Drugs for Pain and Inflammation

Question 1

Name the two categories of drugs that treat pain

Answer 1

1. Opioid

2. Nonopioid

Question 2

What severity of pain do opioids relieve

Answer 2

Moderate to severe

Question 3

What is the prototypical opioid analgesic used for comparing other drugs to?

Answer 3

Morphine

Question 4

What are the 3 opioid receptors that effect spinal and supra spinal analgesia?

Answer 4

Mu, Kappa, and Delta

Question 5

Opioid receptor that causes sedation, respiratory depression, constipation, inhibits neurotransmitter (ACh, dopamine) release, increases hormonal release (prolactin, growth hormone)

Answer 5

Mu

Question 6

Opiod receptor that causes sedation, constipation and psychotic effects

Answer 6

Kappa

Question 7

Opioid receptor that increases hormonal release (growth hormone) and inhibits neurotransmitter (dopamine) release

Answer 7

Delta

Question 8

The most important opioid receptor in mediating the analgesic effects of morphine and other opioids; located in specific locations in the brain and spinal cord; opioids have high affinity to this receptor type; mediate problematic side effects

Answer 8

Mu

Question 9

Opioids that selectively stimulate _____ and _____ receptors may provide sufficient analgesia while less likely causing respiratory depression and abuse if they avoid or block _____ receptors (mixed agonist-antagonist opioids)

Answer 9

Kappa and Delta; Mu

Question 10

What is classification of different opioids based on?

Answer 10

Their interaction with opioid receptors

Question 11

Opioid classification: Used to treat severe pain; high affinity for certain receptors (primarily mu); i.e., morphine, fentanyl, hydromorphone

Answer 11

Strong agonists

Question 12

Opioid classification: not as high of an affinity or efficacy as strong agonists; i.e., codeine, hydrocodone, oxycodone

Answer 12

Mild-to-Moderate agonists

Question 13

Opioid classification: Exhibit some agonist and antagonists like activity at the same time; produces adequate analgesia while decreasing the risk of respiratory depression; i.e., butorphanol, nalbuphine, pentazocine

Answer 13

Mixed agonist-antagonist

Question 14

Causes analgesia by binding to activating kappa receptors while blocking (or partially activating) mu receptors

Answer 14

Butrophanol

Question 15

What is used to treat opioid overdoses and addiction? u

Answer 15

Antagonists

Question 16

Rapidly and dramatically reverse the respiratory depression which usually causes death in a person

Answer 16

Nalmefene and naloxone

Question 17

Used in conduction with with behavioral therapy to maintain an opioid-free state in people recovering from addiction; blocks receptors so that if a person shoots up with heroin, they will not feel the effects

Answer 17

Naltrexone

Question 18

What metabolically inactivates opioids?

Answer 18

Liver

Question 19

How are opioids excreted?

Answer 19

Kidneys excrete the drug metabolite

Question 20

How do opioids work?

Answer 20

Inhibit afferent pain transmission, allow descending pathways to become more helpful in controlling pain by reducing painful sensations at the spinal cord level

Question 21

When compared to other forms of analgesia, why are opioids unique?

Answer 21

The alter the perception of pain rather than eliminating the painful sensation entirely

Question 22

Other than pain management, what are opioids used for?

Answer 22

1. Anesthesia (premedication or adjunct)
2. Cough suppression (codeine)
3. Decrease GI motility (in cases of diarrhea
4. Adjunct for acute pulmonary edema

Question 23

How long does it take to decrease tolerance to the point where you can begin taking the original prescribed dose?

Answer 23

2 weeks

Question 24

When will doses of opioids need to be increased?

Answer 24

After 2-3 weeks

Question 25

Problems with addiction, tolerance, and dependence are minimized when opioid medications are used _______.

Answer 25

Therapeutically

Question 26

Strong opioid agonist used to treat addiction; used as substitute for the abused opioid and slowly tapered down and withdrawn along with the pt in counseling; low success rate

Answer 26

Methadone

Question 27

Mixed agonist-antagonist (agonist at mu, antagonist at kappa); sustains opioids effects to prevent withdrawal; blocks cellular changes that promote addiction

Answer 27

Buprenorphine

Question 28

How would opioid analgesics in patients requiring rehab be helpful?

Answer 28

Pt is in less pain, so more able to do exercises

Question 29

How would opioid analgesics in patients requiring rehab be detrimental?

Answer 29

Pt could injure themselves being confused, could be drowsy, could affect respiratory function

Question 30

When should a pt take their opioid relative to their rehab?

Answer 30

30 mins - 1 hour

Question 31

What is something else you may have to watch out for while at work?

Answer 31

Coworkers or family members stealing opioids

Question 32

What are the uses for Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?

Answer 32

1. Decrease inflammation 2. Relieve mild-to-moderate pain 3. Decrease elevated body temp 4. Decrease blood clotting

Question 33

What does NSAIDs inhibit the synthesis of?

Answer 33

Prostaglandins

Question 34

Produced by all cells except RBCs; hormones that act locally to help regulate cell fxn under normal conditions; thromboxjnes and leukotrienes also derived from the same precursor

Answer 34

Prostaglandins

Question 35

Name 3 Eicosanoids

Answer 35

1. Prostaglandins 2. Trombones 3. Leukotrienes

Question 36

What enzymes do NSAIDs inhibit?

Answer 36

COX

Question 37

The blockage 2 COX enzymes causes both beneficial and adverse side effects. Which enzyme is it beneficial to block and which causes side effects if blocked?

Answer 37

COX2 is beneficial; this produces pain and inflammation, and overactive enzymes cause problems COX1 causes side effects; enzyme produces prostaglandins that protect the stomach lining, maintain renal function, and regulate normal platelet activity

Question 38

What is the primary concern for COX2 selective drugs?

Answer 38

Increased risk for serious CV events such as heart attack and stroke

Question 39

What is the only COX2 inhibitor on the market?

Answer 39

Celecoxib (Celebrex)

Question 40

Equal to NSAIDs in terms of analgesic and antipyretic effects; no anti-inflammatory or anticoagulant effects; not associated with GI irritation; High doses are toxic to the liver and can be fatal

Answer 40

Acetaminophin