Opioids and Low Back Pain Management
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Questions and Answers

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?

    <p>Enkephalins</p> Signup and view all the answers

    What is the effect of opioids on pain perception?

    <p>They mute the channel to inhibit pain</p> Signup and view all the answers

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

    <p>3-5 days</p> Signup and view all the answers

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

    <p>Decreased activity</p> 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?

    <p>Full opioid agonists</p> Signup and view all the answers

    What is the primary metabolite of morphine?

    <p>Morphine-3-glucuronide</p> Signup and view all the answers

    What is the mechanism of analgesic effect of tramadol?

    <p>Inhibition of neuronal reuptake of serotonin and norepinephrine</p> Signup and view all the answers

    What is the duration of action of morphine?

    <p>4 hours</p> Signup and view all the answers

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

    <p>CYP2D6</p> Signup and view all the answers

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

    <p>Formation of a physical barrier</p> Signup and view all the answers

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

    <p>Gastric and duodenal ulcers</p> Signup and view all the answers

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

    <p>85%</p> Signup and view all the answers

    Which of the following is a contraindication for misoprostol?

    <p>Pregnancy</p> Signup and view all the answers

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

    <p>Diarrhea</p> Signup and view all the answers

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

    <p>25%</p> Signup and view all the answers

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

    <p>Peripheral vascular resistance</p> Signup and view all the answers

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

    <p>Renin-angiotensin-aldosterone system</p> Signup and view all the answers

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

    <p>Vasoconstriction</p> Signup and view all the answers

    What is the mechanism of action of ACE inhibitors?

    <p>Binding to the zinc atom at the active site of ACE</p> Signup and view all the answers

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

    <p>Decreased sodium retention</p> Signup and view all the answers

    Why is Quinapril administered in a prodrug form?

    <p>To prolong its duration of action</p> Signup and view all the answers

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

    <p>It binds to opioid receptors and prevents conformational change necessary for activation and agonist activity.</p> Signup and view all the answers

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

    <p>30-40 hours</p> Signup and view all the answers

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

    <p>3.4g once daily</p> Signup and view all the answers

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

    <p>They hydrate and soften stool.</p> Signup and view all the answers

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

    <p>Short-term treatment of constipation</p> Signup and view all the answers

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

    <p>They decrease intestinal motility and increase transit time.</p> Signup and view all the answers

    What is the primary indication for using loperamide?

    <p>Treatment of diarrhea</p> Signup and view all the answers

    What is the effect of antidepressants on gastrointestinal transit time?

    <p>They increase colonic transit time and are effective for diarrhea-dominant IBS.</p> Signup and view all the answers

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

    <p>Forming a physical barrier between acid and lower esophageal sphincter</p> Signup and view all the answers

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

    <p>25-100mg daily</p> Signup and view all the answers

    What is the common adverse effect of magnesium hydroxide?

    <p>Diarrhea</p> Signup and view all the answers

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

    <p>Cardiac dysrhythmia</p> Signup and view all the answers

    What is the mechanism of action of H2 receptor antagonists?

    <p>Competitive inhibition of H2 receptors</p> Signup and view all the answers

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

    <p>6-8 weeks</p> Signup and view all the answers

    What is the indication for omeprazole in patients taking NSAIDs?

    <p>To prevent ulcers</p> Signup and view all the answers

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

    <p>20-40mg once daily</p> Signup and view all the answers

    What is the common adverse effect of omeprazole?

    <p>All of the above</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

    What is the effect of ranitidine on gastric emptying time?

    <p>No effect on gastric emptying time</p> Signup and view all the answers

    What is the scheduling of antacids and alginates administration?

    <p>PRN after meals</p> Signup and view all the answers

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

    <p>Dry cough</p> Signup and view all the answers

    What is the mechanism of action of Direct Renin Inhibitors?

    <p>Binding to the active site of renin, preventing cleavage of angiotensinogen</p> 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?

    <p>Verapamil</p> Signup and view all the answers

    What is the primary difference between Candesartan and Quinapril?

    <p>Candesartan does not interfere with bradykinin metabolism</p> Signup and view all the answers

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

    <p>It is not recommended</p> Signup and view all the answers

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

    <p>Amlodipine</p> Signup and view all the answers

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

    <p>They do not interfere with bradykinin metabolism</p> 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?

    <p>Benzothiazepine</p> Signup and view all the answers

    What is the primary mechanism of action of Sympatholytic Drugs?

    <p>Interfering with adrenergic signalling</p> Signup and view all the answers

    What is the contraindication for using Aliskiren in pregnancy?

    <p>It is contraindicated</p> Signup and view all the answers

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

    <p>Decreases peripheral resistance</p> Signup and view all the answers

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

    <p>Selective blockade of B1 receptors</p> Signup and view all the answers

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

    <p>Treatment of hypertension that does not respond to other medications</p> Signup and view all the answers

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

    <p>Decrease renin secretion</p> Signup and view all the answers

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

    <p>Rebound hypertension</p> Signup and view all the answers

    What is the primary mechanism of action of clonidine?

    <p>Stimulation of a2-adrenoreceptors in the CNS</p> Signup and view all the answers

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

    <p>Loop diuretics</p> Signup and view all the answers

    What is the primary effect of loop diuretics like furosemide?

    <p>Decreased sodium reabsorption in the ascending loop of Henle</p> Signup and view all the answers

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

    <p>Ototoxicity</p> Signup and view all the answers

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

    <p>Treatment of edema</p> Signup and view all the answers

    What is the mechanism of action of thiazide diuretics?

    <p>Decreased sodium reabsorption in the distal convoluted tubule</p> Signup and view all the answers

    In which population is thiazide diuretic particularly effective?

    <p>African-American populations</p> Signup and view all the answers

    What is the effect of thiazide diuretics on calcium levels?

    <p>Decreased calcium excretion</p> Signup and view all the answers

    What is the mechanism of action of spironolactone?

    <p>Inhibition of downstream effects of aldosterone binding to nuclear mineralocorticoid receptor</p> Signup and view all the answers

    What is the primary indication for spironolactone?

    <p>Heart failure</p> Signup and view all the answers

    What is the effect of thiazide diuretics on potassium levels?

    <p>Increased potassium excretion</p> Signup and view all the answers

    What is the absolute risk reduction (ARR)?

    <p>The difference in the number of events between a treated and control group, divided by the number of people in the control group</p> Signup and view all the answers

    What is the number needed to treat (NNT)?

    <p>The number of people that need to be treated to have an impact on one person</p> Signup and view all the answers

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

    <p>To identify patients with modifiable risk factors</p> Signup and view all the answers

    What is the Framingham risk assessment tool used for?

    <p>To estimate the risk of cardiovascular disease in the next 10 years</p> Signup and view all the answers

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