Pharmacology Exam 2- Semester 2

Which of the following would be a cause of phantom pain

previous amputation

Ab fibers

light touch sensations

• nonoxoius mechanical stimulus (touching with feather)

Adelta fibers

noxious mechanical stimulus (hitting with hammer)

C fibers

noxious heat and chemical stimuli

Acute inflammation (step 1 inflammation)

histamine is released causing vasodilation

Subacute inflammation (step 2 inflammation)

inflammatory cells move to the area

Chronic lymphocytic phase (step 3 inflammation)

cytokines, interleukins and TNF-alpha (injury cleansing)

Activated mast cells release

prostaglandins, leukotrienes, complement derived products

What is released first in inflammation?

histamine

Platelets

Highest source of serotonin-5HT (mediators); pick it up from the GIT

• do NOT synthesize, pick it up

Non-narcotic analgesics

• Aspirin and NSAIDs

• Acetaminophen

Narcotic analgesics

Opioids (CNS depressants)

Which of the following is important in successful pain management?

Dosing schedule

NSAID use

Short term use <1 week or 5 days

• do not depress CNS depression like opioids

After 3 days NSAIDS for fever

discontinue medication (they can mask infection)

D/C NSAIDs after ____ days for the use of pain

10

Chronic inflammation of RA- use of NSAIDs

Doses are 2-3 times higher and are monitored closely by Rheumatologist or prescriber

Do not combine

Aspirin and Sulfasalazine

Aspirin (salicylates)

Acetylsalicylic acid (ASA), willow bark extract

• MOA: inhibit COX activity (preventing synthesis of COX product)

• Use: analgesic, anti pyretic (therapeutic dose), anti-inflammatory (high dose), anti-platelet (low dose)

Kawasaki Dz

Fever, runny nose, red eyes, ill looking

• should give aspirin in children

Aspirin should be avoided in

children unless that have Kawasaki’s Dz

Which of the following drugs is an anti-pyretic, analgesic, and a anti-platelet?

Aspirin

COX1

constitutional (present in the body)

• form protective prostaglandin: protect gastric mucosa (PG-E2), renal activity, aid platelet aggregation (thromboxane, TX-B2)

COX-2

synthesized in the body when signaled

• sensitize skin pain receptors, recruit inflammatory cells, results hypothalamic temperature control (fever)

Inhibit COX1

NSAIDs and aspirin

Inhibit COX2

COX-2 inhibitors, NSAIDs, Aspirin

• COX-2 only: good for gastric mucosa bc it does not block COX-1, allows platelet aggregation to still occur (DO NOT USE IN CV RISK PT)

Around 20% of

Asthma pts cannot tolerate ibuprofen or similar drugs

Which of the following 2 effects are observed with inhibition of COX-1?

Bleeding and gastric irritation

Antiplatelet effect of Aspirin

325mg - thromboxane and prostaglandins cancel each other out

81mg - thromboxane is selectively inhibited

Indication of Aspirin

Block COX enzyme irreversibly (effect lost in 8 days)

• acts peripherally (not in the brain)→ local reduction of prostaglandins

• relief of mild to moderate pain

• ceiling effect

Max dose of aspirin

4g a day

Which of the following drugs does not have a ceiling effect?

Hydrocodone

MOA of salicylates- aspirin

• inhibit cell migration

• inhibit neutrophil fxn

• suppress T cells (reduces production of RF)

• Reduces capillary permeability

• reduced antibody production

• does NOT stop joint destruction

Aspirin Anti-inflammatory

• Inhibit PG synthesis at the site of injury and inflammation

  • PGs sensitize pain receptors to histamine and bradykinin

  • Bradykinin induce PG synthesis

• Blocks production of PGE2 and PGF2 alpha

• Different onset of analgesic and anti-inflammatory effects

  • Analgesia within 1 hour (pain relief does not take days)

  • Anti-inflammatory in days to weeks
    

Is NSAID a DMARD?

No

Is Sulfasalazine a DMARD?

Yes

60 mg of codeine is ____ effective than 650 mg of aspirin

less

• Best is an aspirin and codeine combination for pain relief