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PHRM 845 > exam 5 pain rogers > Flashcards

exam 5 pain rogers Flashcards

1
Q

How is pain classified?

A

acute vs chronic
noiceptive or neuropathic or both

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2
Q

what are some non-pharmacological therapies for pain?

A

exercise, correct cause, physical manipulation, heat/ice accupuncture, massage
used in combo with analgesics

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3
Q

what is the treatment approach to pain therapy?

A

step 1: non opioid +/- adjuvant analgesic
step 2 + 3: opioid + nonopioid +/- adjuvant analgesics

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4
Q

what are non-opioid analgesics?

A

APAP
NSAIDs

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5
Q

what are adjuvant therapies?

A

gabapentinoids
SNRIs
TCAs
Skeletal muscle relaxants
antiepileptics
topical agents

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6
Q

what are the formulations of APAP?

A

tablet, capsule, chewable, liquid, IV, suppository

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7
Q

what is dosing, side effects, and clinical pearls of APAP?

A

adults: 325-1000mg PO q4-6h prn max 3-4g/day, max 2g in liver disease pts
PEDs: 10-15mg/kg PO q4h PRN, max dose 3-4g/day
sides: hepatotoxicity likely with >10g dose
pearls: gold standard for OA due to fewer sides than NSAIDs

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8
Q

what are side effects and clinical pearls of NSAIDs?

A

GI bleeding, nephtotoxicity, fluid retention, increased CV events
take with food, caution use in geriatric patients (BEERs), avoid systemic NSAIDs in patients with cardiac history, avoid severe liver or kidney disease

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9
Q

what is aspirin formulations?

A

chew, EC, capsule, ER, suppostitory

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10
Q

what are dosing and clinical pearls for aspirin?

A

adults: 325-1000mg q4-6h PRN (max 4g/day)
PEDs: not recommended due to reyes syndrome
clinical pearls: avoid in blood thinners due to antiplatelet activity

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11
Q

what is reyes syndrome?

A

associated with children and teens when using ASA and they have a viral infection
rare condition causing swelling in brain and liver

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12
Q

what are ibuprofen formulations?

A

suspension, chewable, IV

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13
Q

what is ibuprofen dosing?

A

adults 200-800mg PO q6-8h PRN
max 3200mg
PEDS: 5-10mg PO q4-6h PRN max 2400mg

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14
Q

what are diclofenac formulations?

A

IV, suppository, topical gel, topical solution, opthalmic, patch

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15
Q

what are naproxen formulations?

A

ER tablet, suspension

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16
Q

what are ketolroac formulations?

A

IV/IM, nasal spray, opthalmic solution

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17
Q

what is important about ketorolac?

A

maximam duration of 5 days
oral dosing is only for continuation of IM or IV therapy

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18
Q

what are celebrex formulations?

A

capsule and oral solution

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19
Q

what is important about celebrex?

A

COX 2 selective

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20
Q

what are the formulations for gabapentinoids?

A

ER and liquid

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21
Q

what is important a gabapentinoids?

A

Gabapentin dosing: 100-300mg po TID max dose 3600mg
pregabalin dosing: 75mg PO BID max 600mg/day
titrate up slowly to limit sedation

22
Q

what is are the formulations of SNRIs?

A

capsule/tab
ER

23
Q

what drug should be avoided in patients with CrCl <30mL/min

A

duloxetine
renal dose adjustments needed for venlafaxine

24
Q

what are the formualtions for TCAs?

A

amitriptyline: tablet
nortriptilylin: capsule and oral solution

25
Q

what are the formulations for muscle relaxants?

A

tablet/capsule (IR/XR)

26
Q

what are the available formulations for carbamazepine?

A

ER capsule/tablet
suspension

27
Q

which drug has increased hypersensitivity with HLAB-1502 allee?

A

carbamazepine
also has autoinduction of enzymes

28
Q

what is important about lidocaine?

A

tachyphylaxis with continous use
12 hour break between patches
less systemic sides

29
Q

what is capsacian used for?

A

muscle/joint pain
neuropathic pain

30
Q

what drugs should be avoided in the elderly?

A

Non COX2 selective
indomethacin + ketorolac
skeletal muscle relaxants: carisoprodol, cyclobenzaprine, methocarbamol
opioids and BZDs
opioids and gabapentinoids
anticholinergics
combination of these 3 or more

31
Q

what should be used with caution in the elderly?

A

SNRIs
TCAs
Carbamazepine

32
Q

what are side effects of opioids?

A

antitussive, constipation, N/V, itching, orthostatic hypotension, respriratory depression
can start stool softener or stimulant laxative

33
Q

what is codeine?

A

metabolized to morphine via CYP 2D6

34
Q

what is tramadol?

A

US boxed warning use of 3A4 inducers, inhibitors, 2D6 inhibitors require careful dosing considerations

35
Q

what is morphine?

A

itching is predominant compared to other opioids
morphine and metabolites are renally excreted and can accumulate in renal dysfunction
Avoid alcohol when taking capsules

36
Q

what is hydromorphone?

A

solution for injection, suppository
boxed warning: medication errors

37
Q

what is us boxed warning: use with CYP 3A4 inhibitors may increase levels

A

hydrocodone, oxycodone, fentanyl, tramadol, methadone, merpiridine

38
Q

what can be used in renal impairment?

A

fentantyl

39
Q

what is important about methadone?

A

qt prolongation

40
Q

what are natural opioids?

A

morphine
codein

41
Q

what are semi-synthetic opioids?

A

hydromorphone
oxycodone
oxymorphone
hydrdocodone
buprennorphine

42
Q

what are synthetic opioids?

A

fentanyl
methadone
meperidine
tramadol

43
Q

what should be given in patients with allergies to semi-synthetic or natural opioids?

A

synthetic opoiods
fentanyl
methadone
mepiridine
tramadol

44
Q

how do you reduce/ taper and opioid?

A

decrease by 10% per month if pt has been on it for 1+ years
decrease by 10% per week if patient has been on it for weeks to months

45
Q

what is treatment for acute pain?

A

PRN analgesia
around the clock analgesia

46
Q

what is michigan OPEN?

A

recommended APAP and ibuprofen q6h while awake

47
Q

what is treatment for acute pain in the hospital?

A

can only have one order for each severity of pain

48
Q

what is the recommended treatment for low back pain?

A

nonpharm - exercise, CBT, rehab
first line: APAP and NSAIDs
second line: SNRIs and TCAs

49
Q

what is the treatment for OA?

A

nonpharm - excercise, weight loss, education
firstline: APAP and NSAIDs
second line: intra-articular hyaluronic acid or capsaicin

50
Q

what is treatment for mibromyalgia?

A

nonpharm: exercise, CBT, rehab
medications: FDA pregabalin, duloxetine
other options: gabapentin, TCAs, venlafaxine

51
Q

what is treatment for neuropathic pain?

A

first line: SNRIs, gabaptentin/pregabalin
second line: topical lidocain, TCAs

52
Q

what are the hospice medications?

A

pain relief: morphine
anxiety/agitation: lorazepam
N/V: ondansetron ODT
secretions: atropine, glycopyrrolate, scopalamine

PHRM 845 (9 decks)

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