Opiates & Nsaids

Front 1

Is pain subjective or objective?

Back 1

subjective - whatever the patient says it is

Front 2

NSAIDs categorized by

Back 2

structure

Front 3

Acetylsalicylic acid
-class

Back 3

NSAID

Front 4

Indomethacin
-class

Back 4

NSAID

Front 5

Meloxicam
-class

Back 5

NSAID

Front 6

Ibuprofen
-class

Back 6

NSAID

Front 7

Naproxen
-class

Back 7

NSAID

Front 8

Ketorolac
-class

Back 8

NSAID

Front 9

Which drug is the prototype NSAID?

Back 9

Aspirin

Front 10

NSAID MOA

Back 10

Blocks synthesis of prostaglandins by irreversibly binding to COX I and/or COX II enzymes

Front 11

Adverse effects of NSAIDs

Back 11

GI distress
Prolonged bleeding
Tenitis

Front 12

Which NSAID is better tolerated than Aspirin and Ibuprofen?

Back 12

Meloxicam (Mobic)

Front 13

In an ideal world, NSAIDs would:

Back 13

Block only COX II, which catalyzes teh type of prostaglandin r/t pain
HOWEVER, blocking only COX II may be associated with MI risk.

Front 14

What is the problem with NSAIDs binding to COX I?

Back 14

COX I catalyzes the production of TXA2 and protective prostaglandins in the stomach. Hence the GI irritation.

Front 15

If there is a question pertaining to triglycerides:

Back 15

The answer is probably Indomethacin (Indocin)

Front 16

One alternative use for Indomethacin:

Back 16

Closes the ductus arteriosis in babies (whose should have already closed) through its vasodilating effects (counterintuitive)

Front 17

Binding to COX II prevents the production of ____, where binding to COX I prevents the production of ___

Back 17

Inflammatory prostaglandins associated with hyperalgesia

Protective prostaglandins

Front 18

Celecobix (Celebrex)

-MOA
-Problem with drug

Back 18

The one cyclooxygenase II (COX II) inhibitor known to be safe

New, so no generic = expensive
New, so limited testing = less safe

Front 19

The "other" antiinflammatory
-Name
-Trade
-MOA

Back 19

Acetaminophen (Tylenol)

Inhibits prostaglandin synthesis in the central nervous system.

Front 20

Why is Tylenol dangerous when taken with alcoholic beverage?

Back 20

Alcohol can cause CYP enzymes to convert tylenol to a toxic metabolite

Front 21

Is acetominophen an NSAID?

Back 21

NO

Front 22

From which plant is opoid drugs derived?

Back 22

Poppies
Sedative and opoid effects

Front 23

What percent of acetominophen excreted unchanged?
What percent converted to non-toxic metabolite?

Back 23

2%

94%

Front 24

Three types of opoid receptors

Back 24

Mu

Delta

Kappa

Front 25

Adverse effects of opioids

Back 25

Respiratory depression
Constipation
Altered mental status

Front 26

Where are opiate receptors located?

Back 26

In dorsal horn of gray matter
1. soma of interneurons
2. axon terminal of afferant neurons (from periphery)

Front 27

How do opiates affect the receptors on the afferent neurons?

Back 27

Bind to receptor to inhibit the axon from releasing more neurotransmitter. The neuron then cannot complete the message of pain to CNS.

Front 28

Where are mu receptors located and how do opiates act at these sites?

Back 28

Found on the soma of secondary neurons. Opiates bind to the mu receptors and cause an efflux of K+ from the cell -- causing hyperpolarization. The cell then cannot transmit pain stimulus to brain.

Front 29

Pharmacokinetics of morphine:

Back 29

One of the metabolites is also active in the CNS.
Renal excretion

Front 30

Morphine
-Class

Back 30

Opiate (Morphine)

Front 31

Codeine
-Class
-Also

Back 31

Opiate (Morphine drug)

Also antitussive

Front 32

Hydromorphone
-Class

Back 32

Opiate (Morphine drug)

Front 33

Hydrocodone with acetaminophen
-Class

Back 33

Opiate (Morphine drug)

Front 34

Oxycodone
-Class

Back 34

Opiate (Morphine drug)

Front 35

How do opiates act on the receptors on afferent neuron axon terminals?

Back 35

Binds and causes decreased Ca++ influx into cell and decreases neurotransmitter released onto interneurons.

Front 36

How is codeine related to morphine?

Back 36

Structurally similar, some of codeine is converted to morphine by CYP enzymes.
However, most pain relieved by parent compound.

Front 37

Hydromorphone (Dilaudid)

-Compared to morphine
-Metabolites

Back 37

Actually more potent than morphine when given orally.

No active metabolites.

Front 38

Where does oxycodone fall on the rank of potency and abuse potential?

Back 38

Oxycodone has less potency and abuse potential than morphine, but more than codeine.

Front 39

Which form of oxycodone is especially likely to be abused?

Back 39

Sustained release patch.

Front 40

Meperidine

-Class
-Trade

Back 40

Opiate (Meperidine drug)

Demerol

Front 41

Fentanyl

-Class
-Trade

Back 41

Opiate (Meperidine drug)

Duragesic

Front 42

Two patient rights to keep in mind while giving meperidine

Back 42

-Right route (There are many many routes for this drug)

-Right dose (The doses vary greatly between routes)

Front 43

In what ways are Meperidine and Morphine similar?

Back 43

Similar in the amount of respiratory depression and sedation.

Front 44

Why is meperidine ideal for OB use?

Back 44

Because has much less respiratory depression on infants.

Front 45

Which patients will not receive meperidine and why?

Back 45

Renal patients and patients with chronic pain - because toxic metabolites can accumulate.

Front 46

Why is codeine not always effective?

Back 46

Because some people have variations in CYP 450 enzymes that alter the drug in ineffective ways.

Front 47

Two noted routes of administration for fentanyl:

Back 47

Buccal (lozenge)

Transdermal

Front 48

Methadone

Class
Trade

Back 48

Opiate (Methadone drug)

Dolophine

Front 49

Propoxyphene

Class
MOA

Back 49

Opiate (Methadone-like drug)

Darvon

Front 50

What are methadone-like drugs used for?

Back 50

They are a long acting PO drug used to wean people off of opiates.

Front 51

Tramadol

Class
Trade
Trade w/ acetaminophen
MOA

Back 51

Opiates (other)

Ultram
Ultracet

Binds to mu receptors and inhibits reuptake of NE and 5HT.

Front 52

Lidocaine

Class
Trade
MOA

Back 52

Topical analgesic

Lidoderm

Stabilizes neuronal membranes; inhibits ion fluxes required for conduction of pain impulse.

Front 53

Nalbuphine

Class
Trade
MOA

Back 53

Opioid agonist/antagonist mix

Nubain

Stimulates kappa, blocks mu; less respiratory depression and potential for abuse but CANNOT be reverse with antagonist.

Front 54

Butorphanol

Class
Trade
MOA

Back 54

Opioid agonist/antagonist mix

Stadol

Stimulates kappa; blocks mu. Causes more sedation; less potential for abuse.

Front 55

Naloxone

Class
Trade

Back 55

Opiate antagonist

Narcan

Front 56

Narcan MOA

Back 56

Antagonizes opiate receptors to treat opiate OD.