Analgesia & Pharmacology

Question 1

What is the most dangerous adverse side effect of opioid analgesics?

Answer 1

Respiratory depression

Question 2

What are the contraindications to opioids?

Answer 2

Respiratory dysfunction of any cause (including obesity), head trauma, hypotension, shock, hypothyroidism, impaired hepatic function.

Question 3

What is an endogenous agonist of the mu opioid receptor subtype?

Answer 3

Beta endorphin

Question 4

All opioid receptor subtypes are linked to which G protein?

Answer 4

Gi/o

Question 5

What kind of pain do opioids not affect?

Answer 5

Neurogenic pain

Question 6

What opioid drug class does morphine belong to?

Answer 6

Opioid phenanthrene mu agonist

Question 7

What opioid drug class does fentanyl belong to?

Answer 7

Meperidine mu agonist

Question 8

What opioid drug class does loperimide belong to?

Answer 8

Meperidine mu agonist

Question 9

What opioid drug class does tramadol belong to?

Answer 9

Opioid phenanthrene mu agonist

Question 10

What opioid drug class does propoxyphene belong to?

Answer 10

Methadone mu agonist

Question 11

What opioid drug class does buprenorphine belong to?

Answer 11

Mixed agonst/antagonist

Question 12

What opioid drug class does codeine belong to?

Answer 12

Opioid phenanthrene mu agonist

Question 13

What opioid drug class does naloxone (Narcan) belong to?

Answer 13

Mu antagonist

Question 14

What opioid drug class does hydrocodone belong to?

Answer 14

Opioid phenanthrene mu agonist

Question 15

What drug is used to treat opioid withdrawal?

Answer 15

Clonidine (alpha2 agonist)

Question 16

Is opioid withdrawal life-threatening?

Answer 16

No!

Question 17

What are the three structural pieces of all local anesthetics?

Answer 17

Lipophilic aromatic portion, intermediate alkyl chain, and hydrophilic amine portion

Question 18

Are all local anesthetics that contain a single “i” in the name esters or amides?

Answer 18

Esters

Question 19

Are all local anesthetics that contain two “i”s in the name esters or amides?

Answer 19

Amides

Question 20

What is the formula to determine what percentage of local anesthetic is in its neutral or cationic form, given the pH and pKa?

Answer 20

(neutral form)/(cationic form) = 10^(pH-pKa)

Question 21

When an area is infected, why does a patient need a higher does of local anesthetic?

Answer 21

The pH is lower at the infection site, leading to less available drug in neutral form to cross membranes.

Question 22

Does a local anesthetic bind the Na channel extracellularly or intracellularly?

Answer 22

Intracellularly

Question 23

Does the Na channel have higher affinity for local anesthetic in its neutral or charged form?

Answer 23

Charged

Question 24

Which fiber type is preferentially blocked by local anesthetics?

Answer 24

C fibers

Question 25

What is the relationship between the pKa of a local anesthetic and its lipid solubility?

Answer 25

The lower the pKa value, the higher the lipid solubility

Question 26

What is the main mechanism of ester local anesthetic termination?

Answer 26

Hydrolization primarily in plasma by an esterase

Question 27

What is the main mechanism of amide local anesthetic termination?

Answer 27

Metabolized in liver only

Question 28

How are local anesthetics excreted?

Answer 28

Renally

Question 29

Why are many local anesthetics combined with a vasoconstrictor like epinephrine?

Answer 29

The duration will be prolonged dramatically by reducing blood flow thereby retarding systemic absorption.

Question 30

Where do tetrodotoxin and saxitoxin act on the Na channel?

Answer 30

Extracellular entrance (pore)

Question 31

How do tetrodotoxin and saxitoxin cause death?

Answer 31

By paralyzing respiratory muscles

Question 32

What is first line therapy for termination of moderation to severe migraine?

Answer 32

Triptans

Question 33

What is the mechanism of action of triptans?

Answer 33

5HT 1B/1D receptor agonist

Question 34

What are some adverse effects of triptans?

Answer 34

Parasthesis, flushing, dizziness, drowsiness, fatigue, pressure in chest, coronary vasospasm & angina, MI, arrhythmia, stroke, death

Question 35

What is the mechanism of action of ergot alkaloids?

Answer 35

5HT 1B/1D receptor agonist

Question 36

What is first-line therapy for prevention of chronic migraines?

Answer 36

Propanolol

Question 37

What two dietary supplements are safe and can possibly prevent migraines?

Answer 37

Riboflavin and butterbur