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Pain Management

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Mu receptors   produce analgesia, resp depression, sedation, euphoria, dependence, constipation  
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K receptors   analgesia, resp depression, anxiety, hallucinations  
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Delta receptors   analgesia without adverse events  
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pure opioid agonists (mu mostly, some kapp) examples   fentanyl, hydromorphone, levophanol, mepiridine, methadone, morphine, oxycodone, oxymorphone  
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moderate-mild opioids examples   codeine, hydrocodone, propoxyphene  
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mixed agonist-antagonist (Kappa, weak on mu) examples   pentazocine, butophanol, nalbuphine, buprenorphine, dezocine  
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Opioid antagonists that block but mu and kappa examples   Naloxone, Naltrexone, Nalmefene  
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mixed agonist-antagonist effects   more euphoria, psychomimetic effects, less resp depression  
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opioid antagonists effects   used to reverse resp depression and CNS depression  
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opioid ADRs   CNS effects, chronic sedation, muscle jerks, changes in hormone levels, high doses create convulsions, resp depression, orthostatic hypotension, N/V, constipation, bladder spasm and urgency, urinary retention, flushing of face, sweating, pruritis  
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opioids DDI   CNS depressants, anticholinergics, TCAs, atropine, antihypertensives, MAOI's  
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ASA + APAP + Caffeine   Excedrin  
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Abortive therapy for migraines   Ergotamine, Combinations with caffeine, Dihydroergotamine, triptans  
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Ergotamine ADR   N/V, weakness in legs, myalgia, numbness/tingling, angina-like, tachycardia, bradycardia; overdose can cause ergotism -- ischemia, myalgias, parethesias, gangrene  
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Ergotamine DDIs/Drug-dz interactions   SSRIs (separate by 24 hrs), Ci in renal or hepatic impairment, sepsis, CAD, PVD  
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Ergotamine   Ergomar, Ergostat, Wigrettes, Gynergen, Medihaler-Mergotamine  
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Ergotamine/Caffeine   Cafergot, Wigraine  
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Ergotamine/pentobarbital/bellafoline   bellergal  
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ergotamine/pentobarbital/belladona/caffeine   cafergot PB  
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Isometheptene/dichloralphenazone/APAP   midrin  
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Dihydroergotamine   little peripheral vasoconstriction, n/v or physical dependence but diarrhea predominant  
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DHE CI   CAD, PVD, pregnancy, sepsis, hepatic or renal impairment; dont give within 24 hrs of SSRI  
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Triptan ADR   tingling, parethesias, warmth of head, neck, chest, limbs, dizziness, flushing, back pain, stiffness, chest symptoms, heavy arms, agina (rarE), vertigo, malaise, fatigue  
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Triptan DDI/D-DzI   ergots, triptans, MAOI's; CI in IHD, MI, uncontrolled HTN  
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Almotriptan   Axert  
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Sumatriptan   Imitrex  
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Eletriptan   Relpax  
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Frovatriptan   Frova  
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Rizatriptan   Maxalt  
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Zolmitriptan   Zomig  
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Naratriptan   Amerg  
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migraine prophylaxis   beta blockers, anticonvulsants, antidepressants, CCBs, methysergide  
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Beta blockers in migraine prophylaxis   propranolol and timolol DOC  
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Antidepressants in migraine prophyalxis   amitriptyline, fluoxetine  
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Divalproex ADR   weight gain, hair loss, tremor, teratogenic  
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Topiramate ADR   parethesia, fatigue, nausea, dizziness, difficulty concentration, wieght loss, anorexia  
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Methysergide   ergot alkaloid  
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Methyseride ADR   retroperitoneal, pleuropulmonary, cardiac fibrosis, vascular insufficiency, insomina, altered mood, depersonalization, hallucinations, nightmares, GI disturbances, N/V, diarrhea  
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