Podcast
Questions and Answers
What is one of the primary objectives in drug administration for analgesics and anti-inflammatory drugs?
What is one of the primary objectives in drug administration for analgesics and anti-inflammatory drugs?
Which class of drugs is primarily used to treat severe pain by acting on the central nervous system?
Which class of drugs is primarily used to treat severe pain by acting on the central nervous system?
What is emphasized as a better approach to pain management?
What is emphasized as a better approach to pain management?
What type of analgesics are primarily used to manage mild to moderate pain?
What type of analgesics are primarily used to manage mild to moderate pain?
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Which drug combination is used for treating severe pain?
Which drug combination is used for treating severe pain?
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What is the primary pharmacologic action of codeine in the central nervous system?
What is the primary pharmacologic action of codeine in the central nervous system?
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Which patient population should receive caution when prescribed codeine due to a risk of respiratory depression?
Which patient population should receive caution when prescribed codeine due to a risk of respiratory depression?
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Which of the following is a contraindication for using codeine?
Which of the following is a contraindication for using codeine?
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What is a common side effect of codeine when used as a cough suppressant?
What is a common side effect of codeine when used as a cough suppressant?
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Why should codeine be avoided in patients with a strong cough reflex?
Why should codeine be avoided in patients with a strong cough reflex?
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What effect does codeine have on mucous membranes?
What effect does codeine have on mucous membranes?
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For which adverse effect should patients be monitored when taking higher doses of codeine?
For which adverse effect should patients be monitored when taking higher doses of codeine?
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When is codeine most effective for pain management?
When is codeine most effective for pain management?
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Which of the following is NOT a chemical class of Non-Steroidal Anti-Inflammatory Agents (NSAIDs)?
Which of the following is NOT a chemical class of Non-Steroidal Anti-Inflammatory Agents (NSAIDs)?
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What is a common risk associated with all NSAIDs regardless of their COX preference?
What is a common risk associated with all NSAIDs regardless of their COX preference?
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What is the maximum recommended daily dose of Acetylsalicylic acid (Aspirin)?
What is the maximum recommended daily dose of Acetylsalicylic acid (Aspirin)?
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Which of the following actions does Acetylsalicylic acid (Aspirin) NOT perform?
Which of the following actions does Acetylsalicylic acid (Aspirin) NOT perform?
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Which condition is a contraindication for using Acetylsalicylic acid (Aspirin)?
Which condition is a contraindication for using Acetylsalicylic acid (Aspirin)?
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In which group should Aspirin be used with caution due to potential severe reactions?
In which group should Aspirin be used with caution due to potential severe reactions?
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What is the primary mechanism by which Aspirin exerts its analgesic effects?
What is the primary mechanism by which Aspirin exerts its analgesic effects?
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What is one of the adverse effects associated with mild aspirin toxicity, known as salicylism?
What is one of the adverse effects associated with mild aspirin toxicity, known as salicylism?
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Which condition is a contraindication for the use of acetaminophen?
Which condition is a contraindication for the use of acetaminophen?
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What is the recommended treatment for acetaminophen overdose?
What is the recommended treatment for acetaminophen overdose?
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Which patient group is more susceptible to hepatotoxicity from acetaminophen?
Which patient group is more susceptible to hepatotoxicity from acetaminophen?
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Which precaution should be taken for patients taking acetaminophen?
Which precaution should be taken for patients taking acetaminophen?
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Acetaminophen is considered the drug of choice for which population?
Acetaminophen is considered the drug of choice for which population?
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What common adverse effect may result from high doses or prolonged use of acetaminophen?
What common adverse effect may result from high doses or prolonged use of acetaminophen?
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What is the primary method to minimize adverse effects while taking Etanercept?
What is the primary method to minimize adverse effects while taking Etanercept?
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Which assessment is crucial before administering acetaminophen?
Which assessment is crucial before administering acetaminophen?
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Which of the following conditions is NOT an indication for Etanercept therapy?
Which of the following conditions is NOT an indication for Etanercept therapy?
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Patients on warfarin need to be cautious with acetaminophen because:
Patients on warfarin need to be cautious with acetaminophen because:
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What is the most serious adverse effect associated with Etanercept?
What is the most serious adverse effect associated with Etanercept?
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Which patient education point is crucial for someone taking Etanercept?
Which patient education point is crucial for someone taking Etanercept?
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How is Colchicine typically administered?
How is Colchicine typically administered?
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What should be monitored closely due to Etanercept's black box warning?
What should be monitored closely due to Etanercept's black box warning?
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What is a major contraindication for the use of Etanercept?
What is a major contraindication for the use of Etanercept?
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Which vitamin is recommended to minimize adverse effects in patients taking certain medications mentioned?
Which vitamin is recommended to minimize adverse effects in patients taking certain medications mentioned?
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Study Notes
Drugs Treating Severe Pain
- Morphine with naloxone and codeine are used for pain management.
- Pain therapy aims to either correct the pathophysiology causing pain, reduce the pain response itself, or prevent pain.
- It is easier to prevent pain than treat it, and it's more effective to treat pain at a lower level.
Opioid Analgesics: Codeine
- Codeine acts on the central nervous system to interfere with the pain experience.
- It produces analgesia, euphoria, and sedation.
- Codeine suppresses the cough reflex by acting directly on the medullary cough center.
- It has a drying effect on mucous membranes.
Codeine Contraindications
- Avoid combining codeine with other narcotics.
- Use caution in patients who need to cough to maintain their airways.
- Use caution in patients with pre-existing heart conditions due to the potential for bradycardia and vasodilation.
- Exercise caution during pregnancy and lactation.
- Use cautiously in patients who have experienced a head injury or craniotomy to avoid increasing intracranial pressure.
Codeine Adverse Effects
- As a cough suppressant: drowsiness, sedation, dry mouth, nausea, vomiting, and constipation.
- As an analgesic: similar to morphine but less severe.
- Allergic reactions: rashes and urticaria have been reported in highly sensitive individuals.
- Respiratory and Cardiovascular Effects: can occur with higher doses.
Non Steroidal Anti- Inflammatory Agents
- There are various chemical classes of NSAIDs including propionic acids, acetic acids, fenamates, oxicams, and COX-2 inhibitors.
- All NSAIDs inhibit COX (cyclooxygenase) and prostaglandin synthesis.
- All NSAIDs carry a black box warning stating they increase the risk of myocardial infarction and stroke, regardless of COX-1 or COX-2 preference.
Acetylsalicylic Acid (Aspirin)
- Systemic class: Nonsteroidal anti-inflammatory drugs (NSAIDs) - Salicylates.
- Prototype drug: Acetylsalicylic acid (Aspirin).
Acetylsalicylic Acid (Aspirin) Pharmacotherapeutic Uses
- Relieves mild to moderate pain related to inflammation.
- It can help with arthritis, rheumatoid arthritis, headaches, myalgia, arthralgia, dental or oral surgery pain.
- Treats fever.
- Useful for treating pericarditis in patients with systemic lupus erythematosus (SLE)
- Helps prevent myocardial infarction, transient ischemic attacks (TIAs), and cerebrovascular accidents (CVAs)
- Maximum recommended daily dose is 4 grams.
Acetylsalicylic Acid (Aspirin) Pharmacodynamics
- Antipyretic effects: inhibit prostaglandin E2 (PGE2) synthesis in the hypothalamus.
- Anti-inflammatory action: inhibit prostaglandin synthesis.
- Analgesic effects: inhibit COX2 resulting in decreased prostaglandin production.
- Antiplatelet action: irreversibly inhibits thromboxane A2, a prostaglandin that induces platelet aggregation.
Acetylsalicylic Acid (Aspirin) Pharmacokinetics
- Absorbed within 30 minutes in the stomach, but most is absorbed in the small intestine.
- Crosses the milk-blood barrier and placenta.
- Metabolized by the liver into salicylate and other metabolites.
- Half-life: 15 minutes for aspirin, while the half-life of salicylate is 2 hours.
- Excreted through the kidneys.
Acetylsalicylic Acid (Aspirin) Contraindications
- Salicylate hypersensitivity.
- Peptic ulcer or bleeding disorders.
- Anticoagulation therapy.
- Pregnancy, labor, and breastfeeding.
- Gout and those with renal or liver impairment.
- Children with varicella or flu-like illness due to the risk of Reye syndrome.
- Smokers and alcohol abusers.
Acetylsalicylic Acid (Aspirin) Precautions
- Use caution in patients with:
- Asthma
- Nasal polyps
- Hyperuricemia
- Older than 60 years
- Individuals taking corticosteroids.
Acetylsalicylic Acid (Aspirin) Adverse Effects
- Salicylism (mild aspirin toxicity): headache, dizziness, tachypnea, gastrointestinal distress.
Acetaminophen (Tylenol) Contraindications
- Active hepatic disease and viral hepatitis.
- Chronic malnutrition.
- Severe hypovolemia or alcoholism.
- Renal impairment.
Acetaminophen (Tylenol) Precautions
- Patients with pre-existing anemia.
- Patients taking warfarin.
- Pregnant or lactating women.
Acetaminophen (Tylenol) Adverse Effects
- Generally well tolerated.
- Adverse effects are more common with high doses or long-term use.
- Hepatotoxicity and hepatic necrosis.
- Renal toxicity and potential for acute renal failure (ARF).
- Overdose is potentially fatal and requires urgent medical management with acetylcysteine as an antidote.
Etanercept (Abatacept)
- Systemic class: Tumor necrosis factor inhibitors.
- Prototype drug: Etanercept.
- Disease-modifying antirheumatic drug (DMARD), often used in combination with methotrexate to slow RA progression.
Etanercept (Abatacept) Pharmacotherapeutic & Pharmacokinetic Uses
- Used for Rheumatoid arthritis (RA), active polyarticular course juvenile idiopathic RA, psoriatic arthritis, ankylosing spondylitis, and psoriasis.
- Administered via weekly subcutaneous injections.
- Has a slow onset of action.
Etanercept (Abatacept) Pharmacodynamics
- In RA, TNF (inflammatory mediators) are released by T cells.
- Etanercept binds to circulating TNF, preventing it from binding to TNF receptors on cell membranes.
Etanercept (Abatacept) Contraindications
- Immunosuppression
- Poorly controlled diabetes mellitus (DM)
- Active infection
- Hypersensitivity
Etanercept (Abatacept) Adverse Effects
- Most Common: Nausea, headache, upper respiratory infections, injection site reactions.
- Most Serious: Upper respiratory tract (URT) infections, blood dyscrasias, seizures, injection site irritation.
Colchicine (Colcrys)
- Systemic Class: Anti-Gout Drug - Acute Gout.
- Prototype drug: Colchicine.
- Can be administered orally or intravenously.
- Parenteral use is usually avoided due to the risk of toxicity.
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Description
This quiz covers the use of codeine and other opioid analgesics in severe pain management. Assess your knowledge on the mechanisms, benefits, and contraindications of these medications, including cautions for specific patient populations. Make sure to understand the implications of pain management strategies as well.
