pain

Question 1

Give two examples of weak opioids

Answer 1

• Codeine
• Tramadol

Question 2

Give two examples of strong opioids

Answer 2

• Morphine
• Fentanyl (heroin)

Question 3

What is the primary mechanism of action of opioids?

Answer 3

• Depressant effect on cellular activity
• Multiple sites in pain pathway where activation of opioid receptor leads to decreased perception or increased tolerance to pain
• Anti-tussive effect (cough suppressant) due to decreased activation of afferent nerves relaying cough stimulus from airways to brain

Question 4

What is the drug target for opioids?

Answer 4

Opioid receptor

Question 5

What are the main mild side effects of opioids?

Answer 5

• Nausea and vomiting (increased activity in chemoreceptor trigger zone)
• Constipation (opioid receptors in GIT can reduce gut motility)

Question 6

What are the overdose side effects of opioids?

Answer 6

Respiratory depression (direct and indirect inhibition of respiratory control centre)

Question 7

What is the primary mechanism of action of co-amoxiclav?

Answer 7

• Amoxicillin binds to bacterial penicillin binding proteins
  
  • Prevents transpeptidation (cross linking process for bacterial wall synthesis)
• Clavulanate is an inhibitor of beta lactamase which is a bacterial enzyme that can degrade beta lactam antibiotics

Question 8

What is the drug target of co-amoxiclav?

Answer 8

• Amoxicillin- penicillin-binding proteins
• Clavulanate- beta lactamase

Question 9

What are the main side effects of co-amoxiclav?

Answer 9

• Amoxicillin is well tolerated
• Common side effects are nausea and diarrhoea

Question 10

What is amoxicillin good against?

Answer 10

Amoxicillin works against a lot of gram +ve and gram -ve bacteria

Question 11

What can be a problem with penicillin?

Answer 11

Hypersensitivity to penicillin is common- usually associated with rash but can cause anaphylactic reactions

Question 12

What is the primary mechanism of action of lactulose?

Answer 12

• It’s a non-absorbable disaccharide so reaches large bowel unchanged
• Causes water retention via osmosis and makes it easier to pass stool
• Can also be metabolised by colonic bacteria which has additional laxative effect

Question 13

What is the drug target of lactulose?

Answer 13

None

Question 14

What are the main side effects of lactulose?

Answer 14

• Abdominal pain
• Nausea
• Diarrhoea
• Flatulence

Question 15

How long does lactulose take?

Answer 15

• Begins working within 8-12 hours but may take up to 2 days to improve constipation
• Constipation is very common side effect of opioids- lactulose is thus often prescribed prior to starting opioids