Opioid and Non-Opioid Analgesics Overview

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Questions and Answers

What is the mechanism of action of Tramadol?

Agonizes the Mu opioid receptor while inhibiting reuptake of serotonin and norepinephrine (correct)
Blocks NMDA receptors
Acts only as a Kappa agonist
Inhibits reuptake of dopamine and norepinephrine

Which side effect is associated with Tramadol use?

Bradypnea (correct)
Hypotension
Constipation
Tachycardia

What is a contraindication for using Tramadol?

Concurrent use with SSRIs (correct)
Controlled substance regulation
Chronic pain over 6 months
Opioid dependence

What is indicated use of Buprenorphine?

Treatment of opioid dependence (C) Signup and view all the answers

How should the dosage of a new opioid be adjusted when switching medications?

Decrease the dose by 25% to 50% to manage overdose risk (D) Signup and view all the answers

Which of the following is a potential risk when using Tramadol?

Seizures (D) Signup and view all the answers

In which circumstance is Buprenorphine not recommended?

For chronic pain management (C) Signup and view all the answers

What is the recommended percentage of total daily Morphine milligram equivalents (MME) reserved for PRN dosing?

10-15% (B) Signup and view all the answers

What interaction concern exists with Tramadol?

Risk of serotonin syndrome with SSRIs (B) Signup and view all the answers

What is the therapeutic ceiling effect in the context of Buprenorphine?

Signifying a limit to its analgesic effect (B) Signup and view all the answers

What is the primary mechanism of action of aspirin in relation to platelet aggregation?

It acetylates cyclooxygenase, preventing thromboxane A(2) synthesis. (C) Signup and view all the answers

Which of the following is a potential side effect of overdose with acetaminophen?

Oxidative damage to hepatocytes due to NAPQI production. (A) Signup and view all the answers

In what scenario is acetaminophen recommended as a first-line treatment?

For pregnant patients. (B) Signup and view all the answers

What is the recommended maximum daily dose of acetaminophen?

4 grams (B) Signup and view all the answers

Which of the following statements about NSAIDs is true?

Consideration is necessary in patients with excessive alcohol consumption. (A) Signup and view all the answers

What is a contraindication for the use of aspirin?

History of gastrointestinal bleeding. (C) Signup and view all the answers

Which of the following parameters may require renal dosing adjustments when using acetaminophen?

Creatinine clearance less than 30 (A) Signup and view all the answers

What is the reason for aspirin's irreversible effect on platelet aggregation?

Acetylation of cyclooxygenase prevents new cyclooxygenase formation in nuclear-free thrombocytes. (C) Signup and view all the answers

What is the primary mechanism of action of acetaminophen?

Antipyretic and analgesic properties (A) Signup and view all the answers

Which of the following is an important adverse effect of acetaminophen?

Liver toxicity at high doses (A) Signup and view all the answers

What is a primary therapeutic use for acetaminophen?

Relief of fever (D) Signup and view all the answers

What consideration should be made regarding the dosing of acetaminophen?

Dosage may need adjustment in individuals with liver impairment (A) Signup and view all the answers

Which of the following conditions should contraindicate the use of acetaminophen?

Severe liver disease (B) Signup and view all the answers

In terms of side effects, which of the following is NOT typically associated with acetaminophen?

Gastrointestinal bleeding (C) Signup and view all the answers

What is a distinguishing feature of acetaminophen compared to NSAIDs?

Primarily acts as an analgesic and antipyretic (A) Signup and view all the answers

Which patient population requires careful monitoring when administering acetaminophen?

Individuals with chronic alcohol use (D) Signup and view all the answers

Which mechanism of action does NOT apply to acetaminophen?

Anti-inflammatory pathway activation (B) Signup and view all the answers

In cases of overdose, which intervention is crucial for patients who have taken excessive acetaminophen?

N-acetylcysteine (NAC) therapy (C) Signup and view all the answers

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Study Notes

Opioid Analgesics

Morphine is a strong opioid agonist with a high risk of overdose.
Converting to a different opioid should be done with a 25% to 50% dose reduction to avoid overdose due to incomplete cross-tolerance and individual variability in opioid pharmacokinetics.
10-15% of total daily MME (Morphine milligram equivalents) should be reserved for PRN (as needed) dosing.
Tramadol binds to the Mu opioid receptor and inhibits serotonin and NE reuptake.
Tramadol should be avoided in patients taking SSRIs due to the risk of serotonin syndrome.
Tramadol is not approved for use in children and XR products should be avoided in patients with CrCL < 30 or severe hepatic impairment.
Buprenorphine is a partial opioid agonist/antagonist with a ceiling effect.
Buprenorphine is not appropriate for chronic pain control.

Non-Opioid Analgesics

Acetaminophen has antipyretic and analgesic properties, but no anti-inflammatory effects.
Acetaminophen is thought to inhibit COX-3 in the CNS, reducing prostaglandins and increasing pain threshold.
Acetaminophen overdose can lead to hepatic injury and the antidote is N-acetylcysteine.
Aspirin is a potent inhibitor of both prostaglandin synthesis and platelet aggregation.
Aspirin irreversibly inactivates cyclooxygenase via acetylation.
Aspirin inhibits platelet aggregation for the life of the platelet, which is 7 to 10 days.
Aspirin inhibits the synthesis of thromboxane A(2) irreversibly.

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