00 Pain Management

Question 1

What is the MOA of Salicylates?

Answer 1

IRREVERSIBLY inhibit COX-1 and COX-2, prevent prostaglandin formation, inhibit platelet aggregation

Question 2

What is the generic name of Cystex?

Answer 2

Sodium Salicylate (nonacetylated salicylate)

Question 3

When should Cystex be avoided?

Answer 3

(Sodium Salicylate): avoid in sodium-restricted patients, cardiovascular disease

Question 4

What is the generic name of Doan’s?

Answer 4

Magnesium Salicylate

Question 5

When should Doan’s be avoided?

Answer 5

(Magnesium Salicylate): Avoid in renal insufficiency

Question 6

What medications fall under the Enolic Acids (NSAIDs)?

Answer 6

Meloxicam, Piroxicam

Question 7

What medications fall under the Acetic Acids (NSAIDs)?

Answer 7

Diclofenac, Etodolac, Sulindac, Ketorolac

Question 8

What medications fall under the Propionic Acids (NSAIDs)?

Answer 8

Ibuprofen, Naproxen, Ketoprofen

Question 9

What medication falls under the COX-2 Inhibitor (NSAID)?

Answer 9

Celecoxib (only one left on the market)

Question 10

What is important to know about the length of use for Ketorolac?

Answer 10

More GI toxicity than other NSAIDs, not to exceed more than 5 days of use

Question 11

Which NSAIDs have once daily dosing?

Answer 11

Meloxicam, Piroxicam, Nabumetone, Oxaprozin

Question 12

Which NSAID is commonly used for gout exacerbations?

Answer 12

Indomethacin

Question 13

What is NSAID use like in pregnancy?

Answer 13

Generally avoid. Category B 1st & 2nd trimester, Category D in 3rd

Question 14

What are the opiate side effects?

Answer 14

SPEND: Sedation, Postural hypotension, Euphoria, Nausea, Derm rashes. SCRAM: Sex hormone drugs needed, Constipation, Respiratory depression, Addiction, Miosis

Question 15

What is the drug of choice for pain associated with myocardial infarction?

Answer 15

Morphine

Question 16

What impairment is morphine not a good choice with?

Answer 16

Renal impairment

Question 17

What is the generic name of Roxanol?

Answer 17

IR Morphine (Q4h)

Question 18

What is the generic name of Kadian?

Answer 18

CR Morphine (Q12h)

Question 19

What is the generic name of MS Contin?

Answer 19

CR Morphine (Q12h)

Question 20

What is the generic name of Avinza?

Answer 20

ER Morphine (Q24h)

Question 21

What is the generic name of Lorcet?

Answer 21

Hydrocodone + APAP

Question 22

What is the generic name of Lortab?

Answer 22

Hydrocodone + APAP

Question 23

What is the generic name of Tylenol #3?

Answer 23

Codeine + APAP

Question 24

What is the generic name of OxyIR?

Answer 24

IR Oxycodone (Q4-6h)

Question 25

What is the generic name of Oxycontin?

Answer 25

ER Oxycodone (Q12h)

Question 26

What is the generic name of Dilaudid?

Answer 26

IR Hydromorphone (Q4-6h)

Question 27

What is the generic name of Exalgo?

Answer 27

ER Hydromorphone (Q24h)

Question 28

What is the generic name of Opana?

Answer 28

Oxymorphone

Question 29

What is the generic name of Ultram?

Answer 29

Tramadol

Question 30

What is the MOA of Ultram (Tramadol)?

Answer 30

Inhibits reuptake of serotonin and norepinephrine

Question 31

What are the toxicities related to Ultram (Tramadol)?

Answer 31

Seizures. Nausea & Dizziness

Question 32

What is the generic name of Butrans?

Answer 32

Buprenorphine Patch (Q7 days)

Question 33

What must you do before starting Butrans Patch?

Answer 33

Taper the patient's long-acting opioids for up to 7 days to no more than 30mg of oral morphine or equivalent

Question 34

When might the Butrans Patch not work well?

Answer 34

In patients needing > 80mg/day morphine equivalent

Question 35

What is the generic name of Demerol?

Answer 35

Meperidine

Question 36

What is a unique indication for Demerol (Meperidine)?

Answer 36

Rigors as well as moderate-severe pain

Question 37

What are the ADRs like for Demerol (Meperidine)?

Answer 37

Many ADRs, risk of seizures d/t metabolite normeperidine

Question 38

When can Fentanyl be used?

Answer 38

Only for opioid-tolerant patients (60mg morphine equivalent/day x at least 7 days)

Question 39

What is the generic name of Duragesic?

Answer 39

Fentanyl Transdermal

Question 40

If a patient is on 50mg of morphine equivalent/day, what Fentanyl patch should they be on?

Answer 40

25mcg (MICROGRAMS). Common practice is to use a 2:1 ratio

Question 41

What is a risk with Methadone?

Answer 41

Risk of QTc prolongation, baseline ECGs

Question 42

If a patient has a true allergy to codeine, morphine, hydrocodone, etc., what may he/she safely take?

Answer 42

Methadone. Meperidine. Fentanyl

Question 43

What is the generic name of Narcan?

Answer 43

Naloxone (for overdose of opiates)

Question 44

What are some different medication options for Neuropathic Pain?

Answer 44

AEDs (Gabapentin, Pregabalin, Topiramate, Carbamazepine, Oxcarbazepine). Anesthetics (Lidocaine). Corticosteroids. SNRIs (Venlafaxine, Duloxetine). TCAs (Amitriptyline, Desipramine, Nortriptyline). Opiates. Topical preps

Question 45

What are the 3 FDA-approved medications for Fibromyalgia Syndrome (FMS)?

Answer 45

Lyrica (Pregabalin). Cymbalta (Duloxetine). Savella (Milnacipran - SNRI w/ some NMDA inhibition)

Question 46

How does the analgesic activity of Celecoxib compared to traditional NSAIDs?

Answer 46

Less analgesic activity compared to traditional NSAIDs

Question 47

What is sometimes combined with NSAIDs to decrease the incidence of GI bleeding?

Answer 47

Misoprostol