robbypowell's version from 2016-10-03 16:55

nonopioid analgesics ... oh, and also opioids

Question Answer
_______ (acute/chronic) pain has a source that is hard to identifyChronic
_____ causes hyperalgesia by sensitizing afferent nociceptive free nerve endings to other chemicals (histamine and bradykinin)Prostaglandin E2 (PGE2)
Acute pain signals travel to CNS via what 2 types of fibers? to what nucleus?A-delta & C-fibers; Nucleus Caudalis of Medulla
NSAID's act by inhibiting ______ synthesisProstaglandin (usually via COX inhibition)
_____ are a family of potent arachidonic acid metabolites, which modulate some components of inflammation, body temperature, paint transmission and platelet aggregationProstaglandins
T/F: Prostaglandins are rapidly degraded, so their half-life is in the range of seconds or minutesTrue
T/F: Prostaglandins are broken down slowly and have relatively long half-livesFalse (rapid degradation; t-1/2 seconds or minutes)
T/F: Acetaminophen (Tylenol) can have the undesirable effect of GI upset or bleedingFalse (this is Aspirin aka Acetylsalicylic acid)
T/F: Aspirin (Acetylsalicylic Acid) can have the undesirable effect of GI upset or bleedingTrue
This drug should be avoided with children because of the risk of causing Reye's SyndromeAspirin (Acetylsalicylic Acid)
_____ is the only parenteral NSAID for pain reliefKetorolac (Toralac)
For maximum effectiveness it is necessary to give ____-___ mg of Aspirin (Acetylsalicylic Acid)650-1000 mg
Which is better used as an anti-inflammatory drug, Aspirin or Acetaminophen?Aspirin (Acetaminophen has much weaker anti-inflammatory effect)
T/F: Salicylates analgesic action is both central and peripheralTrue (analgesic site close to anti-pyretic region in hypothalamus)
What effect does Aspirin (Salicylate) have on platelet aggregation and bleeding timeLess platelet aggregation --> Longer bleeding time
List the 3 GI tract effects of AspirinGastric distress (upset), Occult bleeding (blood in stool), and sudden Acute Hemorrhage ****
What Salicylate can be taken twice daily (shrug, this is the only thing they said about it)Diflunisal (less likely to cause GI bleeding and Tinnitis, may cause acute interstitial nephritis - source Clinical Pharm MRS)
What is the most efficacious agent for anti-pyretic (fever reduction) therapeutic useAspirin (dose 650-1000mg)
What non-opioid pain med should not be taken by patients with gout because it interferes with uric acid excretion?Aspirin (Salicylate)
T/F: Aspirin has an equal or greater effect than codeine for pain relief in dentistryTrue
T/F: If patients take larger than usual doses of aspirin, they will have greater pain reductionFalse (analgesic effect does not increase with greater than normal therapeutic dose of 650-1000mg)
What is given for aspirin overdose, that can facilitate renal excretion of aspirin?Sodium Bicarb
T/F: A patient that is aspirin intolerant can instead use NSAIDsFalse
T/F: A patient that is aspirin intolerant cannot switch to NSAIDs but can use APAP/AcetaminophenTrue
Child patients with the flu (or other viral infection) should not be given aspirin because it will likely induce _____ syndromeReye's syndrome (rapidly progressing encephalopathy)
These 2 drugs should not be taken with Aspirin because of increased risk of bleedingWarfarin & Coumadin
_____ has a drug interaction with ACE-inhibitors, B-adrenergic blockers & diuretics that can negate their anti-hypertensive effectsAspirin
T/F: APAP is an effective analgesic, antipyretic and anti-inflammatoryFalse (not anti-inflammatory)
____ is an Inhibitor of Prostaglandin synthesis Centrally, giving analgesic and anti-pyretic but not anti-inflammatory effectsAPAP/Acetaminophen
T/F: Acetaminophen/APAP has no effect on platelet aggregation, does not induce GI bleeding, and does not exacerbate goutTrue (Aspirin does cause these problems)
T/F: Aspirin has no effect on platelet aggregation, does not induce GI bleeding, and does not exacerbate goutFALSE (it does all these things) (Acetaminophen does not)
______ should not be taken for greater than for days if patient has pre-existing hepatic damage, due hepatotoxicity caused by its metabolite N-acetyl-benzoquinone-imineAPAP/Acetaminophen
Phenacetin & Acetanilid get converted to ______APAP***
What is the therapeutic dose of APAP?650-1000mg (same as aspirin apparently)
T/F: Aspirin and APAP have the same therapeutic dose rangeTrue (650-1000mg)
T/F: APAP crosses the placentaTrue
T/F: APAP does not cross the placentaFalse (it does)
T/F: NSAID's are analgesic, anti-pyretic, and anti-inflammatoryTrue
T/F: NSAID's are analgesic, anti-pyretic, but not anti-inflammatoryFalse (NSAID's are all 3)
Which NSAID should not be taken for more than 5 days to avoid renal toxicity?Ketolorac (the only parenteral NSAID... can be taken orally also)
T/F: NSAID's, APAP and Aspirin are acidic, while opiates are alkalineTrue
T/F: NSAID's, APAP and Aspirin are alkaline, while opiates are acidicFalse (vice-versa)
***What is the antidote for narcotic overdose?***Naloxone (narcan) or Naltrexone (trexan)
***what is a Drug that is both and agonist and antagonist for narcotics***Pentazocine (Talwin) (Nalbuphane also)
***what is the structure of Opioid receptors***7 membrane-spanning alpha helical segments that are linked to G proteins
T/F: All opioids suppress respirationTrue
_____ pupils and constipation are hallmarks of opioid usePinpoint pupils
Nausuea, as a consequence of opioid use, is caused when opioids stimulate what part of the brain?Medullary CTZ (Chemoceptor Trigger Zone)
T/F: There is a ceiling effect on the analgesic effects of opioidsFalse (there is for non-opioids, though)
death from opioid overdose is due to _____ depressionRespiratory depression
this opioid has an OCH3 substitute in place of OH (C3) of morphineCodeine
***What is the anti-tussive dose of Codeine? analgesic dose? ***15-20mg; 30-60 mg
***_____ is now listed as a Schedule 2 substance (as of Oct 2014) while Oxycodone has always been schedule 2***Hydrocodone
10 mg of morphine is equivalent to ____mg of codeine120mg (codeine not as strong as morphine)
Codeine is metabolized in the _____Liver
T/F: Codeine has a slower development of tolerance than does morphineTrue
What Opioid can cause Serotonin Syndrome?Meperidine
_____ syndrome can be caused by Meperidine and its mild symptoms are shivering & diarrhea; its severe symptoms are seizuresSerotonin syndrome
***_____ is different from other opioids in that it has Atropine-like activity, can cause Serotonin Syndrome, creates cardiovascular instability, and CNS excitation***Meperidine
T/F: Methodone is equipotent to morphineTrue
Short acting Opioid antagonist (given via IV administration... cannot give orally)Naloxone (narcam)
Long acting Opioid antagonist (oral admin, follow-up to short-acting)Naltrexone (can also be given to for maintenance of detoxified opioid users)
This mixed acting opioid agonist-antagonist has adverse effects similar to other opioids, but unlike them it can increase HR and BPPentazocine
*** ____mg Oxycodone = ____mg Hydrocodone = ____mg Codeine***5 (oxy); 10 (hydro); 30-60 (codeine)
corticosteroids block ________ and thus production of arachidonic acidPhospholipase A2
______ modifiers are used to treat chronic asthmaLeukotriene

opioid receptors

Question Answer
morphine is a natural ligand for ____ receptorsMu
Morphine receptor for supraspinal analgesiaMu1
Morphine receptor for spinal analgesia, respiratory depression and GI actionsMu2
Enkephalins bind to and act on _____ receptorsDelta
__________ bind to and act on Delta receptorsEnkephalins (endogenous)
Dynorphins bind to and act on ______ receptorsKappa
__________ bind to and act on Kappa receptorsDynorphins (endogenous)
_____ receptors are not true opioid receptors even though some opioids interact with them... may be involved with dependenceSigma
Psychedelic drugs (not opioid... but hey had to put it somewhere) mainly bind to _____ receptorsSigma
_______ act mainly on local circuits or CNS interneurons and have inhibitory effectsEnkephalins
Naloxone has what effect of on which 2 pituitary hormones?Increase LH and FSH secretion

***sites and mechanisms of action***

Question Answer
opioids use an endogenous pathway and mainly exert their effect on the ____ _____ _____ pathwaydescending pain modulating pathway (DPMP)
list 3 CNS parts that act as sites of action for opioidsPeri-aqueductal brain matter (midbrain), Rostra-Ventral Medulla, Dorsal Horn (of spinal cord)
Once opioid targets engage opioids, they send signals to the medulla's relay center, which synapse with the dorsal spinal horn that releases what 2 neurotransmitters?Norepi & Serotonin
T/F: Opioids directly inhibit pain sensationFalse (act indirectly... ultimately leading to serotonin and Norepi inhibition of pain transmission)
Opioids effect their targets by increasing ____ conductance and decreasing ____ influxPotassium (increased conductance); Calcium (influx decreased)

Recent badges