Term
| What are the Pure Opiate Agonists? |
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Definition
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Term
| What are the Partial Agonist Opiates? |
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Definition
|
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Term
| What are the Opiate Antagonists? |
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Definition
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Term
| What are the NMDA receptor antagonists? |
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Definition
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Term
| 7. In determining the type of opioid treatment, what factors should be assessed? |
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Definition
| 7. Pathological mechanisms |
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Term
| 13. Where are pain-modulating neurons found in the midbrain and medulla? |
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Definition
| 13. Periaqueductal Gray area |
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Term
| 14. How pain modulating neurons in the midbrain and medulla control pain? |
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Definition
| 14. Indirectly control pain transmission pathways by enhancing descending inhibition to the dorsal horn |
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Term
| 15. How is Pain relayed to the Brain? |
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Definition
| 15. Noxious Stimulus at periphery àAP à Dorsal Horn à Neurotransmission à CNS neurons à sends signal to Brain. |
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Term
| 16. Where do NSAIDs modulate pain? |
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Definition
| 16. at periphery, initial signal transduction |
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Term
| 17. What blocks signal conduction in nociceptive fibers? |
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Definition
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Term
| 18. What drugs modulate pain transmission in the spinal cord by decreasing the signal relayed from the periphery to the central pain pathways? |
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Definition
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Term
| 19. What drugs modulate the central perception of painful stimuli? |
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Definition
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Term
| 20. What receptors at the periphery are heat-sensitive cation channels? |
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Definition
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Term
| 21. What receptors at the periphery are activated by chemical stimuli? |
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Definition
| 21. Acid Sensitive Ion Channels (ASIC) |
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Term
| 22. How does the G protein-coupled receptor enhance ion influx at the periphery? |
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Definition
| 22. Activates Phospholipase C à increases Ca release from intracellular stores à activates PKC |
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Term
| 23. What causes G protein stimulation? |
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Definition
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Term
| 24. How is Pain transmitted to Spinal Cord neurons? |
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Definition
| 24. AP from periphery à activates presynaptic voltage sensitive Ca Channels à Ca influx à Neurotransmitter released à postsynaptic receptors activated à Na and Ca influx in Post synaptic terminal à AP generation |
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Term
| 25. What neurotransmitters are released from the presynaptic terminal? |
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Definition
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Term
| 26. What does stimulation of ionotropic glutamate receptors lead to? |
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Definition
| 26. fast postsynaptic depolarization |
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Term
| 27. How does activation of the presynaptic mu receptor inhibit central relaying of nociceptive stimuli? |
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Definition
| 27. decreases Ca influx in response to incoming AP |
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Term
| 28. How does activation of the postsynaptic mu receptors inhibit pain? |
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Definition
| 28. increases K+ conductance of postsynaptic membrane, decreasing the response to excitatory neurotransmission |
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Term
| 29. How is does sensitization to pain occur centrally? |
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Definition
| 29. Primarly through NMDA receptors. |
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Term
| What drug can be used to block the NMDA receptors to prevent surgery-induced sensitization? |
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Definition
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Term
| 32. What are the side effects of Dextromethorphan? |
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Definition
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Term
| 33. What are ways that pain transmission shows activity-dependent plasticity? |
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Definition
| 33. -Central sensitization |
|
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Term
|
Definition
| 34. normally innocuous stimuli are now painful |
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Term
| 35. What is hyperalgesia? |
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Definition
| 35. high intensity stimuli perceived as more painful |
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Term
| 36. How do extra-neuronal inflammatory components induce peripheral sensitization? |
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Definition
| 36. G-protein coupled effects |
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Term
| 37. What are some Extra-neuronal inflammatory components? |
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Definition
|
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Term
| 38. How do substance P and CGRP (intra-neuronal mechanisms) induce sensitization? |
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Definition
| 38. -stimulate inflammatory cells to release histamine and TNF-alpha |
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Term
| 39. How does Loss of neurotrophic support alter sensitivity and activity of nociceptive fibers? |
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Definition
| 39. Alters gene expression à Na channels become hyper active |
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Term
| 41. Which Opiate receptor type causes decreased respiration? |
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Definition
|
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Term
| 42. Which Opiate receptor has a higher affinity for Enkephalins? |
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Definition
|
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Term
| 43. Which opiate receptors decrease GI transit? |
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Definition
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Term
| 44. Which opiate receptor has a higher affinity for Dynorphins? |
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Definition
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Term
| 45. Which opiate receptor has a higher affinity for Endorphins? |
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Definition
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Term
| 47. In the presence of Morphine how does Codeine work? |
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Definition
| 47. acts like an antagonist |
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Term
| 48. Most drugs that have a High 1st pass metabolism, will have what kind of oral:IV potency ratio? |
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Definition
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Term
| 49. Comparing Codeine and Oxycodone, which drug has the lowest approx. equivalent dose? |
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Definition
| 49. Oxycodone ( 4.5 mg) < Codeine (30-60mg) |
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Term
| 50. What drugs have a Low Oral:IV potency ratio? |
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Definition
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Term
| 51. What drugs have a High Oral:IV potency ratio? |
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Definition
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Term
| 52. What drugs have a Medium Oral:IV Potency Ratio? |
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Definition
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Term
| 54. What route of administration is best for a patient with poor GI tract absorption or dysphagia? |
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Definition
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Term
| 55. What route of administration would be preferred over a PO opioid for if constipation is an issue? |
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Definition
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Term
| 56. What opioid drugs can be administered Rectally? |
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Definition
|
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Term
| 57. Why is accumulation of opioids limited in adipose tissue? |
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Definition
|
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Term
| 59. How do Opiate drugs cause desensitization? |
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Definition
| 59. Drug binds receptoràreceptor slowly pulled into cytoàreceptor slowly put back onto surface if at all |
|
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Term
| 60. Why don’t endogenous substances cause desensitization? |
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Definition
| 60. after binding are quickly pulled into cyto and quickly returned to the membrane |
|
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Term
| 61. What side effects of opiates are not effected by developing tolerance? |
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Definition
|
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Term
| 62. Why are opiates not a good choice as a long term cough suppressant? |
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Definition
| 62. Likelihood of Tolerance developing is High |
|
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Term
| 63. What symptoms have a high likelihood of developing tolerance with prolonged opiate use? |
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Definition
|
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Term
| 64. When is there a risk of Respiratory Depression with opiate use? |
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Definition
| 64. –Titrated too rapidly |
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Term
| 65. What drug can be used to reverse the affects of respiratory depression caused by opiate overdose? |
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Definition
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Term
| 66. A patient shows up unconscious, with pinpoint pupils, and decreased respiration, what do you suspect? |
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Definition
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Term
| 67. What drug decreases baseline beta-endorphin release? What is it used for? |
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Definition
| 67. Naltrexone; decreases alcohol cravings in alcoholics |
|
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Term
| 68. What are the effects of Sedative-Hypnotics used with Opioids? |
|
Definition
| 68. CNS depression – Respiratory Depression |
|
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Term
| 69. What effects do Antipsychotic tranquilizers and opioids have? |
|
Definition
|
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Term
| 70. Why are MOA inhibitors and Opioids contraindicated? |
|
Definition
| 70. high incidence of hyperpyrexic coma |
|
|
Term
| 71. What does CYP2D6 metabolize codeine to? |
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Definition
|
|
Term
| 72. What drug is contraindicated for a patient where tachycardia could be a problem? |
|
Definition
|
|
Term
| 73. Why is Meperidine contraindicated in tachycardia? |
|
Definition
| 73. Meperidine has significant antimuscarinic effects |
|
|
Term
| 74. Why is Methadone used to help prevent withdrawal symptoms from Heroin? |
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Definition
|
|
Term
| 75. What drugs are contraindicated in Renal Failure? |
|
Definition
|
|
Term
| 76. What drugs lack active metabolites and could be considered in the setting of renal insufficiency? |
|
Definition
|
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Term
| 77. What is a common approach to management of poorly responsive pain? |
|
Definition
|
|
Term
| 78. What symptoms can be expected from a patient in Opiate withdrawal? |
|
Definition
|
|
Term
| 79. Are fever, seizures, hallucinations, and delirium associated with opiate withdrawal? |
|
Definition
| 79. No, suggests poly-drug withdrawal or associated medical illness |
|
|
Term
| 80. Opiate withdrawal should have Pulse and BP that are what? |
|
Definition
|
|
Term
| 81. What drug can be used as an outpatient short-term treatment of Opiate withdrawal? |
|
Definition
|
|
Term
| 82. Why is Naloxone combined with Buprenorphine to treat opioid dependence? |
|
Definition
| 82. Naloxone will induce withdrawal in injected. Keeps patients from abusing treatment. |
|
|
Term
| 83. What are some side effects to Methadone maintenance therapy? |
|
Definition
| 83. Constipation, mild drowsiness, excess sweating, peripheral edema, Reduced testosterone, Prolonged QT and Arrhythmia |
|
|
Term
| 84. How does Gabapentin treat pain? |
|
Definition
| 84. Binds to alpha2-delta subunit, preventing trafficking to cell surface, decreasing the upregulation of voltage-gated Ca channels that occurs in hyper sensitization |
|
|
Term
| 85. What drug is useful in neuropathy, stroke, MS, and phantom limb? |
|
Definition
|
|
Term
| 86. How are TCAs useful for Pain? |
|
Definition
| 86. NE and 5-HT reuptake blocking properties |
|
|
Term
| 87. Where is the cough pattern generator located? |
|
Definition
| 87. Nucleus of Solitary Tract |
|
|
Term
| 88. What is the “Gold Standard” in Antitussive Agents? |
|
Definition
|
|
Term
| 89. What is a nonprescription opiod agonist used as an Antidiarrheal? |
|
Definition
|
|
Term
| 90. What are some non-drug treatments for Non-Cancer Pain? |
|
Definition
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