Pharmacology Class Quiz

Enteral Drug Administration Disadvantage

• Potential for first-pass metabolism: Drugs administered orally pass through the liver before reaching systemic circulation, which can significantly reduce their bioavailability (amount available to the body).

Factors Influencing Drug Distribution

• Drug's affinity for plasma proteins: Drugs bind to proteins in the blood. Only unbound drugs are free to distribute to tissues.

Intravenous vs. Intramuscular Injection

• Intravenous injection: Immediate absorption into the bloodstream – fast onset of action.
• Intramuscular injection: Absorption is slower, but more sustained release than intravenous.

Types of Drugs Crossing Cell Membranes

• Lipid-soluble drugs: More likely to cross cell membranes, as they can dissolve in the lipid bilayer of cell membranes.

Barriers to Oral Medication Absorption

• First-pass metabolism in the liver: A significant amount of the drug can be metabolized in the liver before it reaches systemic circulation.

Factors Limiting Drug Distribution

• Blood-brain barrier: A protective barrier that limits the passage of drugs from the bloodstream into the brain.

Non-Invasive and Convenient Self-Administration

• Oral administration: Swallowing tablets or capsules is easy for self-administration without need for needles.

Conditions Influencing Drug Distribution

• Pregnancy: Physiological changes during pregnancy can affect drug distribution, including increased blood volume and changes in protein binding.

Antidote Function in Neuropathic Pain

• To reverse the effects of a specific medication: Antidotes are used to counter the toxic effects of certain drugs.

Bisphosphonate Use in Cancer Pain

• To reduce bone pain caused by bone metastases (cancer spreading to bones): Bisphosphonates work by inhibiting bone resorption and reducing bone turnover.

Drugs for Neuropathic Pain and Depression

• Tricyclic antidepressants (TCAs): Useful for both neuropathic pain and depression due to their dual action on neuronal pathways.

Topical Agents for Neuropathic Pain

• Provide localized pain relief: These agents target specific areas of the body affected by neuropathic pain, minimizing systemic side effects.

Nerve Block Procedure

• Perineural injection: Local anesthetics are injected near specific nerves to block pain signals transmitting to the brain.

Neurolytic Procedure Example

• Alcohol injection: Alcohol can be injected into specific nerves to destroy them and eliminate pain signals.

Cannabinoid Function in Cancer Pain

• Modulate pain perception: Cannabinoids can activate receptors in the nervous system to reduce pain perception.

Critical Patient Selection for Pain Management

• To optimize treatment outcomes and minimize risks: Patient selection ensures procedures are appropriate for individual needs and conditions.

First-Line Pediatric Pain Treatment

• Non-pharmacological approaches: These methods like distraction, relaxation techniques, and positioning are preferred for initial pain management in children.

Opioid Use Disorder Pain Management

• Non-opioid pain management: Focus remains on alternative pain methods like non-pharmacological approaches and non-opioid analgesics.

Patient Education: Not a Recommended Component

• Delaying pain management until after diagnosis: Immediate and thorough pain management is essential to improve quality of life.

Engaging with Caregivers in Pediatric Pain Management

• Collaboration and shared decision-making: Open communication with caregivers allows for a comprehensive understanding of the child's needs and preferences.

Adjuvant Medications in Pain Management

• Enhance the effects of primary analgesics: Adjuvants can enhance pain relief or address specific symptoms like nausea or anxiety.

Opioid Dosing Based on Weight

• Prevent overdose and achieve optimal pain relief: Weight-based dosing ensures a safe and effective medication dose.

Comprehensive Patient Education Benefit

• Improved medication adherence and self-management skills: Well-informed patients are better equipped to manage their pain and optimize treatment outcomes.

Non-drug Therapies in Pain Management

• They are increasingly recognized as a valuable part of a comprehensive pain management plan: Non-drug therapies can offer benefits to manage pain and improve overall function.

Common Sumatriptan Side Effect

• Dizziness: This side effect is experienced by approximately 50% of patients using sumatriptan.

Medications To Avoid Combining with Sumatriptan

• Ergot alkaloids: Combining these with sumatriptan can increase the risk of vasoconstriction and potentially lead to cardiovascular complications.

Rare Sumatriptan Adverse Effect

• Coronary vasospasm: This event is very rare, but risk factors like coronary artery disease increase its possibility.

Name (Brand) of a Triptan Medication

• Rizatriptan: Also known as Maxalt, this medication is used to treat migraines.

Mechanism of Action of Lasmiditan

• Selective 5-HT1F receptor agonist: Lasmiditan targets a specific serotonin receptor in the brain, unlike traditional triptans that work on various serotonin receptors.

Lasmiditan Side Effect Not Reported

• Hallucination: This is not a reported side effect of lasmiditan.

Lasmiditan Classification Property

• Non-triptan: While effective for migraines, lasmiditan structurally differs from traditional triptans.

Lasmiditan Approved Use

• Adult migraine with or without aura: Lasmiditan is indicated for acute treatment of migraine events in adults.

Topiramate's Action in Migraine Prevention

• Blocks voltage-gated sodium channels: Topiramate's mechanism contributes to its effectiveness in reducing migraine frequency and severity.

Common Tricyclic Antidepressant Side Effect

• Sedation: A common side effect of tricyclic antidepressants (TCAs) used for migraine prevention.

Cluster Headache Duration vs. Migraine Duration

• Cluster headaches: Characterized by periods of intense pain lasting from 15-180 minutes.
• Migraines: Usually last for several hours to days.

Amitriptyline's Initial Dosage for Migraine Prevention

• 10-25mg at bedtime: This is a typical starting dose, with adjustments based on individual response and tolerance.

Treatment Not Used for Acute Migraines

• Anti-epileptic medications: These are primarily used for migraine prevention, not acute relief.

Neurotransmitter Affected by Tricyclic Antidepressants

• Serotonin: While targeting various neurotransmitters, tricyclic antidepressants affect serotonin reuptake in migraine pathways.

Cluster Headache Preventive Treatment

• Oxygen therapy: High-flow oxygen administration is a primary preventive treatment for cluster headaches.

Characteristic Cluster Headache Symptom

• Unilateral facial pain: Pain often focuses on one side of the face, while migraine pain can be unilateral or bilateral.

Major Symptom of FGA Overdose

• Extrapyramidal symptoms (EPS): These are involuntary movements resulting from dopamine blockade, and can be severe in overdose.

Treatment for Severe EPS

• Anticholinergic medications: Used to relieve EPS by counteracting the effects of dopamine blockage.

High vs. Low Potency FGAs: Key Characteristic

• Potency refers to the relative amount of dopamine blockade: High-potency FGAs (higher doses = same effect) are associated with a higher risk of EPS.

Pharmacologic Property of SGAs

• Partial agonism at dopamine receptors: SGAs possess a weaker dopamine blockade compared to FGAs, contributing to a lower risk of EPS and metabolic side effects.

SGAs: Effect Associated with Binding Ratio

• Lower risk of extrapyramidal symptoms (EPS): The higher 5-HT2A/D2 binding ratio in SGAs suggests a better balance of serotonin and dopamine activity, reducing EPS.

Meaning of FGA

• First-generation antipsychotics: The older, more potent antipsychotics, commonly associated with dopamine receptor antagonism.

Potential Fatal Complication of FGA Overdose

• Neuroleptic malignant syndrome: This is a potentially life-threatening neurological disorder characterized by fever, muscle rigidity, and altered mental status.

Focus of Management in FGA Overdose

• Supporting vital functions and managing symptoms: Treatment aims to stabilize the patient's condition and prevent further complications.

Characterization of Allodynia and Hyperalgesia

• Neuropathic pain: This type of pain often manifests as allodynia (pain from non-painful stimuli) and hyperalgesia (exaggerated response to painful stimuli).

Pain from Tumor Involvement

• Somatic pain: Direct involvement of surrounding tissues by tumors leads to intense pain localized to the affected area.

Less Likely to Respond to Traditional Analgesics

• Neuropathic pain: NSAIDs and other traditional analgesics may have limited effectiveness in addressing neuropathic pain.

Sensation Characteristic of Burning or Electric-Like Pain

• Neuropathic pain: These atypical pain sensations are commonly associated with nerve damage or dysfunction.

Anxiety and Depression Exacerbating Pain

• Psychogenic pain: Pain perception is heightened by psychological factors, creating a vicious cycle where anxiety and depression exacerbate the pain experience.

Chemotherapy-Related Pain

• Cancer-related pain: Chemotherapy's side effects can lead to pain, including mucositis (inflammation of the mouth), neuropathy (nerve damage), and musculoskeletal pain.

Pain Requiring Individualized Treatment

• Cancer pain: The multifaceted nature of cancer pain necessitates individualized treatment plans tailored to the patient's unique needs and symptoms.

Pain from Patient Assessment Complications

• Procedural pain: Pain can arise from interventions or testing performed during the assessment process, emphasizing the need for careful procedures and pain management strategies.

Nurse Action to Minimize Drug Interactions

• Reviewing the patient's medication history: A comprehensive review of past and current medications helps identify potential drug interactions and guide safe and effective treatment.

Pharmacokinetics and Medication Management

• Understanding pharmacokinetics aids in optimizing drug dosage: Understanding the drug's absorption, distribution, metabolism, and elimination allows for informed decisions regarding dosage and timing.

PRN Drug Administration

• Evaluating the patient's condition for administering PRN drugs: Nurses must carefully assess the patient's pain level, current medications, and overall medical status before administering PRN medications.

Proactive Side Effect Management Strategy

• Monitoring for potential side effects: Regular monitoring of patients for known side effects allows for early identification and intervention to manage adverse reactions.

Resource for Avoiding Drug Interactions

• Medication guide and patient education materials: Providing patients with clear and accessible information about their medications helps them understand potential interactions and avoid them.

Nurse Responsibility with New Prescriptions

• Educating patients about new medications: Nurses play a vital role in informing patients about medication purpose, dosage, potential side effects, and interactions.

Nurse Monitoring Drug Interactions

• Ensure patient safety and optimal therapeutic outcomes: Monitoring for drug interactions helps prevent potentially serious adverse effects.

Basis for PRN Medication Administration

• Patient's individual needs and assessment findings: Clinical judgment is crucial for administering PRN drugs, considering the patient's pain level, overall condition, and medication history.

Buprenorphine Action at Mu-Opioid Receptor

• Partial agonist: Buprenorphine binds to the mu-opioid receptor, producing less intense effects compared to full agonists.

Onset Time for Immediate-Release Hydrocodone

• 15-30 minutes: Immediate-release formulations of hydrocodone produce pain relief within this time frame.

Metabolism of Oxycodone and Hydrocodone

• Both medications are metabolized through CYP3A4: This enzyme plays a significant role in their metabolism, potentially leading to drug interactions.

Effects of Hydrocodone for Cough Suppression

• Suppresses the cough reflex: Hydrocodone is often used for cough suppression due to its antitussive properties.

Feature of Extended-Release Hydrocodone

• Sustained pain relief for 12 hours or more: Extended-release formulations offer longer-lasting pain relief compared to immediate-release options.

Common Side Effect of Hydrocodone and Oxycodone

• Constipation: This is a common side effect associated with both hydrocodone and oxycodone, related to their opioid effects.

Buprenorphine's Low Overdose Risk Feature

• Ceiling effect: Buprenorphine's affinity to the mu-receptor limits its effects, preventing excessive respiratory depression even with high doses.

Control Classification of Hydrocodone Combination Products

• Schedule II: These products are classified as Schedule II controlled substances due to their potential for abuse and dependence.

Fentanyl Administration for Breakthrough Pain

• Sublingual: Sublingual fentanyl is specifically indicated for breakthrough cancer pain in opioid-tolerant patients.

Meperidine vs. Morphine Limitation

• Shorter duration of action: Meperidine has a shorter duration of action compared to morphine, requiring more frequent administration.

Increased Risk with Morphine and MAOIs

• Serotonin syndrome: Combining morphine with MAOIs can lead to the development of a potentially life-threatening condition characterized by confusion, agitation, and hyperthermia.

Fentanyl Administration Route

• Parenteral: Fentanyl can be administered intravenously, intramuscularly, or subcutaneously for pain management.

Meperidine Adverse Effect Related to Metabolite

• Neurotoxicity: Normeperidine, a metabolite of meperidine, can accumulate in the body and cause seizures or neurotoxicity, especially in patients with renal impairment.

Interaction of Morphine and Antihypertensive Agents

• Increased hypotensive effects: Combining morphine with antihypertensive medications can lead to excessive blood pressure lowering due to their synergistic effects on blood vessel dilation.

Transdermal Fentanyl Administration

• Continuous, sustained pain relief over 72 hours: Transdermal fentanyl patches provide slow, continuous release of the drug, minimizing the need for frequent dosing.

Situation Where Meperidine Should Be Avoided

• In patients with renal impairment or receiving medications metabolized by CYP2D6: Meperidine is not recommended in these situations to reduce the risk of normeperidine accumulation and neurotoxicity.

Non-Drug Therapy for Pain Perception

• Mindfulness-based therapies: Techniques like mindfulness meditation and yoga aim to alter pain perception and improve coping mechanisms.

Characteristic Symptom of Migraine Headaches

• Pulsating or throbbing pain: Migraines are often accompanied by a throbbing or pulsating pain, frequently described as a severe headache.

First-Line for Moderate to Severe Migraines

• Triptans: These medications are considered first-line for abortive therapy of moderate to severe migraine attacks.

CAM in Pain Management

• Complementary and alternative medicine (CAM): Offers a variety of non-pharmacological approaches for pain management, often used alongside conventional therapies.

NSAIDs in Acute Migraine Management

• Reduce inflammation and pain: NSAIDs help to manage the pain and inflammation associated with migraines.

Migraine Aura Characteristic

• Visual disturbances: An aura is a sensory disturbance that precedes a migraine attack, often involving visual changes like flashing lights or blind spots.

Migraine Attack Frequency

• Variable: Migraine attack frequencies can range from a few times a year to several times a month.

Physical Therapy for Pain Relief

• Therapeutic exercise: Specifically tailored exercises can help improve physical function, decrease pain-related immobility, and enhance overall well-being.

Wide Therapeutic Index Property

• Safe margin between effective dose and toxic dose: Drugs with a wide therapeutic index allow for greater flexibility in dosing.

Primary Mu-Opioid Receptor Activation Effect

• Analgesia and euphoria: Activating mu-opioid receptors produces pain relief and feelings of euphoria.

Agonist-Antagonist Opioids vs. Pure Agonists

• Partial agonist properties: Agonist-antagonist opioids only partially activate the mu-receptor, reducing risk of overdose when used with pure opioids.

Kappa (κ) Receptors

• Play a role in analgesia, dysphoria, and sedation: Kappa receptors are involved in pain modulation, but their activation can lead to dysphoria or adverse effects.

Safety Profile of Drugs with Narrow Therapeutic Index

• Lower safety margin: Drugs with a narrow therapeutic index have a small margin between an effective dose and a toxic dose, requiring careful monitoring.

Consequence of Agonist-Antagonist Misuse

• Precipitated withdrawal: Mixing agonist-antagonist opioids with pure opioid agonists can trigger withdrawal symptoms in individuals with opioid dependence.

Why Mu (μ) Receptors are Primary Opioid Focus

• Strongest analgesic effects: Mu receptors mediate the most potent pain-reducing effects among opioid receptors.

Endogenous Opioid Peptides and Delta (δ) Receptors

• Endogenous opioids bind to delta (δ) receptors: These naturally occurring peptides play a role in various physiological processes, including pain modulation.