Pain Medications

Question 1

What do NSAIDs work on?

Answer 1

1) NSAIDs inhibit cycloxygenase enzyme

2) Results in the inhibition of prostaglandin synthesis

Question 2

Define analgesic

Answer 2

Pain relief medication

Question 3

Define Antipyretic

Answer 3

Anti-fever

Question 4

Drug that is selective for COX-2 enzyme; no effect on bleeding time/platelets

Answer 4

Celecoxib (celebrex)

Question 5

Drug that irreversibly inhibits COX enzyme

Answer 5

Aspirin

Question 6

Where is Thromboxane A2 produced and what is its functions?

Answer 6

1) Platelets
2) Vasoconstrictor
3) Activator of platelet aggregation

Question 7

How long does it take for platelet aggregation to recover in a patient who has taken aspirin?

Answer 7

1) Aspirin irreversibly inhibits COX enzyme resulting in decreased production of Thromboxane A2
2) 8-11 days

Question 8

What prostaglandin is involved with sensitization of pain nerve endings, causes vasodilation, inhibits gastric acid secretion, and Promotes mucosal blood flow

Answer 8

Prostaglandin E2

Question 9

When should NSAIDs and COX-2 inhibitors be used with caution?

Answer 9

Pt. has:

1) Reduced renal function
2) Heart failure
3) Liver dysfunction
4) Pt. on ACEi or diruetics

Question 10

Why should NSAIDs and COX-2 inhibitors be used with caution in states of high levels of vasoconstrictors?

Answer 10

1) NSAIDs and COX-2 inhibit prostaglandin synthesis

2) Prostaglandins cause vasodilation of the afferent arteriole

Question 11

What is contraindicated to children with chicken pox or influenza?

Answer 11

1) Salicylates

2) Can cause Reye’s syndrome

Question 12

What prostaglandin keeps a patent ductus areteriosus open? What drug is used to close it? What is this drug also used for?

Answer 12

1) PGE2
2) Indomethacin
3) Suppression of uterine contraction

Question 13

What are the two main contraindications for NSAIDs/aspirin?

Answer 13

1) Aspirin allergy

2) Third trimester of pregnancy

Question 14

What are the uses for indomethacin?

Answer 14

1) Closure of a patent ductus arteriosus
2) Decrease uterine contractions
3) Can only be used episodically because stronger than aspirin

Question 15

Most efficacious NSAID analgesic, weak anti-inflammatory effect; used for post op pain

Answer 15

Ketorolac

Question 16

Non-narcotic analgesic and antipyretic with weak anti-inflammatory acitivty

Answer 16

Acetaminophen (tylenol)

Question 17

What is used to treat an overdose of acetaminophen?

Answer 17

1) N-acetylcysteine

Question 18

Drugs that bind to opioid receptors

Answer 18

Opioids

Question 19

Natural products and derivatives obtained from the opium poppy

Answer 19

Opiates

Question 20

What are the types of opioid receptors

Answer 20

1) Mu
2) Kappa
3) Delta

Question 21

What opioid receptor binds to endorphins?

Answer 21

1) Mu

2) Stronger than enkephalin

Question 22

What opioid receptor binds to enkephalins?

Answer 22

1) Mu

2) Delta

Question 23

What opioid receptor binds to dynorphins?

Answer 23

1) Kappa

Question 24

What are endorphins derived from?

Answer 24

POMC

Question 25

What are enkephalins derived from?

Answer 25

1) POMC (met-enkephalin) | 2) Preproenkephalin (6-met and 1-leu)

Question 26

What are dynorphins derived from?

Answer 26

Prodynorphins

Question 27

What are the classic effects of opioids? (6 total)

Answer 27

1) Analgesia 2) Euphoria 3) Miosis 4) Respiratory distress 5) Physiological dependence 6) Reduced GI motility

Question 28

Why is Meperidine only used for short periods of time?

Answer 28

1) Because its metabolite causes seizures

Question 29

What are the high efficacy mu opioids?

Answer 29

1) Morphine 2) Meperidine 3) Methadone 4) Fentanyl 5) Heroin

Question 30

Opioid that has a long half life, blocks NMDA receptors and monoamine reuptake pumps, used in rehab for opioid abuse

Answer 30

Methadone

Question 31

Most lipid soluble mu opioid; highest potency; effective with a transdermal patch

Answer 31

Fentanyl

Question 32

What are the high efficacy kappa opioids?

Answer 32

1) Butorphanol | 2) Nalbuphine

Question 33

What are two of the main effects on the kappa opioid receptor?

Answer 33

1) Dysphoria | 2) Psychotomimetic response

Question 34

What drug is a kappa agonist and a Mu antagonist? Used post op for pt. with respiratory depression.

Answer 34

1) Nalbuphine

Question 35

What are opioids with intermediate efficacy?

Answer 35

1) Hydrocodone 2) Oxycodone 3) Pentazocine

Question 36

What is more efficacious with oral intake? Morphine or Oxycodone?

Answer 36

1) Oxycodone | 2) Morphine has a low oral:parenteral potency

Question 37

Characterized by signs and symptoms when drug use is stopped; not an addiction

Answer 37

Dependence

Question 38

Using a drug for its euphoric effect, observed as escalation in drug dose unrelated to pain level

Answer 38

Abuse

Question 39

Moderate Kappa agonist; partial Mu agonist/pure Mu antagonist

Answer 39

Pentazocine

Question 40

Opioids with low efficacy

Answer 40

1) Buprenorphine | 2) Codeine

Question 41

Low efficacy opioid; long duration of action, slow to dissociate from Mu receptors; not readily reversed

Answer 41

Buprenorphine

Question 42

Enzyme that is involved with converting codeine to morphine

Answer 42

1) CYP2D6 | 2) Responsible for demethylation

Question 43

What is the MOA for Tramadol?

Answer 43

1) Weak Mu agonist 2) CNS serotonin releaser 3) Norepinephrine re-uptake inhibitor

Question 44

What given with serotonin selective reuptake inhibitors can cause a serotonin syndrome?

Answer 44

1) Tramodol

Question 45

How do weak partial agonists act when given with a full agonist?

Answer 45

Weak partial agonist become antagonists

Question 46

What are three opioid antagonists?

Answer 46

1) Naloxone (injection only) 2) Naltrexone (oral only) 3) Nalmefene

Question 47

What is the triad of primary findings observed in opioid overdose?

Answer 47

1) Lethargy/coma 2) Miosis 3) Depressed respiration

Question 48

What is the drug of choice for opioid overdose?

Answer 48

Naloxone

Question 49

What opioids are used for treatment of Diarrhea?

Answer 49

1) Ioperamide 2) Diphenoxylate 3) Difenoxin

Question 50

What drug is used to treat the reactive (affective) portion of pain?

Answer 50

Amitriptyline

Question 51

What are the adverse effects of salicylism?

Answer 51

1) Nausea 2) Vomiting 3) Tinnitus 4) Hyperventilation