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Therapeutics III > Rogers Pain Part 3 > Flashcards

Rogers Pain Part 3 Flashcards

1
Q

Uses of opioids

A

Acute and chronic pain

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2
Q

Opioid side effects

A

-Antitussive
-Constipation
-Nausea and vomiting
-Itching
-Orthostatic hypotension
-Urinary retention
-Sedation
-Respiratory depression

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3
Q

Opioid clinical pearls

A

-Consider starting stool softener and/or stimulant laxative
-Potential for tolerance, dependence and addiction
-Schedule 2 controlled substances besides tramadol and codeine

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4
Q

Available formulation for codeine

A

-Tablet
-Cough syrup

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5
Q

Codeine clinical pearls

A

-Schedule 5, 3, or 2 controlled substances
-Metabolized to morphine via CYP 2D6
-Not recommended in breastfeeding mothers or children less than 12

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6
Q

Codeine brand name

A

Tylenol #3

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7
Q

Tramadol available formulations

A

-Capsule ER 24hr
-Tablet - IR and ER 24hr
-Oral solution
-Combination products with acetaminophen and celecoxib available

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8
Q

Tramadol clinical pearls

A

-Risk of serotonin syndrome when used with other serotonergic medications
-Renally dose adjusted
-US boxed warning: use of CYP 450 3A4 inducers, 3A4 inhibitors, and 2D6 inhibitors with tramadol requires careful consideration of the effects on the parent drug and metabolite
-Schedule 4 controlled substance

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9
Q

Tramadol brand name

A

-Ultram-discontinued
-Conzip
-Qdolo

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10
Q

Morphine available formulations

A

-Capsule ER 24hr
-Tablet - IR and 12hr ER (MS contin)
-Oral solution
-Solution for injection (IM, IV, subQ)
-Suppository

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11
Q

Morphine clinical pearls

A

-Itching more prominent compared to other opioids
-Morphine and its metabolites are renally excreted and accumulate in renal dysfunction (avoid in patients with renal disease)
-US boxed warning: avoid alcohol while taking ER capsules - leads to increased morphine plasma levels and potentially fatal overdose

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12
Q

Hydromorphone available formulations

A

-IR and ER tablets
-Oral solutions
-Solution for injection
-Suppository

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13
Q

Hydromorphone clinical pearls

A

US boxed warning about dosing errors when prescribing, dispensing, and administering:
-Oral solution - do not confuse mg and mL
-IV solution - do not confuse high potency solution with other solutions

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14
Q

Hydromorphone brand name

A

Dilaudid

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15
Q

Hydrocodone +/- acetaminophen available formulations

A

-Oral solution
-ER tablet
-Tablet

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16
Q

Hydrocodone +/- acetaminophen clinical pearls

A

-Counsel patients on acetaminophen use
-US boxed warning: Use with CYP 3A4 inhibitors may increase hydrocodone plasma concentrations

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17
Q

Oxycodone +/- acetaminophen available formulations

A

-Tablet (IR and ER 12hr)
-Capsule (IR and ER 12hr)
-Oral solution

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18
Q

Oxycodone +/- acetaminophen clinical pearls

A

-Counsel patients on acetaminophen use with combination product
-ER capsules/tablets are abuse-deterrent
-US boxed warning: use with CYP 3A4 inhibitors may increase oxycodone plasma concentrations

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19
Q

Oxycodone brand names

A

-Oxycontin
-Xtampza

20
Q

Oxycodone + acetaminophen brand name

A

Percocet

21
Q

Fentanyl available formulations

A

-Buccal tablet
-Sublingual liquid
-Lozenge
-Injectable solution
-Patch

22
Q

Fentanyl clinical pearls

A

-US boxed warning: monitor patients receiving CYP 3A4 inhibitors or inducers
-Can be used in renal impairment
-Less hypotension than morphine or hydromorphone at similar doses
-Non-injectable forms are only indicated with patients who are opioid-tolerant
-Doses are not converted from one fentanyl product to another on a mcg-per-mcg basis

23
Q

What is opioid tolerance?

A

Taking morphine 60mg per day (or equivalent) for at least 1 week

24
Q

Fentanyl brand name

A

Duragesic

25
Q

Fentanyl patch counseling

A

-Apply one patch every 72 hours (3 days)
-Apply the patch to the chest, back, flank, or upper arm
-Do not cut patches or use a patch that is torn or damaged (could cause an overdose)
-Do not use the patch over broken skin
-Do not let the patch get too warm while wearing (body will absorb too much)

25
Q

Methadone available formulations

A

-Oral solution
-Injectable solution
-Tablet

26
Q

Methadone brand name

A

Methadose

26
Q

Meperidine available formulations

A

-Injectable solution
-Oral solution
-Tablet

26
Q

Methadone uses

A

-Last line treatment for chronic pain
-Opioid detoxification

26
Q

Methadone clinical pearls

A

-US boxed warning: QTc prolongation (check baseline ECG before initiation)
-US boxed warning: monitor patients receiving CYP #A4 inhibitors or inducers
-Long half life (8-59 hours)

27
Q

Meperidine clinical pearls

A

-Avoid in the elderly, avoid in renal impairment, caution use in hepatic impairment
-US boxed warning: monitor patients receiving CYP 3A4 inhibitors or inducers
-US boxed warning: do not use within 14 days of monoamine oxidase inhibitors (MAOIs)
-Metabolized by the liver into an active metabolite (accumulation of this metabolite can cause delirium and seizures)
-Not commonly used due to adverse effects

28
Q

Which opioid has serotonergic activity?

A

Tramadol

29
Q

What do opioids with serotonergic activity have the risk to do?

A

-Lower seizure threshold
-Cause serotonin syndrome when used with other agents with serotonergic activity

30
Q

Initial dosing of codeine in opioid naive patients

A

15-60mg PO Q4H PRN

31
Q

Initial dosing of tramadol in opioid naive patients

A

25-50mg PO Q4-6H PRN

32
Q

Initial dosing of morphine in opioid naive patients

A

-5-10mg PO Q4H PRN
-2.5-5mg IV Q3-4H PRN

33
Q

Initial dosing of hydromorphone in opioid naive patients

A

-2.4mg PO Q4-6H PRN
-0.2-1mg IV Q2-3H PRN

34
Q

Initial dosing of hydrocodone in opioid naive patients

A

2.5-10mg PO Q4-6H PRN

35
Q

Initial dosing of oxycodone in opioid naive patients

A

5-15mg PO Q4-6H PRN

36
Q

Initial dosing of fentanyl in opioid naive patients

A

25-50mcg Q30-60min PRN

37
Q

Which opiates are natural opiates?

A

-Morphine
-Codeine

38
Q

Which opiates are semi synthetic opioids?

A

-Hydromorphone
-Oxycodone
-Oxymorphone
-Hydrocodone
-Buprenorphine

39
Q

Which opiates are synthetic opioids?

A

-Fentanyl
-Methadone
-Meperidine
-Tramadol

40
Q

Is there allergic cross reaction for natural opiates with other opioids?

A

Yes, avoid in patients with allergy to other natural opiates and semi synthetic opioids

41
Q

Is there allergic cross reaction for semi synthetic opioids with other opioids?

A

Yes, avoid in patients with allergy to other natural opiates and semi synthetic opioids

42
Q

Is there allergic cross reaction for synthetic opioids with other opioids?

A

No, can be used if patient has an allergy to another synthetic opioid, semi synthetic opioid or natural opiate

43
Q

How do you switch between opioids?

A

-Calculate daily consumption for each opioid
-Convert each opioid to oral morphine
-Add morphine doses together to get total daily oral morphine dose
-Due to cross-tolerance, reduce the equal analgesic dose by 25-30%
-Split total daily dose into appropriate dosing interval based on opioid selected (duration of action)

Therapeutics III (42 decks)

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