1. What is the MOA of morphine?
    G protein coupled receptors which increase adenylate cyclase to reduce intracellular cAMP content.
  2. What is morphine metabolised to?
    morphine-6-glucuronide which contributes to action
  3. what is the plasma half life of morphine and how is it excreted?
    • Half life: 3-6hours
    • Excreted: renally
  4. Give 6 SE of morphine
    • 1. respiratory depression
    • 2. N&V
    • 3. constipation, reduce GI motility and so reduce absorption of other drugs
    • 4. pupil constriction
    • 5. mast cell release histamine so bronchoconstriction and hypotension
  5. What does tolerance mean?
    Need higher dose to get the same effect
  6. What does dependance mean?
    When come off it, get withdrawal symptoms and cant sleep, nausea…cravings
  7. Apart from morphine overdose, when else is naloxone needed?
    Give to neonate im if pethidine used in labour
  8. What is the half life of naloxone, why is it important?
    Only 2-4 hours so may need to be repeated or given by infusion as morphine half life is 3-6 hours.
  9. Apart from analgesia, what other property does codeine have?
  10. How does codeine work?
    Converted to morphine
  11. What is codeine’s main SE?
  12. What is the MOA of tramadol…careful!
    • 2 MOA – one opioid agonist
    • Also NA/5HT reuptake inhibitor
  13. What are the properties of fentanyl? And 2 main uses
    • Highly potent and short acting
    • Use: anaesthesia, palliative care (patches and lollipops)
  14. What are the main SE or unwanted effects of pethidine
    • Restlessness (not sedation unlike morphine)
    • Anti-muscarinic: dry mouth, blurred vision
  15. Why is pethidine used in labour?
    Short acting so safer
  16. What is methadone used for?
    Heroin and morphine addiction
  17. What is the half life of methadone?
    Over 24 hours. Good as less sedative than morphine. It is a synthetic opioid
  18. Give 4 uses of NSAIDs
    • 1. anti-inflammatory eg in arthritis
    • 2. pain relief for orthopaedic pts – no evidence that NSAIDs reduce bone healing
    • 3. opiate sparing
    • 4. closure of patent ductus arteriosus
  19. what is MOA of NSAIDs?
    COX inhibit so less PG and TXA2 made
  20. What is the difference between COX1 and COX2?
    • COX1: constitutive – eg gastric mucosa protected by it
    • COX2: inducible – formation of pro-inflammatory mediators
  21. What are 4 ‘a’ effects of NSAIDs?
    • Anti-inflammatory
    • Anti-pyretic
    • Analgesic
    • Anti-platelet
  22. Which 4 systems are affected by NSAIDs? (SE)
    • GI: gastritis, bleeds
    • Renal: reduced PG means less vascular tone so makes renal failure worse
    • Respiratory: bronchoconstriction
    • Cardiac: CCF, pedal oedema
  23. What is the MOA of aspirin?
    IRREVERSIBLE COX 1 and 2 inhibitor
  24. What additional SE does aspirin have?
    • Dizziness, deafness, tinnitus
    • Reye’s syndrome (liver failure in children who take aspirin)
    • Drug interactions as aspirin is highly protein bound so interacts with warfarin
  25. What is the MOA of paracetamol?
    COX3 inhibitor
  26. What are the 2 main effects of paracetamol?
    • Antipyretic
    • Analgesic
  27. What is the MOA of gabapentin?
    • Anti-epileptic
    • Binds VGCC, acts at glycine site of NMDA receptor, subsP
  28. What are the SE of amitryptiline?
    • Anticholinergic
    • Hypotensive
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