Analgesics

Question 1

NSAIDS MOA

Answer 1

inhibit formation of various prostaglandins & decrease pain impulses received by the CNS

Question 2

COX-1 physiologic effects

Answer 2

gastroprotective prostaglandings, thromboxane A2, vasodilation of renal blood vessels

Question 3

COX-2 physiologic effects

Answer 3

pain, inflammation, antithrombosis, vasodilation of renal blood vessels

Question 4

non-selective NSAIDS MOA and examples

Answer 4

inhibit cox-1 and cox-2

diclofenac
ibuprofen
ketorolac
naproxen

Question 5

partially selective NSAIDS MOA and examples

Answer 5

inhibit cox-2 only (but inhibit both at higher levels)

celecoxib
meloxicam

Question 6

AE of NSAIDs

Answer 6

gastric irritation, renal dysfunction, platelet inhibition, increased risk of CV events, fluid retention, may alter effects of aspirin

Question 7

acetaminophen MOA

Answer 7

inhibits COX-1 an COX-2 in CNS (not periphery) & decreases pain impulses received by the CNS

Question 8

tool used to estimate hepatotoxicity toxicity from acute acetaminophen OD?

Answer 8

rumack-matthew nomogram

Question 9

when should long-acting/ER opioids be used?

Answer 9

pain requiring around-the clock long term treatment

not as needed

Question 10

schedule I meds

Answer 10

high abuse potential

ecstasyy, heroin, LSD

Question 11

schedule II meds

Answer 11

high abuse potential

codeine, fentanyl, hydrocodone, hydromorphone, methadone, meperidine, morphine, oxycodone

Question 12

schedule III meds

Answer 12

moderate abuse potential

acetaminophen with codeine, ketamine

Question 13

schedule IV meds

Answer 13

low abuse potential

tramodol

Question 14

immediate-release oral opioid use & examples

Answer 14

moderate to severe pain

morphine
oxycodone
tramadol

Question 15

IV opioids that should be avoided w renal dysfunction

Answer 15

meperidine

morphine

Question 16

methadone MOA

Answer 16

pain receptor agonist, NDMA receptor antagonist, and 5HT and NE reuptake inhibitor

Question 17

precautions for methadone

Answer 17

numerous drug interactions
monitor QTC
do not titrate > q 5 days

Question 18

common AEs of opioids

Answer 18

autonomic - xerostomia, urinary retention, postural hypotension

CNS - resp depression, confusion, hallucinations, decreased cough reflex

cutaneous - pruritis, sweating, flushing

GI - N/V/C, ileus, obstruction

Question 19

recommended meds for opioid-induced constipation

Answer 19

scheduled senna or bisacodyl

polyethylene glycol, MOM

Question 20

available naloxone routes

Answer 20

IV, IM, SQ, IN, NEB, IO, ET

Question 21

s/s of opioid withdrawal

Answer 21

N/D, coughing, lacrimation, yawning, sneezing, rhinorrhea, sweating, muscle twitching, piloerection, hot/cold flashes, muscle cramps

Question 22

long term AE of opioids

Answer 22

addiction, physical dependence, tolerance, pseudoaddiction

Question 23

adjuvant pain therapies

Answer 23

muscle relaxants
systemic lidocaine
ketamine
dexmedetomidine
anticonvulsants
TCAs
SNRIs
topical agents

Question 24

common muscle relaxants

Answer 24

baclofen - antispasmotic
cyclobenzaprine
methocarbamol
tizanidine

Question 25

lidocaine MOA

Answer 25

Na channel blocker used as adjuvant pain therapy

Question 26

ketamine MOA and use

Answer 26

NMDA receptor antagonist pain adjuvant therapy helps lower opioid consumption by 40%

Question 27

AE of ketamine

Answer 27

psychomimetic effects HTN, tachycardia does not cause resp depression at normal pain dosages :)

Question 28

dexmedetomidine

Answer 28

A2-adrenergic agonist

Question 29

anticonvulsants used as adjuvant pain therapy

Answer 29

gabapentin, pregabalin

Question 30

TCAs used as adjuvant pain therapy

Answer 30

nortriptyline | amitriptyline

Question 31

SNRIs used as adjuvant pain therapy

Answer 31

duloxetine | venlafaxine

Question 32

therapy for nociceptive pain

Answer 32

1 - NSAID 2 - duloxetine or TCA 3 - opioid

Question 33

therapy for neuropathic pain

Answer 33

1 - gabapentin, pregabalin, SNRI or TCA + topical lidocaine 2 - tramodol or combo first line therapies 3 - pain specialist referral

Question 34

therapy for cancer pain

Answer 34

nociceptive - non-opiods + opioids/adjuvants neuropathic - opioids + gabapentin, pregabalin, SNRI or TCA

Question 35

therapy for bone pain

Answer 35

NSAIDS + opioids adjuvants