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Pharmacology II > Quiz 5 > Flashcards

Quiz 5 Flashcards

(63 cards)

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1
Q

Tx mild pain

A

Non-opiod analgesic

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2
Q

Tx mild to moderate pain

A

Weak opiod + non-opiod analgesic

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3
Q

Tx moderate to severe pain

A

Strong opiod w/ or w/o non-opiod analgesic

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4
Q

NRS

A

Numeric Rating Scale for pain

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5
Q

What type of injury is nociceptive pain?

A

Tissue injury

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6
Q

What type of injury is neuropathic pain?

A

Nerve injury

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7
Q

Which type of pain doesn’t respond as well to opiod therapy?

A

Neuropathic pain

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8
Q

MOA opiates

A
  1. CNS depression w/ mu & kappa receptors

2. Inhibition of painful stimuli in the substantia gelatinosa of spinal cord, brainstem, RAS, thalamus & limbic system

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9
Q

Mu receptors

A
  1. Located in brain (usually preacqueductal area)
  2. Somatic pain & some visceral
  3. Assoc. w/ respiratory depression, euphoria, dependence, dec. GI motility & miosis
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10
Q

Kappa receptors

A
  1. Located in spinal cord
  2. Visceral pain
  3. Assoc. w/ sedation, miosis & dysphoria
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11
Q

Delta receptors

A
  1. Located in spinal cord
  2. Antagonistic activity
  3. Assoc. w/ tachycardia, tachypnea, dysphoria, hallucinations, mydriasis, hypertonia

Doesn’t really affect pain but does cause side effects

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12
Q

Opiates kinetics

A
  1. Big 1st pass effect
  2. CYP450/2D6
  3. Urine excretion

Watch w/ renal failure & liver disease

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13
Q

Protease inhibitors effect on opiates

A

inc. affect

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14
Q

Which opiates are metabolized by CYP3A4?

A
  1. Fentanyl

2. Methadone

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15
Q

Which drugs have a big depressant affect w/ opiates?

A
  1. Alcohol
  2. Sedatives
  3. Muscle relaxants
  4. Phenothiazines
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16
Q

Contraindications w/ opiates

A
  1. Allergy
  2. Acute bronchial asthma/upper airway obstruction
  3. MAOI w/in 2 wks

Careful with:

  1. Hx of intolerance, serious side effects, lack of efficacy
  2. Pt w/ sleep apnea not on CPAP
  3. COPD Pts
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17
Q

Is there a class effect w/ allergies & opiates?

A

No mammary glands

Move to different chemical grouping

True allergies rare

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18
Q

Dosing opiates

A
  1. Start w/ lowest possible dose
  2. Tx Pts for 48hrs w/ immediate release then convert 2/3 daily dosing to XR regimen

No ceiling dose

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19
Q

Which opiates should you avoid in the elderly?

A
  1. Codeine - Inc. CV risk
  2. Meperidine - high risk of delirium, seizures, excessive sedation

Use acetaminophen

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20
Q

Does vicodin (hydrocodone) have a ceiling dose?

A

Yes - it has hydrocodone & acetaminophen so it is limited by that

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21
Q

Which drug is 100x more potent than Morphine?

A

Fentanyl
Less sedation & constipation

No histamine, quick onset, short duration of action, safest w/ renal faiure?

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22
Q

Which opiate is safest w/ renal failure?

A

Fentanyl

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23
Q

Which opiate causes risk of QTc prolongation?

A

Methadone

  1. Inhibition of reuptake monoamines (serotonin, NE)
  2. Inhibition of NMDA receptors

Longest & most variable 1/2 life
Higher freq. at 1st till builds up then taper to avoid toxicity

Used for opiate detox.

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24
Q

Serotonin & NE affect on pain

A

Both nociceptive

S - Inhibits & promotes pain perceptino

NE - Inhibits pain

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25
Pregabalin MOA
Dec. Ca2+ entry, dec. excitatory transmission - dec. pain Big effect on presynaptic N-type channel Antiseizure drug
26
Cymbalta MOA
Anti-depressant Serotonin _ NE reuptake
27
Tx osteoarthritis
1. Wt loss 2. Exercise 3. Pt edu Steps: 1. Acetaminophen PRN 2. NSAID if inflammation 3. Intraarticular steroids
28
Aspirin vs. tylenol
Same except ASA better w/ inflammation
29
Toxic levels of acetaminophen
Liver damage 10-15 g Death 20-25 g Measured by ALT & AST Acetylcysteine antedote
30
What are NSAIDs at risk for?
GI toxicity Ulcer/perforation Check albumin in old people
31
What is the only IV NSAID?
Ketorolac equal to morphine also avail. orally
32
Who shouldn't you give Celecoxib (Celebrex) to?
NSAID - COX2 inhibitor people w/ sulfa allergies Lower GI toxicity
33
Kinetics & drug interactions w/ tramadol
1. Adjust dose w/ CrCl <30 2. Adjust dose w/ liver failure CYP3A4 may react Additive effect on serotonin levels
34
What is the black box warning for Buprenorphine?
Respiratory depression Mu partial agonist, kappa antagonist Thebaine derivative 25-50x more potent than morphine
35
Tx mild RA
1. NSAID | 2. DMARD - hydroxychloroquine/sulfasalzine
36
Tx moderate to severe RA
1. NSAID/corticosteroid | 2. DMARD - methotrexate
37
How often should you check RA Pts blood?
Every 2-3 wks for ~3 mo then 2-3mo for 6 mo then q3mo
38
Uses for hydroxychloroquine
DMARD 1. RA 2. Lupus 3. Malaria prevention/Tx
39
ADRs hydroxychloroquine
``` Takes months for response Easily built up in melanin tissues 1. Eye issues 2. GI issues 3. CNS issues 4. Hemolysis assoc. w/ G6PD deficiency ```
40
Uses for sulfasalazine
DMARD 1. RA 2. Ulcerative colitis 3. Crohn's Risk of hemolytic anemia w/ G6PD deficiency
41
How might you be able to avoid toxicity w/ methotrexate?
Give folic acid every day of the week except when you give methotrexate
42
Uses for methotrexate
DMARD 1. RA 2. Psoriasis 3. Juvenile idiopathic arthritis 4. Oncology
43
Methotrexate clearance
Prodrug DO NOT give w/ NSAID b/c reduce renal clearance Adjust dose w/ renal impairment Avoid booze
44
Serotonin antagonists for IBD
1. Alosetron | 2. Xelnorm
45
Antispasmodics for IBD
1. Bentyl | 2. Levsin
46
What determines a good bone future?
1. Bone deposition in youth 2. Exercise 3. Diet 4. Estrogen
47
How much Calcium should you get per day?
1000mg/day 1500 post-menopausal women 1200 teens
48
How much Vitamin D should you get per day?
600 IU/day Cholecalciferol
49
When should you start estrogen supplements for osteoporosis?
Soon after onset of menopause | Stop after ~5yrs
50
When should you use selective estrogen receptor modulators?
w/ osteoporosis when you can't use others for post-menopausal women only inc. hot flash rate
51
When do you use calcitonin?
w/ osteoporosis when you can't use other drugs & painful Fx Need Ca2+ & Vit D ADR - rhinitis
52
What are the bisphosphenates?
1. Alendronate 2. Ibandronate 3. Risedronate 4. Zoledronic acid Use if >75 yo, males, risk of DVT
53
ADRs of bisphosphenates
ex. Alendronate Osteonecrosis of jaw GI inc. Fx risk
54
Which drug can cause osteonecrosis of the jaw?
Bisphosphenates Alendronate
55
What labs to check with PTH?
Forteo - osteoporosis 1. Ca2+ 2. Renal function 3. Uric acid levels Replenish Vit D Inc. dizziness D/c after 2 yrs due to osteosarcoma
56
What drug has a risk of osteosarcoma?
Forteo - PTH discontinue after 2 years
57
What is Prolia used for?
Monoclonal Ab 1. Oncology 2. Osteoporosis Risk of 1. Osteonecrosis 2. Infection
58
Causes of gout
90% - underexcretion of uric acid | 10% - overproduction of uric acid
59
Tx gout
1. NSAIDs - Naproxen & indomethicin 2. Corticosteroids 3. Colchicine
60
Which NSAIDs are used for gout?
1. Naproxen | 2. Indomethicin
61
How does colchicine work?
Interferes w/ cell division 1. Mitosis 2. Microtubules Deals w/ inflammatory cells
62
Colchicine drug interactions & adjustment
CYP3A4 - inc. levels - poisonous Renal & hepatic adjustment Risk of diarrhea & fatality
63
Who needs allopurinol?
people over-producing uric acid Adjust renally Don't start by itself Can cause SJS

Pharmacology II (10 decks)

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