Pain

Question 1

Steroidal anti-inflammatory drug prototype

Answer 1

corticosterone

Question 2

Steroidal anti-inflammatory MOA

Answer 2

Inhibit arachidonic acid synthesis

Question 3

NSAIDS MOA

Answer 3

inhibit Cox 1 and 2

Question 4

Cox 1 constituative means

Answer 4

always there

Question 5

Cox 2 inducible means

Answer 5

get inflammation and get increase in Cox 2

Question 6

Undesirable effects of NSAIDS

Answer 6

GI irritation, bleeding ulcers, perforations

Question 7

Cox 2 inhibitor examples

Answer 7

celecoxib, rofecoxib, valdecoxib

Question 8

Major indications for NSAIDS

Answer 8

inflammatory pain (RA, osteoarthrosis), post-traumatic or post-operative pain, HA, dysmenorrhea

Question 9

Acetaminophen MOA

Answer 9

distribues to CNS, weak inhibitor COX

Question 10

Which has less gastic distress NSAIDS or Tylenol?

Answer 10

tylenol

Question 11

Undesirable effects of acetaminophen

Answer 11

liver damage with OD

Question 12

Treatment of acetaminophen OD

Answer 12

N-acetylcysteine

Question 13

Major indications for acetaminophen

Answer 13

HA, fever, osteoarthritis

Question 14

Do you develop tolerance to constipation with morphine

Answer 14

No

Question 15

Is opioid withdrawal life-threatening?

Answer 15

No

Question 16

What are some synthetic opioids?

Answer 16

meperdine, fentanyl, methadone

Question 17

Meperidine properties

Answer 17

1. has toxic metabolite that can build up and cause seizures
2. fewer smooth muscle spasms than morphine
3. no meiosis

Question 18

Fentanyl properties

Answer 18

1. 80-100 x more potent than morphine
2. fast onset, short duration
3. available as duragesic patch
4. available orally

Question 19

Opioid antagonist examples

Answer 19

naloxone, naltrexone, nalmefene

Question 20

Signs of opioid OD

Answer 20

1. stuporous or coma
2. decreased RR
3. meiosis (pinpoint pupils)
4. low body temp
5. flacid skeletal muscles

Question 21

Migraine abortive treatments

Answer 21

1. ergot alkaloids- ergotamine

2. Triptans (sumatriptan, naritryptan, zolpitriptan)

Question 22

What are triptans MOA

Answer 22

selective 5-HT1D agonist causing

1. constricts intracranial vessels
2. decreases inflammation
3. decreases plasma extravasation

Question 23

Which drug is used for prophylactic treatment of migraines?

Answer 23

Amitriptyline

Question 24

Local anesthetics MOA

Answer 24

block Na channels

Question 25

Two classes of locals are

Answer 25

1. amides (lidocaine) | 2. esters (procaine)

Question 26

Local anesthetics are acids or bases?

Answer 26

weak bases

Question 27

What effect does pH have on locals?

Answer 27

have less effect in acidic environments such as infected areas

Question 28

Differential sensitivity of nerves to locals occur in these steps

Answer 28

1. sensory- pain, heat/cold, touch, pressure 2. autonomic 3. Motor

Question 29

Recovery from local anesthetics occurs in these steps

Answer 29

1. motor 2. autonomic 3. sensory

Question 30

Local anesthetics toxicity

Answer 30

1. CNS reactions- low systemic levels cause insomnia and apprehension and high levels cause CNS depression, convulsions, resp depression 2. CV- arrhythmias, decreased contraction, low BP, cardiovasular collapse

Question 31

Local anesthtic uses

Answer 31

1. surface anesthesia 2. infiltration anesthesia 3. nerve block 4. spinal anesthesia 5. epidural anesthesia

Question 32

What are the ester locals?

Answer 32

procaine and tetracaine

Question 33

Most commonly used local

Answer 33

lidocaine

Question 34

What local causes methemoglobinemia (turns ppl blue)?

Answer 34

prilocaine

Question 35

What local has high CV toxicity?

Answer 35

bupivicaine- longest duration of action | **DO NOT use in CV compromised patients**

Question 36

Local used for dentistry

Answer 36

articaine

Question 37

Which local has lowest CV toxicity?

Answer 37

procaine

Question 38

What drugs treat Gout?

Answer 38

1. colchicine 2. allopurinol 3. febuxostat

Question 39

Allopurinol MOA

Answer 39

inhibits xanthine oxidase

Question 40

Febuxostat MOA

Answer 40

xanthine oxidase inhibitor

Question 41

Why is Febuxostat superior to allopurinol?

Answer 41

does not require lower doses to those with renal problems

Question 42

Neuropathic pain descriptors

Answer 42

burning, shooting, stabbing, shock-like, tingling, numb

Question 43

Indications for use of antidepressants as analgesics

Answer 43

1. migraine and tension HA 2. postherpetic neuralgia 3. diabetic neuropathy 4. fibromyalgia 5. post-stroke pain

Question 44

Specific anti-depressants used as analgesics

Answer 44

1. amitriptyline 2. desipramine 3. nortipyline 4. imipramine 5. tramadol 6. doxepin

Question 45

Indications for anti-convulsant as analgesics

Answer 45

1. trigeminal neuralgia 2. diabetic neuropathy 3. post-herpetic neuralgia

Question 46

Anti-convulsants used as analgesics

Answer 46

1. gabapentin | 2. pregabalin