Pain and Inflammation Management Agents

Question 1

Phases of Inflammation

Answer 1

Vascular phase
Delayed phase

Question 2

a reaction to tissue injury caused by the release of chemical mediators that trigger both a vascular response and the migration of fluid and cells to the injured site

Answer 2

Inflammation

Question 3

occurs 10-15 minutes after an injury

Answer 3

Vascular phase

Question 4

vasodilation and increased capillary permeability 🡪 fluid shift to the injured site

Answer 4

Vascular phase

Question 5

leukocytes infiltrate the inflamed tissue

Answer 5

Delayed phase

Question 6

Chemical Mediators

Answer 6

Histamine
Kinin
Prostaglandin

Question 7

first mediator

Answer 7

Histamine

Question 8

causes dilation of the arterioles and increases capillary permeability 🡪 fluids shift to the injured area

Answer 8

Histamine

Question 9

-increase capillary permeability and the sensation to pain

Answer 9

Kinins

Question 10

increase in vasodilation, capillary permeability, pain, and fever

Answer 10

Prostaglandins

Question 11

Antiinflammatory Agents aka

Answer 11

Prostaglandin Inhibitors

Question 12

Relieve pain, reduce elevated body temperature, and inhibit platelet aggregation

Answer 12

Antiinflammatory Agents

Question 13

Oldest anti-inflammatory drug

Answer 13

ASPIRIN

Question 14

First used as analgesic and antipyretic

Answer 14

ASPIRIN

Question 15

Aspirin and aspirin-like drugs that inhibit the COX enzyme

Answer 15

NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Question 16

Not suggested for use in alleviating mild headaches and mildly elevated temperature

Answer 16

NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Question 17

More appropriate for reducing swelling, pain, and stiffness in joints

Answer 17

NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Question 18

only OTC NSAIDs

Answer 18

Ibuprofen and naproxen

Question 19

1st generation

Answer 19

• Salicylates
• Para-chlorobenzoic acid derivatives/ indoles
• Phenylacetic acids
• Propionic acid derivatives
• Fenamates
• Oxicams

Question 20

Aspirin aka

Answer 20

acetylsalicylic acid (ASA)

Question 21

Also considered as an antiplatelet drug for patients with cardiac or cerebrovascular disorders

Answer 21

Aspirin

Question 22

a rare disorder that typically occurs after a viral illness that results in brain and liver damage.

Answer 22

Reye’s Syndrome

Question 23

The proposed mechanism for aspirin contributing to the development of Reye’s syndrome is related to __________________________ that can be caused by salicylates, which may be intensified during viral illness by endotoxins and cytokines

Answer 23

mitochondrial damage

Question 24

• used for rheumatoid arthritis, gouty arthritis an osteoarthritis
• potent prostaglandin inhibitor
• 90% protein-bound
• very irritating to the stomach, should be taken with food

Answer 24

Indomethacin

Question 25

Similar to the analgesic and anti-inflammatory effects of aspirin, but minimal to no antipyretic effects

Answer 25

Diclofenac

Question 26

first injectable NSAID

Answer 26

Ketorolac

Question 27

used acute and chronic arthritis

Answer 27

Meclofenamate sodium and Mefenamic acid

Question 28

- for long-term arthritis condition (RA and OA) - lower incidence of ulceration and gastric distress

Answer 28

Piroxicam

Question 29

- Prototype drug - DOC for patients with severe arthritic conditions who need high doses of anti-inflammatory drug

Answer 29

Celecoxib

Question 30

CORTICOSTEROIDS

Answer 30

Prednisone, prednisolone, dexamethasone

Question 31

Controls inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site

Answer 31

CORTICOSTEROIDS

Question 32

- DOC when NSAIDs do not control immune-mediated arthritic disease sufficiently, however more toxic * - Immunosuppressive agents, immunomodulators, antimalarials

Answer 32

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)

Question 33

Immunosuppressive Agents

Answer 33

Azathioprine, Cyclophosphamide, Methotrexate

Question 34

- used to treat refractory rheumatoid arthritis - primarily used to suppress cancer growth and proliferation - might be used to suppress the inflammatory process of rheumatoid arthritis when other treatments fail

Answer 34

Immunosuppressive Agents Azathioprine, Cyclophosphamide, Methotrexate

Question 35

are proinflammatory cytokines that contribute to synovial inflammation and joint destruction

Answer 35

IL-1 and TNF (Interleukin receptor (IL-1) agonists and Tumor necrosis factor(TNF))

Question 36

- Treat moderate to severe rheumatoid arthritis by disrupting the inflammatory process and delaying disease progression - Interleukin receptor (IL-1) agonists and Tumor necrosis factor(TNF) blockers

Answer 36

Immunomodulators

Question 37

IL-1 receptor antagonist

Answer 37

Anakinra

Question 37

Blocks TNF from attaching to TNF receptors on synovial cell surfaces

Answer 37

Infliximab

Question 38

inflammatory condition that attacks joints, tendons, and other tissues

Answer 38

Gout

Question 39

Gout aka

Answer 39

gouty arthritis

Question 40

common site of Gout

Answer 40

Joint of the big toe

Question 41

Uric acid metabolism disorder and a defect in purine metabolism resulting in increase in urates and accumulation of uric acid or an ineffective clearance of uric acid by the kidneys

Answer 41

Gout

Question 42

May appear as bumps, or tophi, in the subcutaneous tissue of earlobes, elbows, hands, and base of large toe

Answer 42

Gout

Question 43

first drug used to treat gout, 1936

Answer 43

Colchicine

Question 44

- Inhibits the migration of leukocytes to the inflamed site - Effective in alleviating acute symptoms of gout - Does not inhibit uric acid synthesis and does not promote uric acid excretion - Taken with food

Answer 44

Colchicine

Question 45

Xanthine oxidase inhibitor

Answer 45

Allopurinol, Febuxostat

Question 46

the level of stimulus needed to create a painful sensation

Answer 46

Pain threshold

Question 47

Amount of pain a person can endure without having it interfere with normal functioning

Answer 47

Pain tolerance

Question 48

Less potent that opioid analgesics

Answer 48

NONOPIOID ANALGESICS

Question 49

Effective for dull, throbbing pain of headaches, dysmenorrhea, inflammation, minor abrasions, muscular aches, and pain, and mild to moderate arthritis

Answer 49

NONOPIOID ANALGESICS

Question 50

- Nonprescription drug for the relief of pain, discomfort, and fever in infants, children, adults, and older adults - Analgesic and antipyretic - Does not have anti-inflammatory properties - Little to no gastric distress and does not interfere with platelet aggregation - Administered every 4hours as needed; max 4g/day

Answer 50

Acetaminophen (Paracetamol)

Question 51

- Prototype - An extraction from opium - Effective against acute pain resulting from acute MI, cancer, and dyspnea from pulmonary edema - May be used as a preoperative medication

Answer 51

Morphine

Question 52

- One of the first synthetic opioids - Schedule II drug - Shorter duration of action than morphine - Primarily effective in GI procedures - No antitussive property; less constipation and urinary retention - Preferred to morphine in pregnancy

Answer 52

Meperidine (Demerol)

Question 53

- Semisynthetic opioid - 6x more potent than morphine; fewer hypnotic effects and less GI distress - Faster onset and shorter duration of action than morphine

Answer 53

Hydromorphone (Dilaudid)

Question 54

Self-administered pain relief as needed

Answer 54

Patient-Controlled Analgesia

Question 55

Provides a continuous around-the-clock pain control that is helpful to patients who suffer from chronic pain

Answer 55

Transdermal Opioid Analgesics

Question 56

Postoperative pain will decrease overtime 🡪

Answer 56

downtitration

Question 57

Cancer-related pain has continual increase in pain 🡪

Answer 57

uptitration

Question 58

Developed for other purposes and later found to be effective for pain relief in neuropathy

Answer 58

ADJUVANT THERAPY

Question 59

nonopioids with or without an adjuvant medication

Answer 59

Mild Pain

Question 60

nonopioids and mild opioids with or without adjuvant medication

Answer 60

Moderate Pain

Question 61

stronger opioid at higher drug dosage levels with our without an adjuvant medication

Answer 61

Severe Pain

Question 62

* Act on the peripheral nerves and CNS by inhibiting neuronal firing * Used for neuropathic pain and prevention of migraine headaches

Answer 62

Anticonvulsants (gabapentin)

Question 63

* Prevent reuptake of serotonin and norepinephrine in the cells * Effective in treating peripheral neuropathy

Answer 63

Tricyclic antidepressants (amitriptyline)

Question 64

Reduce nociceptive stimuli

Answer 64

Corticosteroids

Question 65

Blocks sodium channels to reduce pain

Answer 65

Antidysrhythmics (mexiletine)

Question 66

Interrupts the transmission of pain signals to the brain

Answer 66

Local anesthetics (lidocaine)

Question 67

first triptan drug; short duration of action

Answer 67

Sumatriptan