Pharm Pain

Question 1

Noxious stimulus (chemical, thermal, mechanical) of nociceptors releases neural chemicals that stimulate other nociceptors. Transmita signal to spinal cord. What are types of neural chemicals?

Answer 1

Bradykinn, histamine, prostaglandins, leukotrienes, serotonin, substance p, potassium

Question 2

Transmission

Answer 2

Action potential moves from site of stimulus to the dorsal horn of the spinal cord, then to CNS

Question 3

A delta

Answer 3

Large diameter/sparsely myelinated

Sharp localized pai

Question 4

C fibers

Answer 4

Small diameter: unmyelinated:

Dull aching pain

Question 5

From dorsal horn, _______ are released

Answer 5

Neurotransmitters
Glutamate, substance p, calcitonin related peptide
Stimulators and excitatory transmitters send pain to signal CNS

Question 6

Perception, pain impulse is relayed through _______ to ______

Answer 6

Thalamus, higher cortical structures

Question 7

Modulation

Answer 7

Inhibition of impulse via brainstorm by release of endogenous opioids, serotonin, NE, GABA

Help temp escape pain

Question 8

An estimated _____ of patients presenting to doc offices with no cancer painsymptoms receive an opioid

Answer 8

20% or 1 in 5

Question 9

Addiction

Answer 9

When using for beyond what it is meant for to the point it is negatively impacting daily lives

Question 10

Abuse

Answer 10

Using med beyond it’s intended therapeutic use for eurphoric effects

Question 11

Tolerance

Answer 11

Using same dose and not getting same effect. Require increased dose to accomplish same effect

Question 12

Dependence

Answer 12

Need medication to go about regular activities of daily living

Question 13

More than how many days increase risk for addiction of opiates?

Answer 13

5

Many states limit first time prescriptions to 3, 5, 7 days

Question 14

What meds can be just as effective for post op pain

Answer 14

NSAIDs

Question 15

Percentage of pts s/p elective surgery continue to use opiates for at least 90 days

Answer 15

6% suggest not all opiates are cont for surgical pain

Question 16

44% of opiate deaths age group

Answer 16

Greatly increased 45-64 and addiction treatment >50 increased dramatically

Question 17

Opiate use ffor
General surgery
Women’s health
Musculoskeletal

Answer 17

4-9 days
4-13 days
6-15 days
No more than 2 weeks for all

Question 18

What is esmolol broken down by

Answer 18

Red cell esterases, responsible for short half-life and duration

Question 19

Pinpoint pupils

Answer 19

Miosina, kappa receptor

Question 20

All opioids despite diverse structures share a ________ moiety which seems to provide analgesics activity

Answer 20

N-methylpiperdine

Question 21

Opioids must have what to form a strong bond at the opioid receptor?

Answer 21

Ionized

Question 22

What is an opioid prodrug?

Answer 22

Codeine, metabolized to work CYP2D6 to morphine. Only about 10% of codeine is converted

Question 23

Tylenol vs t3 codeine tylenol

Answer 23

Has same outcome in clinical trial

Question 24

Why is morphine not a patch?

Answer 24

Not lipophilic enough to absorb through skin

Question 25

When is morphine most effective?

Answer 25

When given before acute surgical stimulus. | Visceral, skeletal, and integumentary pain

Question 26

Inside CNS M6g is how many more times potent than morphine?

Answer 26

100x. Enters CNS by mass action in chronic use or renal fail

Question 27

Why does morphine increase ICP

Answer 27

Decrease in spontaneous ventilation, buildup of CO2. Most significant increase in ICP compared to other opioids

Question 28

What centers cause Resp effects related to CO2 and periodic breathings

Answer 28

brainstem, pontine, and medullary

Question 29

What does morphine stimulate to cause N/V.

Answer 29

CTZ-Chemoreceptor Trigger Zone in medulla oblongata

Question 30

What therapy should you not use to prevent opioid induced constipation?

Answer 30

Docusate monotherapy

Question 31

What receptor causes respiratory depression?

Answer 31

Mu2

Question 32

Med for Beta blocker overdose and how does it work?

Answer 32

Glucagon, boosts cyclic amp to bring HR up.

Question 33

What binds to mu gut receptors and does not interrupt mu pain binding to prevent conspitation

Answer 33

mu antagonist

Question 34

What muscle tone is increased to gives sense of having to urinate?

Answer 34

Detrusor

Question 35

What makes difficult to urinate with opioids?

Answer 35

increase vesicle sphincter tone

Question 36

Morphine can cause what to make it difficult to mask or intubate patient?

Answer 36

thoracic and abdominal muscle rigidity

Question 37

Which opioids react most with MAO and symptoms caused?

Answer 37

Morphine and demerol. CNS depression and hyperpyrexia

Question 38

Dilaudid active metabolites and histamine?

Answer 38

No active metabolites and less histamine

Question 39

Effect site equilibrium fentanyl

Answer 39

approx. 6minutes

Question 40

Can fentanyl cause bradycardia?

Answer 40

Yes, secondary decrease BP and CO

Question 41

Synergism triad with opioids leading to hypnosis and ventilation depression?

Answer 41

opioids, benzos, and muscle relaxants

Question 42

FDA recommendation for dosing opioids and benzos together?

Answer 42

2 hours apart

Question 43

Name of fentanly lollipops? for cancer and preop

Answer 43

Actiq

Question 44

Sufentanil benefit over fentanyl?

Answer 44

None really, used when fentanyl shortage. Only difference 5-10x more potent and slightly shorter half life

Question 45

Sufentanil CNS effect different

Answer 45

Decreased CMRO2 and CBF

Question 46

Alfentanil effect site equilibrium time

Answer 46

1.4minutes or 1/3 of fentanyl

Question 47

Remifentanil elimination time?

Answer 47

less than 6 minutes due to ester linkage metabolized by nonspecific plasma and tissue ESTERASES to inactive metabolite