Opioids and Low Back Pain Management

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In what scenario is the use of opioids for low back pain not generally recommended?

Acute low back pain (correct)
Low back pain with anxiety
Chronic low back pain
Low back pain with depression

What is the maximum dose of morphine equivalents per day recommended for chronic low back pain?

75
100
50 (correct)
25

What is the primary function of the descending pathway in pain modulation?

To inhibit information that reaches the brain (correct)
To release endogenous ligands
To enhance the ascending pathway
To stimulate the spinothalamic tract

Which of the following endogenous ligands is released throughout the pain axis?

Enkephalins (C) Signup and view all the answers

What is the effect of opioids on pain perception?

They mute the channel to inhibit pain (B) Signup and view all the answers

How long should the initial prescription of opioids for chronic low back pain last?

3-5 days (D) Signup and view all the answers

What is the effect of mu-opioid receptor activation on adenylate cyclase?

Decreased activity (D) Signup and view all the answers

Which of the following opioid classes is associated with a high affinity for opioid receptors and produces a maximal effect?

Full opioid agonists (C) Signup and view all the answers

What is the primary metabolite of morphine?

Morphine-3-glucuronide (A) Signup and view all the answers

What is the mechanism of analgesic effect of tramadol?

Inhibition of neuronal reuptake of serotonin and norepinephrine (D) Signup and view all the answers

What is the duration of action of morphine?

4 hours (C) Signup and view all the answers

What is the enzyme responsible for the metabolism of tramadol to its active metabolite?

CYP2D6 (C) Signup and view all the answers

What is the primary mechanism of action of sucralfate in the treatment of ulcers?

Formation of a physical barrier (C) Signup and view all the answers

What is the primary indication for misoprostol in patients taking NSAIDs?

Gastric and duodenal ulcers (D) Signup and view all the answers

What is the minimum eradication rate of Helicobacter Pylori infection with quadruple therapy?

85% (D) Signup and view all the answers

Which of the following is a contraindication for misoprostol?

Pregnancy (B) Signup and view all the answers

What is the most common adverse effect of quadruple therapy for Helicobacter Pylori eradication?

Diarrhea (B) Signup and view all the answers

What is the estimated percentage of Canadian adults with a diagnosis of hypertension?

25% (D) Signup and view all the answers

What is the primary factor that contributes to vascular stiffness in older adults?

Peripheral vascular resistance (C) Signup and view all the answers

Which system plays a crucial role in regulating blood volume and blood pressure?

Renin-angiotensin-aldosterone system (B) Signup and view all the answers

What is the main effect of angiotensin II on blood vessels?

Vasoconstriction (A) Signup and view all the answers

What is the mechanism of action of ACE inhibitors?

Binding to the zinc atom at the active site of ACE (B) Signup and view all the answers

What is the effect of ACE inhibitors on sodium retention in the kidneys?

Decreased sodium retention (A) Signup and view all the answers

Why is Quinapril administered in a prodrug form?

To prolong its duration of action (B) Signup and view all the answers

What is the primary mechanism of action of naloxone in treating opioid overdose?

It binds to opioid receptors and prevents conformational change necessary for activation and agonist activity. (D) Signup and view all the answers

What is the average intestinal transit time in a healthy individual?

30-40 hours (C) Signup and view all the answers

What is the recommended dose of psyllium for treating constipation and diarrhea?

3.4g once daily (B) Signup and view all the answers

What is the primary effect of osmotic laxatives on the intestines?

They hydrate and soften stool. (D) Signup and view all the answers

What is the primary indication for using senna as a laxative?

Short-term treatment of constipation (D) Signup and view all the answers

What is the primary effect of opioid agonists on intestinal motility?

They decrease intestinal motility and increase transit time. (B) Signup and view all the answers

What is the primary indication for using loperamide?

Treatment of diarrhea (D) Signup and view all the answers

What is the effect of antidepressants on gastrointestinal transit time?

They increase colonic transit time and are effective for diarrhea-dominant IBS. (B) Signup and view all the answers

What is the primary function of alginates in managing stomach acid secretion?

Forming a physical barrier between acid and lower esophageal sphincter (C) Signup and view all the answers

What is the recommended dose of amitriptyline for treating irritable bowel syndrome?

25-100mg daily (B) Signup and view all the answers

What is the common adverse effect of magnesium hydroxide?

Diarrhea (A) Signup and view all the answers

What is the primary adverse effect of loperamide in high doses?

Cardiac dysrhythmia (B) Signup and view all the answers

What is the mechanism of action of H2 receptor antagonists?

Competitive inhibition of H2 receptors (B) Signup and view all the answers

What is the recommended duration of ranitidine therapy for peptic ulcer disease?

6-8 weeks (C) Signup and view all the answers

What is the indication for omeprazole in patients taking NSAIDs?

To prevent ulcers (B) Signup and view all the answers

What is the recommended dosing of omeprazole for peptic ulcer disease?

20-40mg once daily (C) Signup and view all the answers

What is the common adverse effect of omeprazole?

All of the above (D) Signup and view all the answers

What is the association of long-term use of proton pump inhibitors with certain health conditions?

All of the above (D) Signup and view all the answers

What is the effect of ranitidine on gastric emptying time?

No effect on gastric emptying time (B) Signup and view all the answers

What is the scheduling of antacids and alginates administration?

PRN after meals (B) Signup and view all the answers

What is the most common adverse effect of Angiotensin II Receptor Blockers?

Dry cough (D) Signup and view all the answers

What is the mechanism of action of Direct Renin Inhibitors?

Binding to the active site of renin, preventing cleavage of angiotensinogen (B) Signup and view all the answers

Which of the following calcium channel blockers has a higher affinity for L-type calcium channels in the heart?

Verapamil (C) Signup and view all the answers

What is the primary difference between Candesartan and Quinapril?

Candesartan does not interfere with bradykinin metabolism (C) Signup and view all the answers

What is the contraindication for combining ACE inhibitors and Angiotensin II Receptor Blockers?

It is not recommended (A) Signup and view all the answers

Which calcium channel blocker is selective for vasculature and has a tendency to cause rebound tachycardia?

Amlodipine (A) Signup and view all the answers

What is the benefit of using Angiotensin II Receptor Blockers over ACE inhibitors?

They do not interfere with bradykinin metabolism (B) Signup and view all the answers

What is the class of calcium channel blockers that has a higher affinity for L-type calcium channels in both vasculature and the heart?

Benzothiazepine (C) Signup and view all the answers

What is the primary mechanism of action of Sympatholytic Drugs?

Interfering with adrenergic signalling (C) Signup and view all the answers

What is the contraindication for using Aliskiren in pregnancy?

It is contraindicated (A) Signup and view all the answers

What is the primary effect of a1-adrenoreceptor antagonists on peripheral resistance?

Decreases peripheral resistance (C) Signup and view all the answers

What is the mechanism of action of beta blockers like atenolol?

Selective blockade of B1 receptors (D) Signup and view all the answers

What is the primary indication for the use of a1-adrenoreceptor antagonists like prazosin?

Treatment of hypertension that does not respond to other medications (A) Signup and view all the answers

What is the effect of beta blockers like atenolol on renin secretion?

Decrease renin secretion (C) Signup and view all the answers

What is the adverse effect of abruptly discontinuing beta blockers like atenolol?

Rebound hypertension (C) Signup and view all the answers

What is the primary mechanism of action of clonidine?

Stimulation of a2-adrenoreceptors in the CNS (C) Signup and view all the answers

What is the diuretic class that can be used when renal function is substantially decreased?

Loop diuretics (B) Signup and view all the answers

What is the primary effect of loop diuretics like furosemide?

Decreased sodium reabsorption in the ascending loop of Henle (D) Signup and view all the answers

What is a potential adverse effect of loop diuretics like furosemide?

Ototoxicity (C) Signup and view all the answers

What is the primary indication for the use of loop diuretics like furosemide?

Treatment of edema (D) Signup and view all the answers

What is the mechanism of action of thiazide diuretics?

Decreased sodium reabsorption in the distal convoluted tubule (C) Signup and view all the answers

In which population is thiazide diuretic particularly effective?

African-American populations (C) Signup and view all the answers

What is the effect of thiazide diuretics on calcium levels?

Decreased calcium excretion (D) Signup and view all the answers

What is the mechanism of action of spironolactone?

Inhibition of downstream effects of aldosterone binding to nuclear mineralocorticoid receptor (B) Signup and view all the answers

What is the primary indication for spironolactone?

Heart failure (A) Signup and view all the answers

What is the effect of thiazide diuretics on potassium levels?

Increased potassium excretion (A) Signup and view all the answers

What is the absolute risk reduction (ARR)?

The difference in the number of events between a treated and control group, divided by the number of people in the control group (C) Signup and view all the answers

What is the number needed to treat (NNT)?

The number of people that need to be treated to have an impact on one person (B) Signup and view all the answers

What is the primary goal of risk assessment in vascular disease?

To identify patients with modifiable risk factors (B) Signup and view all the answers

What is the Framingham risk assessment tool used for?

To estimate the risk of cardiovascular disease in the next 10 years (A) Signup and view all the answers