Pain and Inflammation Drugs

Question 1

OPQRRRST

Answer 1

Onset
Provocation
Quality
Region
Radiation
Relief
Severity
Time (of pain)

Question 2

Pain Rating /10 and Reasonable Treatment

Answer 2

<4/10:
non-opioids, NSAIDS, tylonel

4-6/10:
Opioids, PO (codeine/morphine)

<6/10:
Higher potency opioids, IV

Question 3

What kind of meds stop pain at the peripheral level? CNS level?

Answer 3

Peripheral:

• non-opioids
• NSAIDS

CNS:

• non-opioid centrally acting (acetaminophen)
• Opioids

Question 4

Acetaminophen

Answer 4

Centrally acting analgesic
Not a NSAID
Not antinflammatory
Anti-pyretic, q4h PO
Toxic Metabolite (N-acetyl benzo) then glutathione (phase 2)
Cmax: 30-60m
low PPB (20%)

Question 5

What is an Agonist?

Answer 5

Initiates a physiologic response when combined with a receptor

Question 6

Mu1 Receptor

Answer 6

Effect: Analgesic (supraspinal,spinal), low abuse potential. Bradycardia, Hypothermia, Urinary Retention
Agonists: Endorphins, morphine, synthetic opioids

Question 7

Mu2 Receptor

Answer 7

Analgesic (spinal)
Depression of ventilation
Physical dependence
CONSTIPATION
Agonists: Endorphins, morphine, synthetic opioids

Question 8

Kappa Receptor

Answer 8

Analgesic (supraspinal,spinal)
Dysphoria,sedation
Low abuse potentional

Diuresis
Agonists: Dynorphins

Question 9

Delta

Answer 9

Analgesic: Supraspinal,spinal
Depression of ventilation
physical dependence

CONSTIPATION
Urinary retention
Agonists: enkephalins

Question 10

High Efficacy Opioids:

Answer 10

Fentanyl
Hydromorphone (dilaudid)
Oxymorphone (numorphan)
Meperidine (Demerol)
Morphine
Methadone (metadol)
Tramadol (Ultram)

Question 11

Moderate Efficacy Opioids:

Answer 11

Hydrocodone
Oxycodone (OxyNeo and oxycotin)
Percocet
Percodan
Vicodin
Tramacet
Buprenorphine

Question 12

Low Efficacy Opioids

Answer 12

Codeine

Tylonel #1-4

Question 13

Combination Drugs

Answer 13

Percocet (oxycodone and acetaminophen)
Percodan (oxycodone and ASA)
Vicodin (hydrocodone and acetaminophen)
Tramacet (tramadol and acetaminophen)
Tylonel #1-4 (acetaminophen and caffiene and codeine)

Question 14

Med for GI Pain

Answer 14

Dicyclomine (Bentyl)

Muscarinic Antagonist, GI smooth muscle relaxant

Question 15

Myocardial Pain Med

Answer 15

Morphine

Opioid, decreased vasoconstriction (decreased BP and CO)

Question 16

Adverse Effects of Opioids:

Answer 16

CNS depression (sedation)
N and V
Itching
Constipation
Urinary Retention
Euphoria

ANTAGONIST is Naloxone

Question 17

NSAIDs

Answer 17

Useful if pain is associated with inflammation caused by cellular injury not allergy
-Prostaglandin target

Question 18

Prostaglandins

Answer 18

Lipids, COX1 and 2

Question 19

COX1

Answer 19

-Present in all tissues
-Protects gastric mucosa, supports kidney fx, promotes platelet aggregation
When inhibited: gastric bleeding and kidney failure

Question 20

COX2

Answer 20

Present at site of tissue injury
-Mediates inflammation, sensitizes pain receptors, mediates fever in the brain
When inhibited: suppression of inflammation (this is the ideal treatment)

Question 21

Selective Cox2 inhibitor?

Answer 21

Celecoxib (Celebrex)

-black box warning, can cause death.

Question 22

Non Selective Cox inhibition?

Answer 22

NSAIDS
-ASA, Ibuprofen (and others like it)
\: Diclofenac (Voltaren0
Naproxen (Aleve, Naprosyn)
Ketorolac (Toradol)
Indomethacin (20x ASA POTENCY)

Question 23

Chose ASA When…

Answer 23

Low dose antithrombotic

Low-moderate joint pain

Question 24

Chose Ibuprofen When…

Answer 24

headache/1st migraine

soft tissue swelling (treatment of sprains)

Question 25

Chose Indomethacin When..

Answer 25

Moderate-severe joint pain

arthritis and gout

Question 26

ASA in Kids Causes..

Answer 26

Reye’s Syndrome: swelling of the brain and liver.

Question 27

Glucocorticoids

Answer 27

Endogenous hormone:
-adrenal cortex secretion
-Lipophilic
-nuclear receptor binding
-for survival during fasting (stimulates gluconeogenesis, protein degradation and lipolysis)
High efficacy as an antiinflammatory. Histamine release suppression, COX2 inhibition and suppression of phagocytes and lymphocytes

Question 28

Glucocorticoid Meds (end in ONE)

Are easily excreted when metabolized. High PPB

Answer 28

Short acting: 
Hydrocortisone
cortisone
Prednisone (prodrug)
Prednisolone
Methylprenisolone

Long Acting:
Dexamethasone

Question 29

Glucocorticoids are used for..

Answer 29

Inflammation (IBD, Lupus):
dexamethasone

Joint Pain: cortisone injection

Anaphylaxis: stabilization of pt post anaphylactic shock. Prednisolone IV followed by PO Prednisone for 3 days

Allergic Rhinitis (intranasally)
Inhalation (asthma)