pain mgmt drugs

Question 1

MOA of aspirin

Answer 1

inhibit PGE2 (analgesic, anti-inflammatory, antipyretic)
inhibition of TXA2 > PGI2 (blood thinner; inhibit promotion of platelet aggregation)

Question 2

SE of aspirin

Answer 2

• Reye’s disease (liver problems, encephalitis): personality changes, vomiting, loss of consciousness, delirium, convulsions
• increased risk of peptic ulcer
• bleeding
• analgesic ceiling

Question 3

which demographic is contraindicated with aspirin

Answer 3

children

Question 4

when is diclofenac used

Answer 4

joint problem (applied topically) since has a longer 1/2 life in synovial fluids

Question 5

when is naproxen used

Answer 5

dysmenorrhoea

Question 6

what is indometacin

Answer 6

reversible non-selective NSAID

Question 7

SE of indometacin

Answer 7

CNS effects: confusion, depression, psychosis, hallucination

Question 8

SE of NSAIDs

Answer 8

1. GI disturbances: nausea, vomiting, increased risk of ulcer formation (> 5 days)
2. renal effects
3. pseudo-allergic rxn: skin rashes, swelling, itching, nasal congestion, anaphylactic shock
4. asthma
5. bleeding

Question 9

which demographic is contraindicated w NSAIDs?

Answer 9

• pts w gastric ulcers
• pts w renal insufficiency
• children (aspirin)
• pregnant women (coxibs)
• pts w cardiovascular disease (coxibs)
• elderly (coxibs)
• pts w nonunion of fractures/ bone repair (coxibs)

Question 10

MOA of coxib

Answer 10

COX-2, inhibiting PGI2 & PGE2, resulting in the increase # of TXA2, hence promoting platelet aggregation, vasoconstriction

Question 11

SE of coxib

Answer 11

• increased risk of thrombosis
• renal effects (causing HTN, MI, stroke)
• delayed ovulation, pregnancy complications
• impairs wound healing

Question 12

which demographics are contraindicated w coxib?

Answer 12

• pts w renal insufficiency
• pts w cardiovascular diseases
• pts w gastric ulcers, nonunion of fractures/ bone repair
• pregnant women

Question 13

SE of paracet

Answer 13

• liver damage (toxic doses)
• allergic skin rxns

Question 14

which demographics are contraindicated w opioids?

Answer 14

• pts w drug abuse hx
• elderly
• pts on CNS depressants
• renal or hepatic insufficiency
• pregnancy

Question 15

MOA of paracet

Answer 15

blocks the interpretation of signal in brain

Question 16

MOA of opioids

Answer 16

act on spinothalamic pathway

Question 17

what conditions are paracet not used for?

Answer 17

• not sufficient for bone fracture (since it is not anti-inflammatory), OA pain