Multimodal Analgesia and Opioid Adjuncts Quiz

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Questions and Answers

Which enzyme is responsible for metabolizing codeine into morphine?

CYP1A2

CYP2D6 (correct)

CYP3A4

CYP2C19

What is the main concern associated with ultra-rapid metabolizers of codeine?

Reduced effectiveness of codeine

Decreased risk of overdose

Lower risk of side effects

Increased risk of toxicity and overdose (correct)

Which opioid receptor agonist is 80-100 times more potent than morphine?

Fentanyl (correct)

Meperidine

Codeine

Sufentanil

What is the role of opioid receptor agonists similar to morphine in terms of effects and side effects?

No antitussive or constipating actions Signup and view all the answers

Which neurotransmitter release is inhibited by the binding of ligands to opioid receptors?

Serotonin Signup and view all the answers

What effect does ligand binding to opioid receptors have on postsynaptic activation?

Decreases postsynaptic activation Signup and view all the answers

What effect does ligand binding to opioid receptors have on presynaptic Ca2+ conductance?

Decreases presynaptic Ca2+ conductance Signup and view all the answers

What is the mechanism by which opioid receptor signaling affects nociception?

No effect on nociception Signup and view all the answers

What is the function of G-protein coupled receptors such as opioid receptors?

Regulate intracellular signaling pathways Signup and view all the answers

What is the potential risk associated with sustained-release tablets of oxycodone and oxymorphone?

Potential for overdose and death if crushed and ingested Signup and view all the answers

Which drug is a neurokinin-1 antagonist usually given at the beginning of surgery?

Aprepitant Signup and view all the answers

Which drug is a GABA analog that is used for pretreatment to reduce opioid use?

Gabapentin Signup and view all the answers

Which type of drug is used to decrease gastric acidity, especially in obstetrics and patients with acid reflux?

H2-receptor antagonists Signup and view all the answers

Which drug is an anticoagulant that should be used with caution in patients with coagulation problems and peptic ulcers?

Ketorolac Signup and view all the answers

Which drug is an mAChR antagonist administered transdermally for patients with a history of postoperative nausea and vomiting (PONV)?

Scopolamine Signup and view all the answers

Which drug class aims to increase gastrointestinal motility, gastric emptying, and tone of the lower esophageal sphincter?

Prokinetic drugs Signup and view all the answers

Which drug is a glucocorticoid often given at the beginning of surgery?

Dexamethasone Signup and view all the answers

Which drug is an anticholinergic with sedative, delirium, and confusion effects, especially in the elderly?

Promethazine Signup and view all the answers

Which type of pain perception involves perceiving normally innocuous stimuli as painful?

Allodynia Signup and view all the answers

What is the main goal of using Tanezumab, a monoclonal antibody against NGF?

To treat pain resistant to other therapies Signup and view all the answers

Which receptors are phosphorylated to increase ion flux upon activation in peripheral sensitization?

Na+ channels Signup and view all the answers

Which class of drugs inhibits both COX-1 and COX-2 and blocks the physiological effects of COX-1?

Glucocorticoids Signup and view all the answers

What is the critical step inhibited by NSAIDs in prostaglandin metabolism?

Formation of prostaglandin H2 Signup and view all the answers

Which drug class is known for its antipyretic, analgesic, and anti-inflammatory effects due to its inhibition of prostaglandin production?

NSAIDs Signup and view all the answers

"Inhibition of prostaglandin (and leukotriene) production by inhibiting phospholipase A2 and COX2" is associated with which drug class?

Glucocorticoids Signup and view all the answers

"Aspirin inhibits the COX by acetylating a single serine residue" is a characteristic associated with which drug?

Aspirin Signup and view all the answers

"The goal of this drug is to limit peripheral sensitization" is associated with which drug?

Tanezumab Signup and view all the answers

"Expression of NGF axis is altered in schizophrenia patients" is a safety concern associated with which drug?

Tanezumab Signup and view all the answers

"Inhibition of COX-1 and COX-2" is a characteristic related to which class of drugs?

NSAIDs Signup and view all the answers

What is the aim of multimodal analgesia?

To reduce the use of opioids and add other medications for pain relief Signup and view all the answers

Which class of drugs is used as adjuncts to opioids and comes with cautions such as coagulation problems and hepatic insufficiency?

Non-steroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

Which medication is used as an adjunct due to its NMDA receptor antagonist properties?

Ketamine Signup and view all the answers

Which drug is used transdermally for patients with a history of postoperative nausea and vomiting (PONV), but caution is advised for its anticholinergic actions in the CNS?

Scopolamine Signup and view all the answers

Which drugs are used to control GI motility, pH, and tone, especially in cases of gastric acidity?

Proton pump inhibitors and non-particulate antacids Signup and view all the answers

What are the stages of general anesthesia in the correct order?

Analgesia, excitement, surgical anesthesia, medullary depression/paralysis Signup and view all the answers

Why are anesthetic agents prescribed in combination with other anesthetics and medications?

To minimize risks and enhance therapeutic effects Signup and view all the answers

What is the main pharmacological property of ketamine that makes it an adjunct to anesthesia?

NMDA receptor antagonist Signup and view all the answers

What is the purpose of using H2-receptor antagonists, proton pump inhibitors, non-particulate antacids, and prokinetic drugs in anesthesia?

To control GI motility, pH, and tone Signup and view all the answers

Which opioid is commonly used for pain relief and cough suppression, but has been associated with life-threatening respiratory depression in some children who have undergone tonsillectomy and/or adenoidectomy?

Codeine Signup and view all the answers

Which synthetic opioid has contraindications for elderly patients, those with kidney function issues, respiratory-compromised patients, and patients with hepatic insufficiency?

Meperidine Signup and view all the answers

Which opioid should be avoided in combination with MAOIs and SSRIs due to potential drug-drug interactions leading to serotonin syndrome?

Meperidine Signup and view all the answers

Which opioid acts as a partial agonist for the μ opioid receptor, decreasing withdrawal symptoms but can increase blood pressure?

Buprenorphine Signup and view all the answers

Which mixed agonist-antagonist opioid has limited use in treating chronic pain, may block morphine-induced analgesia, and can cause withdrawal symptoms in morphine users?

Nalbuphine Signup and view all the answers

Which analgesic acts as both a μ opioid receptor agonist and an inhibitor of norepinephrine reuptake?

Tapentadol Signup and view all the answers

Which opioid antagonist is used to treat opioid poisoning and addiction?

Naloxone Signup and view all the answers

Which opioids are more potent than fentanyl, with carfentanil being used to lace heroin and cause opioid-related deaths?

Carfentanil Signup and view all the answers

Which of the following is a contraindication for NSAID use?

Gastric ulcers Signup and view all the answers

What is the toxic metabolite formed during the metabolism of acetaminophen?

NAPQI Signup and view all the answers

Inflammatory changes associated with Wallerian degeneration include:

Hyperemia Signup and view all the answers

What is the primary mechanism of action of acetaminophen in providing antipyretic and analgesic effects?

Inhibition of prostaglandin synthesis in the CNS Signup and view all the answers

Which population group is at risk of developing Reye syndrome following viral infection if they take aspirin?

Children or teenagers (up to 19 years old) Signup and view all the answers

What can mild doses of salicylate toxicity cause?

Nausea, vomiting, and tinnitus Signup and view all the answers

What is the primary effect of NSAIDs on platelet function?

Inhibition of platelet aggregation Signup and view all the answers

What type of pain may occur without axonal resection and be initiated by low-threshold sensory afferents?

Neuropathic pain Signup and view all the answers

What is the primary role of neuregulin in nerve injury?

Promoting proliferation and remyelination Signup and view all the answers

What differentiates NSAIDs from acetaminophen in terms of their effect on platelet function?

NSAIDs enhance platelet aggregation, while acetaminophen inhibits platelet function. Signup and view all the answers

Which mechanism contributes to the development of neuropathic pain?

Activation of P2X and P2Y receptors by extracellular ATP Signup and view all the answers

What is the main goal of using ketamine in anesthesia?

To block NMDA receptors Signup and view all the answers

What effect does ligand binding to opioid receptors have on postsynaptic activation?

Increases ion flux Signup and view all the answers

Which drug class is known for its antipyretic, analgesic, and anti-inflammatory effects due to its inhibition of prostaglandin production?

NSAIDs Signup and view all the answers

What is the critical step inhibited by NSAIDs in prostaglandin metabolism?

Inhibition of COX-1 and COX-2 Signup and view all the answers

Which opioid receptor agonist is 80-100 times more potent than morphine?

Fentanyl Signup and view all the answers

Which drug is used to limit peripheral sensitization?

Gabapentin Signup and view all the answers

What is the aim of multimodal analgesia?

To target multiple pain mechanisms with different medications or techniques Signup and view all the answers

What is the function of G-protein coupled receptors such as opioid receptors?

To modulate intracellular signaling pathways Signup and view all the answers

What is the main concern associated with ultra-rapid metabolizers of codeine?

Increased risk of respiratory depression and overdose Signup and view all the answers

What is the potential risk associated with sustained-release tablets of oxycodone and oxymorphone?

Increased risk of respiratory depression and overdose Signup and view all the answers

Study Notes

Opioids are used for mild to moderate pain and as cough suppressants
Codeine is commonly used for pain relief and cough suppression, but some children who have undergone tonsillectomy and/or adenoidectomy and received codeine have experienced life-threatening respiratory depression
Meperidine is a synthetic opioid with contraindications for elderly patients, those with kidney function issues, respiratory-compromised patients, and patients with hepatic insufficiency
MAOIs and SSRIs should be avoided when using meperidine due to potential drug-drug interactions leading to serotonin syndrome
Sufentanil and carfentanil are more potent than fentanyl; carfentanil is not used clinically but is used to lace heroin and cause opioid-related deaths
Buprenorphine is a partial agonist for the μ opioid receptor, decreasing withdrawal symptoms but can increase blood pressure
Pentazocine is a mixed agonist-antagonist with limited use in treating chronic pain, may block morphine-induced analgesia, and can cause withdrawal symptoms in morphine users
Nalbuphine and butorphanol are mixed agonist-antagonists with limited use in treating chronic pain, have less psychotomimetic effects than pentazocine, and no cardiac effects but may increase blood pressure
Tapentadol is an analgesic that acts as a μ opioid receptor agonist and inhibitor of norepinephrine reuptake
Tramadol is an analgesic that acts as a weak μ opioid receptor agonist and inhibitor of norepinephrine and serotonin reuptake, can cause anaphylactic reactions, and should not be used in patients with a history of seizures or MAOIs
Naloxone and naltrexone are opioid antagonists used to treat opioid poisoning and addiction
Phenothiazines, monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants can potentiate opioid action
Tolerance and dependence are characteristics of opioid drugs, and their rewarding properties are mediated by excitability of GABAergic interneurons and outflow from the ventral pallidum.
Neuropathic pain results from nerve injury, leading to demyelination, infiltration of inflammatory cells, and loss of neurotrophic support
Bands of Bunger release growth factors and pathfinding signals to aid in nerve repair
Inflammatory cells and dedifferentiated Schwann cells release cytokines, causing complex changes in the nerve
High concentration of extracellular ATP activates P2X and P2Y receptors on macrophages and nociceptor neurons, leading to more cytokines released and nociceptor activation
TTX-resistant sodium channels are potentiated, increasing Na+ influx and neuronal excitability
Allodynia and hyperalgesia are common in neuropathic pain, with allodynia being caused by peripheral sensitization and hyperalgesia by central sensitization
Mechanisms of central sensitization include the use of ketamine to block NMDA receptors, sodium channel blockers such as carbamazepine and oxcarbazepine, gabapentin and pregabalin to reduce neurotransmitter release, ziconotide to block Ca2+ channels, and inhibitors of TNF-α like etanercept, infliximab, and adalimumab
Local and general anesthetics produce a lack of sensation and are often used in combination with other medications and anesthetics to achieve optimal sedation levels during surgery
General anesthesia causes reversible CNS depression and loss of response to external stimuli
The choice of anesthetic combination is determined by the type and duration of the procedure, the patient's characteristics, and other medications they are taking
There is no perfect anesthetic agent, and currently-available anesthetics are prescribed in combination with other medications to produce analgesia, amnesia, and muscle relaxation.

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Test your knowledge of adjunct medications used in multimodal analgesia to reduce opioid use. Questions cover NSAIDs, acetaminophen, ketamine, GABA analogs, and precautions for patients with specific health conditions.

Multimodal Analgesia and Opioid Adjuncts Quiz

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Questions and Answers

Which enzyme is responsible for metabolizing codeine into morphine?

What is the main concern associated with ultra-rapid metabolizers of codeine?

Which opioid receptor agonist is 80-100 times more potent than morphine?

What is the role of opioid receptor agonists similar to morphine in terms of effects and side effects?

Which neurotransmitter release is inhibited by the binding of ligands to opioid receptors?

What effect does ligand binding to opioid receptors have on postsynaptic activation?

What effect does ligand binding to opioid receptors have on presynaptic Ca2+ conductance?

What is the mechanism by which opioid receptor signaling affects nociception?

What is the function of G-protein coupled receptors such as opioid receptors?

What is the potential risk associated with sustained-release tablets of oxycodone and oxymorphone?

Which drug is a neurokinin-1 antagonist usually given at the beginning of surgery?

Which drug is a GABA analog that is used for pretreatment to reduce opioid use?

Which type of drug is used to decrease gastric acidity, especially in obstetrics and patients with acid reflux?

Which drug is an anticoagulant that should be used with caution in patients with coagulation problems and peptic ulcers?

Which drug is an mAChR antagonist administered transdermally for patients with a history of postoperative nausea and vomiting (PONV)?

Which drug class aims to increase gastrointestinal motility, gastric emptying, and tone of the lower esophageal sphincter?

Which drug is a glucocorticoid often given at the beginning of surgery?

Which drug is an anticholinergic with sedative, delirium, and confusion effects, especially in the elderly?

Which type of pain perception involves perceiving normally innocuous stimuli as painful?

What is the main goal of using Tanezumab, a monoclonal antibody against NGF?

Which receptors are phosphorylated to increase ion flux upon activation in peripheral sensitization?

Which class of drugs inhibits both COX-1 and COX-2 and blocks the physiological effects of COX-1?

What is the critical step inhibited by NSAIDs in prostaglandin metabolism?

Which drug class is known for its antipyretic, analgesic, and anti-inflammatory effects due to its inhibition of prostaglandin production?

"Inhibition of prostaglandin (and leukotriene) production by inhibiting phospholipase A2 and COX2" is associated with which drug class?

"Aspirin inhibits the COX by acetylating a single serine residue" is a characteristic associated with which drug?

"The goal of this drug is to limit peripheral sensitization" is associated with which drug?

"Expression of NGF axis is altered in schizophrenia patients" is a safety concern associated with which drug?

"Inhibition of COX-1 and COX-2" is a characteristic related to which class of drugs?

What is the aim of multimodal analgesia?

Which class of drugs is used as adjuncts to opioids and comes with cautions such as coagulation problems and hepatic insufficiency?

Which medication is used as an adjunct due to its NMDA receptor antagonist properties?

Which drug is used transdermally for patients with a history of postoperative nausea and vomiting (PONV), but caution is advised for its anticholinergic actions in the CNS?

Which drugs are used to control GI motility, pH, and tone, especially in cases of gastric acidity?

What are the stages of general anesthesia in the correct order?

Why are anesthetic agents prescribed in combination with other anesthetics and medications?

What is the main pharmacological property of ketamine that makes it an adjunct to anesthesia?

What is the purpose of using H2-receptor antagonists, proton pump inhibitors, non-particulate antacids, and prokinetic drugs in anesthesia?

Which opioid is commonly used for pain relief and cough suppression, but has been associated with life-threatening respiratory depression in some children who have undergone tonsillectomy and/or adenoidectomy?

Which synthetic opioid has contraindications for elderly patients, those with kidney function issues, respiratory-compromised patients, and patients with hepatic insufficiency?

Which opioid should be avoided in combination with MAOIs and SSRIs due to potential drug-drug interactions leading to serotonin syndrome?

Which opioid acts as a partial agonist for the μ opioid receptor, decreasing withdrawal symptoms but can increase blood pressure?

Which mixed agonist-antagonist opioid has limited use in treating chronic pain, may block morphine-induced analgesia, and can cause withdrawal symptoms in morphine users?

Which analgesic acts as both a μ opioid receptor agonist and an inhibitor of norepinephrine reuptake?

Which opioid antagonist is used to treat opioid poisoning and addiction?

Which opioids are more potent than fentanyl, with carfentanil being used to lace heroin and cause opioid-related deaths?

Which of the following is a contraindication for NSAID use?

What is the toxic metabolite formed during the metabolism of acetaminophen?

Inflammatory changes associated with Wallerian degeneration include:

What is the primary mechanism of action of acetaminophen in providing antipyretic and analgesic effects?

Which population group is at risk of developing Reye syndrome following viral infection if they take aspirin?

What can mild doses of salicylate toxicity cause?

What is the primary effect of NSAIDs on platelet function?

What type of pain may occur without axonal resection and be initiated by low-threshold sensory afferents?

What is the primary role of neuregulin in nerve injury?

What differentiates NSAIDs from acetaminophen in terms of their effect on platelet function?

Which mechanism contributes to the development of neuropathic pain?

What is the main goal of using ketamine in anesthesia?

What effect does ligand binding to opioid receptors have on postsynaptic activation?

Which drug class is known for its antipyretic, analgesic, and anti-inflammatory effects due to its inhibition of prostaglandin production?

What is the critical step inhibited by NSAIDs in prostaglandin metabolism?

Which opioid receptor agonist is 80-100 times more potent than morphine?

Which drug is used to limit peripheral sensitization?

What is the aim of multimodal analgesia?

What is the function of G-protein coupled receptors such as opioid receptors?

What is the main concern associated with ultra-rapid metabolizers of codeine?

What is the potential risk associated with sustained-release tablets of oxycodone and oxymorphone?

Study Notes

Studying That Suits You

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