass effect

Answer 14

With oral medication

Absorption by liver

Question 15

which opioids is the comparator

Answer 15

morphine

Question 16

AE for opioids

Answer 16

CNS effects: sedation, resp depression, cough suppression, miosis
Peripheral effects: constipation, urinary retention, reduced GI motility

Question 17

most common AE for opioids

Answer 17

sedation and nausea

Question 18

Tolerance can be develop for every opioids AE except…

Answer 18

miosis and constipation

Question 19

AE of opioids to consider

Answer 19

resp depression
cognitive impairment 
cough suppression 
truncal rigidity
delayed gastric emptying

Question 20

what schedule are opioids

Answer 20

schedule II

Question 21

tolerence

Answer 21

decreased AE and decrease analgesic effect

Question 22

physical dependence

Answer 22

withdrawal symptoms after missed dose

Question 23

addiction

Answer 23

compulsive cravings

Question 24

opioid antagonist

Answer 24

Naloxone

highest affinity for mu receptors

Question 25

Naloxone

Answer 25

opioid antagonist

for acute opioid overdose or respiratory depression

Question 26

PT concerns with opioids

Answer 26

fall risk

drug seeking behaviour

Question 27

what should be avoided with patches

Answer 27

heat, exercise, pressure in area

Question 28

neuropathic pain

Answer 28

disease or injury to peripheral or central NS

Question 29

cause of neuropathic pain

Answer 29

damage in peripheral or central nociceptive pathways

Question 30

types of neuropathic pain

Answer 30

stimulus independent - nerve pain

stimulus dependent - stimuli reaction

Question 31

1st line treatment for NICe guideline (neuropathic pain)

Answer 31

Duloxetine (Cymbalta)
Pregabalin (Lyrica)
Gabapentin (Neurontin)
Amitriptyline