Podcast
Questions and Answers
Which of the following best describes analgesia?
Which of the following best describes analgesia?
- Increased sensitivity to painful stimuli.
- Heightened emotional response to pain.
- The presence of pain in response to stimulation.
- Absence of pain in response to stimulation that would normally be painful. (correct)
What is the primary mechanism by which non-steroidal anti-inflammatory drugs (NSAIDs) exert their analgesic, anti-inflammatory, and anti-pyretic effects?
What is the primary mechanism by which non-steroidal anti-inflammatory drugs (NSAIDs) exert their analgesic, anti-inflammatory, and anti-pyretic effects?
- Inhibiting the synthesis of prostaglandins (correct)
- Enhancing the reuptake of serotonin and norepinephrine in the brain
- Stimulating the release of endogenous opioids
- Directly blocking pain receptors in the central nervous system
Which of the following best describes the role of COX-1 in the body?
Which of the following best describes the role of COX-1 in the body?
- Primarily involved in platelet aggregation
- Primarily involved in the production of fever.
- Primarily involved in inflammation and pain.
- Responsible for the production of prostaglandins that protect the stomach lining. (correct)
Which of the following is a potential adverse effect of non-selective NSAIDs related to their inhibition of COX-1?
Which of the following is a potential adverse effect of non-selective NSAIDs related to their inhibition of COX-1?
Why are COX-2 selective inhibitors considered to have a potentially higher risk of thrombotic events compared to non-selective NSAIDs?
Why are COX-2 selective inhibitors considered to have a potentially higher risk of thrombotic events compared to non-selective NSAIDs?
What is the primary mechanism of action of aspirin in preventing cardiovascular events?
What is the primary mechanism of action of aspirin in preventing cardiovascular events?
Why is aspirin typically discontinued several days before a surgical procedure?
Why is aspirin typically discontinued several days before a surgical procedure?
Which of the following statements best describes the mechanism of action of paracetamol?
Which of the following statements best describes the mechanism of action of paracetamol?
In which of the following patient populations is paracetamol generally considered the first-line analgesic?
In which of the following patient populations is paracetamol generally considered the first-line analgesic?
What is the primary pathway of paracetamol metabolism, and how does an overdose affect this pathway?
What is the primary pathway of paracetamol metabolism, and how does an overdose affect this pathway?
What concerning effect can result from paracetamol overdose due to the accumulation of NAPQI?
What concerning effect can result from paracetamol overdose due to the accumulation of NAPQI?
Which of the following is NOT a typical effect of NSAIDs?
Which of the following is NOT a typical effect of NSAIDs?
Which of the following conditions would require cautious use of NSAIDs?
Which of the following conditions would require cautious use of NSAIDs?
Which non-selective COX inhibitor is administered intramuscularly?
Which non-selective COX inhibitor is administered intramuscularly?
Which mechanism is responsible for NSAID-induced gastric ulcers?
Which mechanism is responsible for NSAID-induced gastric ulcers?
What is a key advantage of selective COX-2 inhibitors over non-selective NSAIDs concerning gastrointestinal adverse events?
What is a key advantage of selective COX-2 inhibitors over non-selective NSAIDs concerning gastrointestinal adverse events?
In the context of pain management, what are eicosanoids?
In the context of pain management, what are eicosanoids?
A patient with a known hypersensitivity to aspirin needs an analgesic. Which of the following would be the safest option?
A patient with a known hypersensitivity to aspirin needs an analgesic. Which of the following would be the safest option?
A patient reports taking high doses of paracetamol daily for chronic pain. Which of the following lab values is MOST important to monitor regularly?
A patient reports taking high doses of paracetamol daily for chronic pain. Which of the following lab values is MOST important to monitor regularly?
Which of the following best describes the impact of NSAIDs on renal function?
Which of the following best describes the impact of NSAIDs on renal function?
You are treating a patient who has a history of GI ulcers. Which analgesic regimen would pose the LEAST risk for GI complications?
You are treating a patient who has a history of GI ulcers. Which analgesic regimen would pose the LEAST risk for GI complications?
Which of the following NSAIDs is available in an intravenous formulation?
Which of the following NSAIDs is available in an intravenous formulation?
A patient with a history of myocardial infarction is prescribed an analgesic for osteoarthritis. Which of the following analgesics should be used with caution?
A patient with a history of myocardial infarction is prescribed an analgesic for osteoarthritis. Which of the following analgesics should be used with caution?
In the arachidonic acid pathway, which enzyme is targeted by NSAIDs to reduce inflammation and pain?
In the arachidonic acid pathway, which enzyme is targeted by NSAIDs to reduce inflammation and pain?
Which of the following best explains why acetaminophen is preferred over NSAIDs in patients with severe renal impairment?
Which of the following best explains why acetaminophen is preferred over NSAIDs in patients with severe renal impairment?
Which of the following NSAIDs is known for its irreversible inhibition of COX-1?
Which of the following NSAIDs is known for its irreversible inhibition of COX-1?
A patient has overdosed on paracetamol. What is the antidote that can prevent liver damage if administered early?
A patient has overdosed on paracetamol. What is the antidote that can prevent liver damage if administered early?
In which specific scenario should aspirin treatment be stopped 7 days before surgery?
In which specific scenario should aspirin treatment be stopped 7 days before surgery?
What is the greatest risk for a 6-year-old child given aspirin for a viral infection?
What is the greatest risk for a 6-year-old child given aspirin for a viral infection?
Which type of pain is most effectively treated with non-opioid analgesics like NSAIDs and paracetamol?
Which type of pain is most effectively treated with non-opioid analgesics like NSAIDs and paracetamol?
A patient with a history of heart failure is prescribed an NSAID for osteoarthritis. Which potential adverse effect is of greatest concern?
A patient with a history of heart failure is prescribed an NSAID for osteoarthritis. Which potential adverse effect is of greatest concern?
What is the key difference between the analgesic effect of paracetamol and NSAIDs?
What is the key difference between the analgesic effect of paracetamol and NSAIDs?
What is the primary reason for the black box warning on COX-2 selective inhibitors?
What is the primary reason for the black box warning on COX-2 selective inhibitors?
A patient with rheumatoid arthritis is taking a high dose of aspirin daily. Which adverse effect is most likely to occur?
A patient with rheumatoid arthritis is taking a high dose of aspirin daily. Which adverse effect is most likely to occur?
Which of the following is the most accurate statement regarding the use of paracetamol during pregnancy?
Which of the following is the most accurate statement regarding the use of paracetamol during pregnancy?
A patient with a known sulfonamide allergy is prescribed celecoxib. What is the appropriate course of action?
A patient with a known sulfonamide allergy is prescribed celecoxib. What is the appropriate course of action?
A patient is taking low-dose aspirin for secondary prevention of cardiovascular events. They now need to start ibuprofen regularly for arthritis pain. What is the most important consideration regarding their medication regimen?
A patient is taking low-dose aspirin for secondary prevention of cardiovascular events. They now need to start ibuprofen regularly for arthritis pain. What is the most important consideration regarding their medication regimen?
A patient presents with signs of liver failure after taking too much paracetamol. Besides laboratory tests, what is the next immediate step in their management?
A patient presents with signs of liver failure after taking too much paracetamol. Besides laboratory tests, what is the next immediate step in their management?
What is the underlying reason why aspirin should be avoided in children presenting with influenza-like symptoms?
What is the underlying reason why aspirin should be avoided in children presenting with influenza-like symptoms?
A researcher is investigating a new drug that selectively inhibits COX-1. Which of the following would be an expected effect of this drug?
A researcher is investigating a new drug that selectively inhibits COX-1. Which of the following would be an expected effect of this drug?
Which of the following is an example of physiological pain?
Which of the following is an example of physiological pain?
The activation of which receptor is most directly involved in the sensation of pressure?
The activation of which receptor is most directly involved in the sensation of pressure?
Which of the following is the most accurate statement regarding the relationship between NSAIDs and afferent arteriolar resistance in the kidneys?
Which of the following is the most accurate statement regarding the relationship between NSAIDs and afferent arteriolar resistance in the kidneys?
Which of the following describes the action of meloxicam?
Which of the following describes the action of meloxicam?
The primary advantage of using selective COX-2 inhibitors over non-selective NSAIDs relates to:
The primary advantage of using selective COX-2 inhibitors over non-selective NSAIDs relates to:
Which of the following is an adverse effect associated with COX-2 inhibition?
Which of the following is an adverse effect associated with COX-2 inhibition?
Aspirin's antiplatelet effect is due to:
Aspirin's antiplatelet effect is due to:
Why is aspirin typically discontinued before surgery?
Why is aspirin typically discontinued before surgery?
Which of the following best describes paracetamol's mechanism of action?
Which of the following best describes paracetamol's mechanism of action?
In which situation is paracetamol generally considered the first-line analgesic?
In which situation is paracetamol generally considered the first-line analgesic?
What is the primary metabolic pathway of paracetamol, and what happens during an overdose?
What is the primary metabolic pathway of paracetamol, and what happens during an overdose?
What direct consequence results from paracetamol overdose due to the accumulation of NAPQI?
What direct consequence results from paracetamol overdose due to the accumulation of NAPQI?
Which adverse effect is NOT typically seen with NSAIDs?
Which adverse effect is NOT typically seen with NSAIDs?
In which condition would NSAIDs need to be used with caution?
In which condition would NSAIDs need to be used with caution?
Which route of administration is specific to ketorolac?
Which route of administration is specific to ketorolac?
What is a key benefit of selective COX-2 inhibitors over non-selective NSAIDs regarding gastrointestinal adverse events?
What is a key benefit of selective COX-2 inhibitors over non-selective NSAIDs regarding gastrointestinal adverse events?
What are eicosanoids?
What are eicosanoids?
A patient with known aspirin hypersensitivity requires pain relief. Which is the safest option?
A patient with known aspirin hypersensitivity requires pain relief. Which is the safest option?
A patient on high-dose paracetamol for chronic pain necessitates monitoring of which lab value?
A patient on high-dose paracetamol for chronic pain necessitates monitoring of which lab value?
How do NSAIDs typically impact renal function?
How do NSAIDs typically impact renal function?
Which analgesic regimen poses the LEAST risk for GI complications in a patient with a history of GI ulcers?
Which analgesic regimen poses the LEAST risk for GI complications in a patient with a history of GI ulcers?
Which NSAID is available in an intravenous (IV) formulation?
Which NSAID is available in an intravenous (IV) formulation?
For a patient with a history of myocardial infarction needing analgesia for osteoarthritis, which is safest?
For a patient with a history of myocardial infarction needing analgesia for osteoarthritis, which is safest?
Which enzyme is targeted by NSAIDs in the arachidonic acid pathway to reduce inflammation and pain?
Which enzyme is targeted by NSAIDs in the arachidonic acid pathway to reduce inflammation and pain?
Why is acetaminophen preferred over NSAIDs in severe renal impairment?
Why is acetaminophen preferred over NSAIDs in severe renal impairment?
Which NSAID is known for its irreversible inhibition of COX-1?
Which NSAID is known for its irreversible inhibition of COX-1?
Which drug is used as an antidote for paracetamol overdose if administered early?
Which drug is used as an antidote for paracetamol overdose if administered early?
For which surgical scenario is aspirin typically stopped 7 days prior?
For which surgical scenario is aspirin typically stopped 7 days prior?
What is the greatest concern when administering aspirin to a 6-year-old with a viral infection?
What is the greatest concern when administering aspirin to a 6-year-old with a viral infection?
Which type of pain do non-opioid analgesics like NSAIDs and paracetamol treat most effectively?
Which type of pain do non-opioid analgesics like NSAIDs and paracetamol treat most effectively?
If a patient with heart failure is prescribed an NSAID for osteoarthritis, which adverse effect is of greatest concern?
If a patient with heart failure is prescribed an NSAID for osteoarthritis, which adverse effect is of greatest concern?
What is the primary difference between the analgesic effect of paracetamol and NSAIDs?
What is the primary difference between the analgesic effect of paracetamol and NSAIDs?
What is the main reason for the black box warning on COX-2 selective inhibitors?
What is the main reason for the black box warning on COX-2 selective inhibitors?
What adverse effect is most likely in a patient taking high-dose aspirin daily for rheumatoid arthritis?
What adverse effect is most likely in a patient taking high-dose aspirin daily for rheumatoid arthritis?
Which statement is true regarding paracetamol use during pregnancy?
Which statement is true regarding paracetamol use during pregnancy?
What is the proper course of action if a patient with a sulfonamide allergy is prescribed celecoxib?
What is the proper course of action if a patient with a sulfonamide allergy is prescribed celecoxib?
A patient takes low-dose aspirin for cardiovascular prevention and needs ibuprofen for arthritis. What is most important?
A patient takes low-dose aspirin for cardiovascular prevention and needs ibuprofen for arthritis. What is most important?
A patient shows signs of liver failure after a paracetamol overdose. After lab tests, what's the next step?
A patient shows signs of liver failure after a paracetamol overdose. After lab tests, what's the next step?
Why should aspirin be avoided in children with influenza-like symptoms?
Why should aspirin be avoided in children with influenza-like symptoms?
A researcher tests a new drug that selectively inhibits COX-1. What effect would be expected?
A researcher tests a new drug that selectively inhibits COX-1. What effect would be expected?
Which of the following best accounts for why paracetamol is considered an antipyretic?
Which of the following best accounts for why paracetamol is considered an antipyretic?
Which of the following best describes the term 'opiate'?
Which of the following best describes the term 'opiate'?
What is the significance of the year 1973 in the context of opioid pharmacology?
What is the significance of the year 1973 in the context of opioid pharmacology?
Activation of the mu (µ) opioid receptor is most likely to result in which of the following?
Activation of the mu (µ) opioid receptor is most likely to result in which of the following?
Which of the following best describes the primary location of mu (µ) opioid receptors responsible for analgesia within the central nervous system (CNS)?
Which of the following best describes the primary location of mu (µ) opioid receptors responsible for analgesia within the central nervous system (CNS)?
Which of the following is a common adverse effect directly related to opioid-induced reduced gut motility?
Which of the following is a common adverse effect directly related to opioid-induced reduced gut motility?
A patient has been taking morphine for chronic pain for several months and now requires a higher dose to achieve the same level of pain relief. This phenomenon is best described as:
A patient has been taking morphine for chronic pain for several months and now requires a higher dose to achieve the same level of pain relief. This phenomenon is best described as:
Which of the following statements accurately distinguishes between physical dependence and addiction in the context of opioid use?
Which of the following statements accurately distinguishes between physical dependence and addiction in the context of opioid use?
Which of the following is a key consideration when titrating morphine for pain management?
Which of the following is a key consideration when titrating morphine for pain management?
Morphine undergoes metabolism in the liver, primarily into which of the following metabolites?
Morphine undergoes metabolism in the liver, primarily into which of the following metabolites?
Which of the following statements is most accurate regarding the use of morphine in patients with renal impairment?
Which of the following statements is most accurate regarding the use of morphine in patients with renal impairment?
Codeine exerts its analgesic effect through which of the following mechanisms?
Codeine exerts its analgesic effect through which of the following mechanisms?
A patient is identified as a 'rapid metabolizer' of codeine. What is the primary implication of this genetic variability?
A patient is identified as a 'rapid metabolizer' of codeine. What is the primary implication of this genetic variability?
Why is codeine no longer recommended for mild to moderate acute pain?
Why is codeine no longer recommended for mild to moderate acute pain?
Which of the following best describes the mechanism by which naloxone reduces abuse potential when combined with oxycodone (Targin)?
Which of the following best describes the mechanism by which naloxone reduces abuse potential when combined with oxycodone (Targin)?
Which of the following statements regarding oxycodone is most accurate?
Which of the following statements regarding oxycodone is most accurate?
How does tramadol exert its analgesic effects?
How does tramadol exert its analgesic effects?
A patient taking tramadol should be cautioned about which of the following potential adverse effects or interactions?
A patient taking tramadol should be cautioned about which of the following potential adverse effects or interactions?
In contrast to morphine, what advantage does tramadol offer in certain clinical situations?
In contrast to morphine, what advantage does tramadol offer in certain clinical situations?
Why is tapentadol considered distinct from other opioids like morphine or oxycodone?
Why is tapentadol considered distinct from other opioids like morphine or oxycodone?
A patient with severe renal impairment requires opioid analgesia. Which of the following opioids should be used with extreme caution?
A patient with severe renal impairment requires opioid analgesia. Which of the following opioids should be used with extreme caution?
Which of the following is considered a strong opioid that is available in both immediate-release (IR) and sustained-release (SR) oral formulations, as well as an intravenous (IV) formulation?
Which of the following is considered a strong opioid that is available in both immediate-release (IR) and sustained-release (SR) oral formulations, as well as an intravenous (IV) formulation?
Methadone is particularly useful in which of the following clinical scenarios?
Methadone is particularly useful in which of the following clinical scenarios?
Why is pethidine generally avoided for pain management?
Why is pethidine generally avoided for pain management?
According to the principles of pain management, which of the following best describes a multimodal approach?
According to the principles of pain management, which of the following best describes a multimodal approach?
How does the WHO analgesia ladder guide treatment for cancer pain?
How does the WHO analgesia ladder guide treatment for cancer pain?
In the context of acute nociceptive pain management, what is the 'Reverse WHO Ladder' approach?
In the context of acute nociceptive pain management, what is the 'Reverse WHO Ladder' approach?
Which of the following strategies is most appropriate in efforts to combat the opioid epidemic?
Which of the following strategies is most appropriate in efforts to combat the opioid epidemic?
Which of the following should be considered when determining the need to prescribe opioid analgesics?
Which of the following should be considered when determining the need to prescribe opioid analgesics?
Which one of the following is the MOST likely adverse effect occurring alongside analgesia, once opioid analgesics are administered?
Which one of the following is the MOST likely adverse effect occurring alongside analgesia, once opioid analgesics are administered?
What is the most appropriate approach regarding opioid prescriptions for patients with chronic, non-cancer pain?
What is the most appropriate approach regarding opioid prescriptions for patients with chronic, non-cancer pain?
What is the most significant risk associated with indiscriminate, long-term opioid prescribing, exemplified by trends observed in the US?
What is the most significant risk associated with indiscriminate, long-term opioid prescribing, exemplified by trends observed in the US?
What is the recommended approach to manage expectations and outcomes when prescribing opioids for patients?
What is the recommended approach to manage expectations and outcomes when prescribing opioids for patients?
A patient presents with chronic, severe disabling pain that has not responded to non-opioid analgesics. Which of the following opioids would be most beneficial in this scenario?
A patient presents with chronic, severe disabling pain that has not responded to non-opioid analgesics. Which of the following opioids would be most beneficial in this scenario?
Which of the following are examples that would contribute to physical harm, regarding an opioid's addictive qualities?
Which of the following are examples that would contribute to physical harm, regarding an opioid's addictive qualities?
Opioid induced constipation can result from:
Opioid induced constipation can result from:
A very rare but harmful side effects that can occur with some opioid analgesics are:
A very rare but harmful side effects that can occur with some opioid analgesics are:
What are some symptoms that a patient might expect when stopping opioid analgesics?
What are some symptoms that a patient might expect when stopping opioid analgesics?
Understanding the implications of opioid usage is important for patients. Which of the following statements embodies the best description of opioid tolerance:
Understanding the implications of opioid usage is important for patients. Which of the following statements embodies the best description of opioid tolerance:
Following abdominal surgery, a patient reports a pain level of 7 out of 10. The patient chart shows codeine is suitable. What considerations are necessary before administering?
Following abdominal surgery, a patient reports a pain level of 7 out of 10. The patient chart shows codeine is suitable. What considerations are necessary before administering?
Following abdominal surgery, a patient reports a pain level of 7 out of 10. What would be the next step to assist this patient?
Following abdominal surgery, a patient reports a pain level of 7 out of 10. What would be the next step to assist this patient?
What is the defining characteristic of an 'opiate'?
What is the defining characteristic of an 'opiate'?
Which of the following is a crucial characteristic of opioid receptors?
Which of the following is a crucial characteristic of opioid receptors?
Which of the following is a commonly reported effect associated with mu (µ) opioid receptor activation?
Which of the following is a commonly reported effect associated with mu (µ) opioid receptor activation?
Opioid receptors are located in what part of the brain?
Opioid receptors are located in what part of the brain?
What is the primary implication of opioid effects being dose-dependent?
What is the primary implication of opioid effects being dose-dependent?
In the context of opioid use, what does 'tolerance' specifically refer to?
In the context of opioid use, what does 'tolerance' specifically refer to?
Which of the following differentiates physical dependence from addiction in opioid use?
Which of the following differentiates physical dependence from addiction in opioid use?
Which action will reduce physical harm from an opioiod's addictive qualties?
Which action will reduce physical harm from an opioiod's addictive qualties?
What is the recommended strategy to avoid precipitating withdrawal symptoms when discontinuing opioids?
What is the recommended strategy to avoid precipitating withdrawal symptoms when discontinuing opioids?
What is a symptom a patient is likely to experience when they have stopped opioid analgesics?
What is a symptom a patient is likely to experience when they have stopped opioid analgesics?
How can opioid-induced constipation be explained?
How can opioid-induced constipation be explained?
A very rare harmful side effect that can occur with some opioid analgesics is:
A very rare harmful side effect that can occur with some opioid analgesics is:
Which of the following is the primary route of morphine metabolism?
Which of the following is the primary route of morphine metabolism?
A patient with severe hepatic impairment requires opioid analgesia. Which of the following would be the MOST appropriate initial action?
A patient with severe hepatic impairment requires opioid analgesia. Which of the following would be the MOST appropriate initial action?
What is the mechanism by which codeine exerts its analgesic effect?
What is the mechanism by which codeine exerts its analgesic effect?
What is the implication of identifying a patient as a 'rapid metabolizer' of codeine?
What is the implication of identifying a patient as a 'rapid metabolizer' of codeine?
What best describes a drug that is a prodrug?
What best describes a drug that is a prodrug?
Why is codeine no longer the top analgesic to use for mild to moderate acute pain in some guidelines?
Why is codeine no longer the top analgesic to use for mild to moderate acute pain in some guidelines?
A child is prescribed codeine for pain relief after a tonsillectomy. The parents are concerned about potential side effects. What is the MOST important consideration?
A child is prescribed codeine for pain relief after a tonsillectomy. The parents are concerned about potential side effects. What is the MOST important consideration?
What distinguishes Targin®, a controlled-release formulation of oxycodone with naloxone, from other oxycodone formulations?
What distinguishes Targin®, a controlled-release formulation of oxycodone with naloxone, from other oxycodone formulations?
Adverse effects similar to which one, can occur when taking oxycodone?
Adverse effects similar to which one, can occur when taking oxycodone?
What is a unique mechanism of action of tramadol, compared to traditional opioids?
What is a unique mechanism of action of tramadol, compared to traditional opioids?
In comparison to morphine, what is an advantage tramadol may offer in clinical settings?
In comparison to morphine, what is an advantage tramadol may offer in clinical settings?
Under which conditions would you be cautious of while treating a patient with Tramadol?
Under which conditions would you be cautious of while treating a patient with Tramadol?
Tapentadol has a unique mechanism of action with?
Tapentadol has a unique mechanism of action with?
A patient with which condition, would you want to be cautious when treating with Tapentadol?
A patient with which condition, would you want to be cautious when treating with Tapentadol?
Which strong opioid has good parental and mucosal absorption but ineffective as an oral route?
Which strong opioid has good parental and mucosal absorption but ineffective as an oral route?
Which of the following is a key characteristic that makes methadone distinct from other strong opioids?
Which of the following is a key characteristic that makes methadone distinct from other strong opioids?
What does 'multimodal analgesia' involve?
What does 'multimodal analgesia' involve?
What is the primary focus of the WHO analgesia ladder?
What is the primary focus of the WHO analgesia ladder?
In the context of the WHO Analgesia Ladder, what is the 'Reverse WHO Ladder' approach primarily used for?
In the context of the WHO Analgesia Ladder, what is the 'Reverse WHO Ladder' approach primarily used for?
What is MOST suggestive of opioid tolerance?
What is MOST suggestive of opioid tolerance?
What is the underlying cause of the opioid epidemic that has been seen in the US?
What is the underlying cause of the opioid epidemic that has been seen in the US?
What are important aspect(s) can we 'do' to combat opioid prescribing and abuse?
What are important aspect(s) can we 'do' to combat opioid prescribing and abuse?
Which is an appropriate opioid prescription for patients with chronic, non-cancer pain?
Which is an appropriate opioid prescription for patients with chronic, non-cancer pain?
Following abdominal surgery, a patient reports a pain level of 7 out of 10 and the patient chart shows codeine is suitable. What should happen next?
Following abdominal surgery, a patient reports a pain level of 7 out of 10 and the patient chart shows codeine is suitable. What should happen next?
Consider a patient that cannot be orally medicated, and is suffering severe pain. Which of the following analgesics could assist?
Consider a patient that cannot be orally medicated, and is suffering severe pain. Which of the following analgesics could assist?
Which opioid, if any, can be useful for neuropathic pain?
Which opioid, if any, can be useful for neuropathic pain?
According to the International Association for the Study of Pain (IASP), which statement defines pain?
According to the International Association for the Study of Pain (IASP), which statement defines pain?
What is the primary differentiating factor between nociceptive and neuropathic pain?
What is the primary differentiating factor between nociceptive and neuropathic pain?
Neuropathic pain is best described as:
Neuropathic pain is best described as:
When diagnostic investigations reveal an abnormality or there is obvious trauma associated with neuropathic pain, the term most commonly used is:
When diagnostic investigations reveal an abnormality or there is obvious trauma associated with neuropathic pain, the term most commonly used is:
For neuropathic pain, if the underlying reason for the 'lesion' is known, the appropriate term to use would be:
For neuropathic pain, if the underlying reason for the 'lesion' is known, the appropriate term to use would be:
What percentage of Australians aged 45 and over are estimated to have a chronic pain condition?
What percentage of Australians aged 45 and over are estimated to have a chronic pain condition?
Which of the following statements is true regarding chronic pain?
Which of the following statements is true regarding chronic pain?
What percentage of Australians are estimated to have neuropathic pain?
What percentage of Australians are estimated to have neuropathic pain?
How can intensively treating the disease process relate to the paradoxes of neuropathic pain?
How can intensively treating the disease process relate to the paradoxes of neuropathic pain?
Which describes a paradox of neuropathic pain?
Which describes a paradox of neuropathic pain?
When prescribing medication for neuropathic pain, what is the best approach to determine therapeutic benefit?
When prescribing medication for neuropathic pain, what is the best approach to determine therapeutic benefit?
What should you consider when prescribing for neuropathic pain?
What should you consider when prescribing for neuropathic pain?
What strategy is the best component of a multidimensional management plan?
What strategy is the best component of a multidimensional management plan?
When assessing a patient, which of the following characteristics would be associated with neuropathic pain?
When assessing a patient, which of the following characteristics would be associated with neuropathic pain?
When assessing a patient, which of the following sensations would be associated with neuropathic pain?
When assessing a patient, which of the following sensations would be associated with neuropathic pain?
What is the definition of allodynia?
What is the definition of allodynia?
What best describes hyperaesthesia?
What best describes hyperaesthesia?
Which of the following medications would be considered first-line treatments for neuropathic pain?
Which of the following medications would be considered first-line treatments for neuropathic pain?
What is the mechanism of action of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)?
What is the mechanism of action of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)?
Duloxetine and Venlafaxine are?
Duloxetine and Venlafaxine are?
An important element to consider, regarding SRNIs, is?
An important element to consider, regarding SRNIs, is?
What is a common adverse effect to Seretonin Syndrome?
What is a common adverse effect to Seretonin Syndrome?
What is especially important to note with Amitriptyline?
What is especially important to note with Amitriptyline?
How are Tricyclic Antidepressants (TCAs) used in treatment?
How are Tricyclic Antidepressants (TCAs) used in treatment?
What is a primary mechanism of action?
What is a primary mechanism of action?
Which factor significantly affect the pharmacokinetics of gabapentin?
Which factor significantly affect the pharmacokinetics of gabapentin?
What is the time to effective dose using recommended titrations?
What is the time to effective dose using recommended titrations?
A patient has gait disturbances and also visual blurring, which adverse effect may they be experiencing?
A patient has gait disturbances and also visual blurring, which adverse effect may they be experiencing?
Gabapentinoids has which notable effect? (select all that apply)
Gabapentinoids has which notable effect? (select all that apply)
Withdrawal symptoms for Gabapentinoids is...
Withdrawal symptoms for Gabapentinoids is...
A patient with chronic kidney disease is experiencing toxicity signs, what could be prescribed to cause this?
A patient with chronic kidney disease is experiencing toxicity signs, what could be prescribed to cause this?
Which is not an off-label use of gabapentinoids?
Which is not an off-label use of gabapentinoids?
Which of the following is a characteristic of lidocaine patches?
Which of the following is a characteristic of lidocaine patches?
Which is the method of action for Lidocaine Patches?
Which is the method of action for Lidocaine Patches?
Capsaicin is highly selective to what?
Capsaicin is highly selective to what?
Capsaicin has been shown to be efficacious for neuropathic pain, what other conditions?
Capsaicin has been shown to be efficacious for neuropathic pain, what other conditions?
Tramadol differs from traditional Opioid Analgesics by:
Tramadol differs from traditional Opioid Analgesics by:
What contributes to why tramadol is prescribed?
What contributes to why tramadol is prescribed?
Which medications must CYP2D6 be concerned with?
Which medications must CYP2D6 be concerned with?
What is the most important takeaway message to remember when assessing neuropathic pain?
What is the most important takeaway message to remember when assessing neuropathic pain?
What differentiates an opiate from an opioid?
What differentiates an opiate from an opioid?
In what year were opioid receptors first discovered?
In what year were opioid receptors first discovered?
What is the direct result of opioid agonists binding to receptors?
What is the direct result of opioid agonists binding to receptors?
Which of the following effects is primarily associated with the activation of the mu (µ) opioid receptor?
Which of the following effects is primarily associated with the activation of the mu (µ) opioid receptor?
Which opioid receptor primarily leads to sedation and depression?
Which opioid receptor primarily leads to sedation and depression?
Besides the brainstem, where in the CNS are mu receptors responsible for analgesia most concentrated?
Besides the brainstem, where in the CNS are mu receptors responsible for analgesia most concentrated?
What is the most common dose-dependent adverse effect of opioid analgesia?
What is the most common dose-dependent adverse effect of opioid analgesia?
Following long term use of opioid analgesics, what statement defines opioid tolerance?
Following long term use of opioid analgesics, what statement defines opioid tolerance?
Which of the following is primarily attributed to physical dependence rather than addiction?
Which of the following is primarily attributed to physical dependence rather than addiction?
What is the primary consideration when titrating morphine?
What is the primary consideration when titrating morphine?
Which statement most accurately describes the use of morphine in patients with renal impairment?
Which statement most accurately describes the use of morphine in patients with renal impairment?
What is the process by which codeine exerts its analgesic effect?
What is the process by which codeine exerts its analgesic effect?
The statement best describes the implications of a patient being identified as a 'rapid metabolizer' of codeine?
The statement best describes the implications of a patient being identified as a 'rapid metabolizer' of codeine?
What is the rationale for administering naloxone with oxycodone?
What is the rationale for administering naloxone with oxycodone?
Besides opioid agonism, how does tramadol exhibit its analgesic effects?
Besides opioid agonism, how does tramadol exhibit its analgesic effects?
What is a potential adverse effect of tramadol?
What is a potential adverse effect of tramadol?
Why might tramadol be preferable to morphine in certain clinical settings?
Why might tramadol be preferable to morphine in certain clinical settings?
In what patient population would taking Tramadol require caution?
In what patient population would taking Tramadol require caution?
How does Tapentadol relieve pain?
How does Tapentadol relieve pain?
What is the most important to consider when administering Tapentadol?
What is the most important to consider when administering Tapentadol?
In what specific clinical scenario is methadone particularly useful?
In what specific clinical scenario is methadone particularly useful?
What is the best example of multimodal approach to pain management?
What is the best example of multimodal approach to pain management?
How is the 'Reverse WHO Ladder' approach best applied in pain management?
How is the 'Reverse WHO Ladder' approach best applied in pain management?
Consider the strategies a physician can implement to improve combating the opioid use epidemic. Which one has the ability to create the greatest impact?
Consider the strategies a physician can implement to improve combating the opioid use epidemic. Which one has the ability to create the greatest impact?
Which of the following is MOST important when prescribing opioid analgesics?
Which of the following is MOST important when prescribing opioid analgesics?
For a patient with chronic, non-cancer pain, what approach should be considered with opioid prescriptions?
For a patient with chronic, non-cancer pain, what approach should be considered with opioid prescriptions?
What would opioid tolerance be described as?
What would opioid tolerance be described as?
What is a rare but harmful side effect that can occur with some opioid analgesics?
What is a rare but harmful side effect that can occur with some opioid analgesics?
What is the next immediate step after abdominal surgery when a patient reports a pain level of 7 out of 10?
What is the next immediate step after abdominal surgery when a patient reports a pain level of 7 out of 10?
Which opioid is known for having no active metabolites?
Which opioid is known for having no active metabolites?
In cases of chronic cancer pain requiring strong opioid analgesia, which of the following would be most suitable according to the WHO analgesia ladder?
In cases of chronic cancer pain requiring strong opioid analgesia, which of the following would be most suitable according to the WHO analgesia ladder?
The accumulation of which primary metabolite of morphine is of particular concern in patients with decreasing renal function?
The accumulation of which primary metabolite of morphine is of particular concern in patients with decreasing renal function?
Which of the following best describes the mechanism by which tolerance to the emetic effects of morphine develops?
Which of the following best describes the mechanism by which tolerance to the emetic effects of morphine develops?
Which of the following accurately describes the role of delta (δ) opioid receptors?
Which of the following accurately describes the role of delta (δ) opioid receptors?
A researcher discovers a novel compound that selectively activates opioid receptors on peripheral sensory neurons but does not cross the blood-brain barrier. What effect would this drug likely have?
A researcher discovers a novel compound that selectively activates opioid receptors on peripheral sensory neurons but does not cross the blood-brain barrier. What effect would this drug likely have?
A patient with a known history of seizures is experiencing severe, chronic pain. Which opioid analgesic would be MOST contraindicated, and why?
A patient with a known history of seizures is experiencing severe, chronic pain. Which opioid analgesic would be MOST contraindicated, and why?
Flashcards
Pain
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Nociceptive Pain
Nociceptive Pain
Pain arising from actual or threatened damage to non-neural tissue due to activation of nociceptors.
Neuropathic Pain
Neuropathic Pain
Pain caused by a lesion or disease of the somatosensory nervous system.
Allodynia
Allodynia
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Hyperaesthesia
Hyperaesthesia
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SNRIs
SNRIs
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SNRI Mechanism
SNRI Mechanism
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SNRI Pharmacokinetics
SNRI Pharmacokinetics
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SNRI Adverse Effects
SNRI Adverse Effects
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TCAs
TCAs
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Amitriptyline Pharmacokinetics
Amitriptyline Pharmacokinetics
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Amitriptyline Adverse Effects
Amitriptyline Adverse Effects
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Gabapentinoids
Gabapentinoids
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Gabapentinoid Pharmacokinetics
Gabapentinoid Pharmacokinetics
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Gabapentinoid CNS Adverse Effects
Gabapentinoid CNS Adverse Effects
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Gabapentinoid Respiratory Depression
Gabapentinoid Respiratory Depression
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Gabapentinoid Withdrawal Symptoms
Gabapentinoid Withdrawal Symptoms
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Gabapentinoid Toxicity
Gabapentinoid Toxicity
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Lidocaine Patch Mechanism
Lidocaine Patch Mechanism
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Capsaicin Mechanism
Capsaicin Mechanism
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Tramadol
Tramadol
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Study Notes
Pain
- Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage as classified by IASP
- Two broad categories of pain include Nociceptive and Neuropathic
Nociceptive Pain
- Nociceptive pain arises from actual or threatened damage to non-neural tissue
- This pain is caused by the activation of nociceptors
- Subcategories of nociceptive pain include somatic and visceral pain
Neuropathic Pain
- Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system
- Neuropathic pain is a clinical description and not a diagnosis
- A demonstrable lesion or disease must satisfy established neurological diagnostic criteria for neuropathic pain
- The term "lesion" refers to an abnormality revealed by diagnostic investigations or obvious trauma
- The term "disease" is used when the underlying cause of the lesion is known
Relevance of Chronic Pain
- 1 in 5 Australians aged 45 and over have a chronic pain condition
- People with chronic pain are more likely to be female, older, have long-term conditions, stay longer in hospital, and report limitations to daily activities
- 7-10% of Australians have neuropathic pain (AIHW 2020)
Paradoxes of Neuropathic Pain
- Neuropathic pain may be a consequence of a disease process
- Intensively treating that disease process may be associated with worse outcomes
- For example, diabetes mellitus intensive blood sugar management with insulin regimens where patients may have a hypoglycaemic episode
- Neuropathic pain may also be a consequence of a disease treatment
- Ceasing that treatment may have long-term consequences
- This may be exemplified by HIV infection where HIV-associated pneumocystic pneumonia treatment can cause psychiatric pain but if stopped can result in Kaposi sarcoma developing
Prescribing Principles for Neuropathic Pain
- Prescribing for neuropathic pain recommends using a targeted history and physical examination
- Consider using a validated screening tool (e.g., DN4) to diagnose neuropathic pain and determine therapeutic approach
- If neuropathic pain is not adequately managed with non-pharmacological approaches, select a medicine based on individual patient factors and medicine properties
- Optimize benefits by starting with a low dose and titrating slowly, assessing response in relation to individual treatment goals
- Recognize medicines often have limited effectiveness and that non-pharmacological strategies are a key component of a multidimensional management plan
- Assess for potentially dangerous interactions and discuss the risks associated with their medicines with patients
Allodynia
- Allodynia is pain due to a stimulus that does not normally provoke pain
- This stimulus leads to an unexpectedly painful response
- Allodynia is a clinical term that does not imply a mechanism
- The original modality is normally nonpainful, but the response is painful
- Allodynia involves a change in the quality of a sensation, whether tactile, thermal, or of any other sort
Hyperaesthesia
- Hyperaesthesia is increased pain from a stimulus that usually provokes pain
- Hyperaesthesia may refer to various modes of cutaneous sensibility including touch and thermal sensation without pain, as well as to pain
- The word is used to indicate both diminished threshold to any stimulus and an increased response to stimuli that are normally recognized
First-Line Drugs
- Drugs used as first-line treatments include: SNRI's like duloxetine and venlafaxine
- Tricyclic antidepressants like amitriptyline,
- Gabapentin,
- Pregabalin.
SNRI
- SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) are a class of antidepressant drugs
- They may be used to treat major depressive disorder (MDD), anxiety disorders, obsessive–compulsive disorder (OCD), social phobia, attention-deficit hyperactivity disorder (ADHD), chronic neuropathic pain, fibromyalgia syndrome (FMS), and menopausal symptoms
- SNRIs inhibit the presynaptic neuronal uptake of 5-HT (serotonin) and norepinephrine following release from the synaptic cleft leading to increased persistence of monoamines in the cleft
SNRIs for Neuropathic Pain
- Venlafaxine and duloxetine are SNRIs used in neuropathic pain
- Venlafaxine inhibits serotonin more than norepinephrine, with both having initial influence on serotonin then norepinephrine, reflecting the side effect profile
SNRI Pharmacokinetics
- SNRIs are mainly hepatically excreted through P-450
- Both SNRIs have formulations allowing once daily dosing
- SNRI half life is approximately 12 hours
- Recommendations include an initial low dose to avoid side effects
- Doses should be reduced incrementally rather than sudden cessation to avoid rebound effects
SNRI Adverse Effects
- General adverse effects include nausea and vomiting, constipation, dizziness, insomnia, fatigue, and headache
- Sexual dysfunction may include low libido, erectile dysfunction, and anorgasmia
- Serotonin Syndrome" can occur, usually when prescribed with another drug altering serotonin levels
Tricyclic Antidepressants (TCAs)
- TCAs include amitriptyline, imipramine, doxepin, dothiepin, and nortriptyline
- TCAs were for many years primary treatment for depression, but are now replaced with drugs classes with safer profiles
- TCAs are used in lower doses for neuropathic pain than for depression, offering better tolerated side effects
Amitriptyline
- Amitriptyline has large first pass metabolism
- Amitriptyline bioavailability is ~50%
- Maximum blood levels occur in 4 hours
- Amitriptyline has active metabolites
- The elimination half life is 21 hours
Amitriptyline Adverse Effects
- In general, amitriptyline adverse effects are similar to that of SNRIs
- Amitriptyline generally results in a transient increase in liver function tests (LFTs)
- Amitriptyline prolongs the QT interval, creating a risk of arrhythmias
- An overdose of amitriptyline cases significant electrocardiac abnormalities
Gabapentinoids
- Gabapentinoids consists of gabapentin and pregabalin
- Gabapentinoids bind to α2δ ligands and Ca2+ α2δ ligands and are GABA analogues
- Gabapentinoids were originally developed as anti-epileptics
- They serve as first line treatment of neuropathic pain
- Gabapentinoids block α2δ subunit-containing voltage-dependent calcium channels
- Mechanisms of action for Gabapentinoids remain unclear
- Gabapentinoids use is increasing off-label
Gabapentinoid Pharmacokinetics
- What matters most is that Gabapentinoids have minimal metabolism: They are excreted renally
- Time to effective dose using recommended titrations is 14 days for gabapentin and 7 days for pregabalin
Gabapentinoid Adverse Effects
- Cause discontinuation in 11% of patients, but serious adverse effects are very infrequent
Gabapentinoid CNS Adverse Effects
- Central nervous system adverse effects include dizziness (19%), somnolescence (14%), gait disturbances (14%), and visual blurring (7%)
- Other adverse effects include impaired concentration, confusion, memory loss, altered mood, movement disorders, sleep disorder, speech impairment, and vertigo
- Most side effects are dose dependent
- The adverse effects includes needing to be warned re driving and operating machinery
- Commencement of initial dosage at night is recommended
- The effects often occur during the initiation of treatment and can diminish after several weeks of treatment
Gabapentinoid Respiratory Depression
- Respiratory depression is often described when used in combination with opioids, it also causes and increased risk of opioid related mortality
- Approximately 20-25% of patients newly prescribed gabapentinoids are already prescribed opioids
- Dose adjustment is required in patients with compromised respiratory function, respiratory or neurological disease, renal impairment, concomitant use of CNS depressants, and for the elderly
Gabapentinoid Withdrawal Symptoms
- Gabapentinoid withdrawal symptoms are common
- They generally occur within 12 hours and 7 days, most frequently within 24-48 hrs
- Symptoms include agitation in >50% of patients
- Confusion and disorientation in 45%
- Other symptoms are similar to benzodiazepine and alcohol withdrawal
- Impacts are worse in elderly
- Tapering reduction in dosage (e.g. twice weekly reduction of 10-25% of dosage) minimises risks of withdrawal from Gabapentinoids
Gabapentinoid Toxicity
- Concerns include accidental vs intentional toxicity
- More common in patients with renal disease
- Higher risk in patients on dialysis
- Symptoms and signs include increased sedation, confusion, unsteady gait, myoclonus, ataxia, episodic leg spasm, asterixis and tremulousness
- Treatment generally supportive
Topical Treatments
- A key option can be topical treatments
- Lidocaine is a key compound
Lidocaine
- Lidocaine (lignocaine, Xylocaine ®) patches were Discovered in 1948
- Primary Use: As a local anaesthetic
- Secondary Use: As an antiarrhythmic and neonatal antiepileptic agent
- Has many OTC uses
Lidocaine Patches
- Were made possible by developments in drug delivery technology
- Administered with a 12 hours on and 12 hours off Schedule
- Designed to block sensitized Na+ channels in nociceptors
- May also inhibit NO production and regulate T-cell activity
- Also offers, A possible central feedback signal
- Should be implemented with: Correct patient selection
- Analgesic effects, which are likely to appear quickly (v. up to 6 weeks for oral treatments)
- But will NOT lead to, cutaneous anaesthesia
- The approach results in being able to, Reduce treatment frequency
- Has a low risk of, Broken skin where it increases- increased risk of lidocaine toxicity
- Generally is well tolerated
- They should be used with: Correct patient selection + Analgesic effects likely to appear quickly (v. up to 6 weeks for oral treats) = the approach will- will NOT lead to cutaneous anaesthesia ➜ reduces treatment frequency but Beware:broken skin – increased risk of lidocaine toxicity + well tolerated
Capsaicin
- Capsaicin methods effects - Transient receptor potential vanilloid-1 (TRPV-1),
- A thermal nociceptor, which plays an important role in the detection of painful stimuli such as heat, acids and irritant chemicals as:
- a potent and highly selective TRPV-1 agonist
- Activation happens initially with: TRPV-1-expressing nociceptors on the skin, resulting in erythema
- With continued exposure, the nociceptors become less sensitive and no longer respond to capsaicin or various other stimuli
- And finally resulting generally in Single applications with may have long term effects
Capsaicin Indications
- Method provides for Relieves pain and improves sleep quality in patients with painful diabetic peripheral neuropathy + Provides rapid and sustained pain relief in patients with postherpetic neuralgia + Efficacious (less evidence) in neuropathic pains; post-traumatic, post-surgical, polyneuropathy, chemotherapy-induced, lumbosacral 4 ➜ Pelvic Neuralgia and critical ischaemia and refractory neuropathic pain and neurofibromatosis and Phantom Pain
Tramadol
- Tramadol is considered a mongrel of a drug
- Tramadol is often classified with opioids, but structurally is not an opioid Has actions on what
- acts on the Mu opioid receptor
- The effects are not completely reversed by naloxone, as the action is that of a non-selective and competitive opioid receptor antagonist
- It is of a Racaemic mixture (+)-tramadol has: greater affinity for μ-opioid receptor and additional prevention of 5- hydroxy tryptamine reuptake (-)-tramadol: leads to successful noradrenaline reuptake inhibitor and further intensifies its release
Administration: Prescribed?
- Less potent and less abuse potentia
- It causes a lower respiratory depression with however can be prescribed for respiratory depression.
- Available in both IR and SR preparations
Caution: Problems?
- Undergoes Metabolised by CYP2D6 to an active metabolite:
- Genetic variations must be considered
- Medications with; TCA.MAOI 3 ➜ SNRI.SSRI 5 ➜BDZ . alcohol should also be factored in.
- Be careful of Epilepsy, factors that could cause Seizures, other genetics
Take Home Messages
- Neuropathic pain is common, and often misdiagnosed
- There are limited treatments, but treatment is relatively successful
- Follow the principles and you won't get into strife
- Make the most of acute and chronic pain services within hospitals (both public and private)
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