74 Questions
In what scenario is the use of opioids for low back pain not generally recommended?
Acute low back pain
What is the maximum dose of morphine equivalents per day recommended for chronic low back pain?
50
What is the primary function of the descending pathway in pain modulation?
To inhibit information that reaches the brain
Which of the following endogenous ligands is released throughout the pain axis?
Enkephalins
What is the effect of opioids on pain perception?
They mute the channel to inhibit pain
How long should the initial prescription of opioids for chronic low back pain last?
3-5 days
What is the effect of mu-opioid receptor activation on adenylate cyclase?
Decreased activity
Which of the following opioid classes is associated with a high affinity for opioid receptors and produces a maximal effect?
Full opioid agonists
What is the primary metabolite of morphine?
Morphine-3-glucuronide
What is the mechanism of analgesic effect of tramadol?
Inhibition of neuronal reuptake of serotonin and norepinephrine
What is the duration of action of morphine?
4 hours
What is the enzyme responsible for the metabolism of tramadol to its active metabolite?
CYP2D6
What is the primary mechanism of action of sucralfate in the treatment of ulcers?
Formation of a physical barrier
What is the primary indication for misoprostol in patients taking NSAIDs?
Gastric and duodenal ulcers
What is the minimum eradication rate of Helicobacter Pylori infection with quadruple therapy?
85%
Which of the following is a contraindication for misoprostol?
Pregnancy
What is the most common adverse effect of quadruple therapy for Helicobacter Pylori eradication?
Diarrhea
What is the estimated percentage of Canadian adults with a diagnosis of hypertension?
25%
What is the primary factor that contributes to vascular stiffness in older adults?
Peripheral vascular resistance
Which system plays a crucial role in regulating blood volume and blood pressure?
Renin-angiotensin-aldosterone system
What is the main effect of angiotensin II on blood vessels?
Vasoconstriction
What is the mechanism of action of ACE inhibitors?
Binding to the zinc atom at the active site of ACE
What is the effect of ACE inhibitors on sodium retention in the kidneys?
Decreased sodium retention
Why is Quinapril administered in a prodrug form?
To prolong its duration of action
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.
What is the average intestinal transit time in a healthy individual?
30-40 hours
What is the recommended dose of psyllium for treating constipation and diarrhea?
3.4g once daily
What is the primary effect of osmotic laxatives on the intestines?
They hydrate and soften stool.
What is the primary indication for using senna as a laxative?
Short-term treatment of constipation
What is the primary effect of opioid agonists on intestinal motility?
They decrease intestinal motility and increase transit time.
What is the primary indication for using loperamide?
Treatment of diarrhea
What is the effect of antidepressants on gastrointestinal transit time?
They increase colonic transit time and are effective for diarrhea-dominant IBS.
What is the primary function of alginates in managing stomach acid secretion?
Forming a physical barrier between acid and lower esophageal sphincter
What is the recommended dose of amitriptyline for treating irritable bowel syndrome?
25-100mg daily
What is the common adverse effect of magnesium hydroxide?
Diarrhea
What is the primary adverse effect of loperamide in high doses?
Cardiac dysrhythmia
What is the mechanism of action of H2 receptor antagonists?
Competitive inhibition of H2 receptors
What is the recommended duration of ranitidine therapy for peptic ulcer disease?
6-8 weeks
What is the indication for omeprazole in patients taking NSAIDs?
To prevent ulcers
What is the recommended dosing of omeprazole for peptic ulcer disease?
20-40mg once daily
What is the common adverse effect of omeprazole?
All of the above
What is the association of long-term use of proton pump inhibitors with certain health conditions?
All of the above
What is the effect of ranitidine on gastric emptying time?
No effect on gastric emptying time
What is the scheduling of antacids and alginates administration?
PRN after meals
What is the most common adverse effect of Angiotensin II Receptor Blockers?
Dry cough
What is the mechanism of action of Direct Renin Inhibitors?
Binding to the active site of renin, preventing cleavage of angiotensinogen
Which of the following calcium channel blockers has a higher affinity for L-type calcium channels in the heart?
Verapamil
What is the primary difference between Candesartan and Quinapril?
Candesartan does not interfere with bradykinin metabolism
What is the contraindication for combining ACE inhibitors and Angiotensin II Receptor Blockers?
It is not recommended
Which calcium channel blocker is selective for vasculature and has a tendency to cause rebound tachycardia?
Amlodipine
What is the benefit of using Angiotensin II Receptor Blockers over ACE inhibitors?
They do not interfere with bradykinin metabolism
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
What is the primary mechanism of action of Sympatholytic Drugs?
Interfering with adrenergic signalling
What is the contraindication for using Aliskiren in pregnancy?
It is contraindicated
What is the primary effect of a1-adrenoreceptor antagonists on peripheral resistance?
Decreases peripheral resistance
What is the mechanism of action of beta blockers like atenolol?
Selective blockade of B1 receptors
What is the primary indication for the use of a1-adrenoreceptor antagonists like prazosin?
Treatment of hypertension that does not respond to other medications
What is the effect of beta blockers like atenolol on renin secretion?
Decrease renin secretion
What is the adverse effect of abruptly discontinuing beta blockers like atenolol?
Rebound hypertension
What is the primary mechanism of action of clonidine?
Stimulation of a2-adrenoreceptors in the CNS
What is the diuretic class that can be used when renal function is substantially decreased?
Loop diuretics
What is the primary effect of loop diuretics like furosemide?
Decreased sodium reabsorption in the ascending loop of Henle
What is a potential adverse effect of loop diuretics like furosemide?
Ototoxicity
What is the primary indication for the use of loop diuretics like furosemide?
Treatment of edema
What is the mechanism of action of thiazide diuretics?
Decreased sodium reabsorption in the distal convoluted tubule
In which population is thiazide diuretic particularly effective?
African-American populations
What is the effect of thiazide diuretics on calcium levels?
Decreased calcium excretion
What is the mechanism of action of spironolactone?
Inhibition of downstream effects of aldosterone binding to nuclear mineralocorticoid receptor
What is the primary indication for spironolactone?
Heart failure
What is the effect of thiazide diuretics on potassium levels?
Increased potassium excretion
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
What is the number needed to treat (NNT)?
The number of people that need to be treated to have an impact on one person
What is the primary goal of risk assessment in vascular disease?
To identify patients with modifiable risk factors
What is the Framingham risk assessment tool used for?
To estimate the risk of cardiovascular disease in the next 10 years
This quiz assesses your understanding of the use of opioids in managing acute and chronic low back pain. It covers the risks and benefits of using opioids, including the recommended dosage and duration of treatment. Test your knowledge of opioid therapy for low back pain.
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