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General work > PAIN MEDS > Flashcards

PAIN MEDS Flashcards

1
Q

Non-selective NSAIDs generic and brand names

A 
Diclofenac (voltaren)
Ibuprofen (advil, motrin)
Indomethacin IR (indocin)
Indomathacin SR (indocin SR)
Meloxicam (mobic)
Nabumetone (relafen)
Naproxen (Naprosyn)
Naproxen Sodium (Anaprox, Aleve)
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2
Q

Cox-2 selective NSAIDs generic and brand name

A

Celecoxib (celebrex)

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3
Q

Immediate release single entity OPIOD ANALGESICs generic and brand names

A 
codeine
Hydromorphone (dilaudid)
Methadone (Dolophine)
Morphine IR (MSIR)
Oral transmucosal Fentanyl Citrate (actiq)
Oxycodone IR (OxyIR)
Propoxyphene (Darvon)
Tramadol (ultram)
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4
Q

Immediate release combination OPIOD ANALGESICs

A

Codeine/Acetaminophen (tylenol with codeine)
Hydrocodone/ Acetaminphen (Lorcet, Lortab, vicodin, norco)
Hydrocodone/ibuprofen (vicoprofen)
Oxycodone/ acetaminophen (Percocet, roxicet)
Oxycodone/ aspirin (Percodan)
Tramadol/ acetaminophen (ultracet)

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5
Q

Sustained release OPIOD ANALGESICs

A

Fentanyl transdermal system (duragesic)
Morphine SR, avinza, Kadian, MS contin, oramorph SR
Oxcodone SR(oxycontin)

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6
Q

adjuvant analgesics, muscle relaxants

A 
baclofen
Carisoprodol (soma)
Chlorzoxazone (parafon forte)
Cyclobenzaprine (flexeril)
Orphenadrine citrate (norflex)
Tizanidine (Zanaflex)
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7
Q

Adjuvant analgesics, Anticonvulsants

A

Gabapentin, neurontin
Pregabalin, lyrica
Topiramate, topamax

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8
Q

adjuvant analgesics, Antidepressants

A

Amitriptyline, elavil
Duloxetine, cymbalta
Nortriptyline, pamelor
Venlafaxine, effexor XR

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9
Q

non-selective NSAID contraindications

A

Use in caution in patients with acute or chronic renal insufficiency and acute hepatic dysfunction, gastritis, or peptic ulcer disease (GI bleeding and ulceration)

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10
Q

COX-2 NSAID contraindication

A

less risk of GIB and ulceration than non-selective but may affect renal function. May be associated with increased risk of cardiovascular event especially when used for long periods or during a risky time. Caution in patients with a hx of SULFA

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11
Q

initial drug treatment for RA

A

Salicylates (ASA), NSAIDs or celecoxib

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12
Q

RA drugs to control symptoms

A

NSAIDs, glucocorticoid joint injections and/or low dose prednisone

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13
Q

Common SE of NSAIDs and how to manage

A

GI disturbances (N/V, constipation and diarrhea). Take with food to reduce these reactions

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14
Q

Caution with opiods

A

Opiods may increase the risk of one or more of the following: respiratory depression, severe asthma, paralytic ileum. Use in caution with head injury, abdominal conditions, concomitant use of other CNS agents, use with older patients and patients with renal or hepatic disease

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15
Q

Caution with Opiods and these mediations

A

Risk of serotonin syndrome when used with SSRIs, tricyclics, MAOIs or neuroleptics. Risk of SZ when used with SNRIs, tricyclics or neuroleptics

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16
Q

Adjuvant analgesics- BACLOFEN- indications

A

Spasticity or pain from multiple sclerosis

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17
Q

Baclofen contraindications

A

May impair renal function, possible association with ovarian cysts, abrupt withdrawal may cause seizures

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18
Q

Baclofen MOA

A

centrally acting muscle relaxant

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19
Q

baclofen dosing

A

20mg-80mg divided TID-QID, start with 5mg daily and increase 15mg every 3 days. Taper gradually to d/c

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20
Q

carisoprodol (SOMA)- indications

A

Acute painful musculoskeletal conditions- does not directly relax tense skeletal muscles.

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21
Q

Carisoprodol- MOA

A

Interrupts neuronal communication, resulting in sedation and alteration in pain perception (centrally acting muscle relaxant)

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22
Q

carisoprodol- Contraindications

A

Acute intermittent porphyria (build up of chemicals), sensitivity to related compounds. Use with caution in patient with diminished kidney or LFTs, potential for abuse

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23
Q

carisoprodol- dosing

A

350mg QID

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24
Q

chlorzoxazone (parafon forte)- indication

A

acute, painful musculoskeletal conditions; does not directly relax tense skeletal muscles

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25
Q

chlorzoxazone- MOA

A

inhibits polysynaptic spinal reflexes, increasing muscle mobility and reducing spasticity (centrally acting muscle relaxant)

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26
Q

chlorzoxazone- Contraindications

A

Risk of liver failure, may enhance effects of ETOH, CNS SE, urine discoloration

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27
Q

cyclobenzaprine HCL (flexeril)- indications

A

muscle spasm associated with acute, painful musculoskeletal conditions

28
Q

cyclobenzaprine HCL- MOA

A

Potentiates norepinephrine and binds to serotonin receptors, reducing spasticity (centrally-acting muscle relaxant)

29
Q

cyclobenzaprine HCL- contraindications

A

Use of MAOIs; acute MI, heart disorders, hyperthyroidism. MAy enhance effects of ETOH, barbiturates and other CNS depressants. SE: photosensitivity, blurred vision,

30
Q

cyclobenzaprine HCL- dosing

A

5-10mg PO TID for up to 3 weeks

15-30mg ER PO QD up to 3 weeks

31
Q

orphenadrine citrate (norflex)- indications

A

mild to moderate acute musculoskeletal pain/ leg cramps

32
Q

orphenadrine citrate (norflex)- MOA

A

centrally acting muscle relaxant that inhibits histamine and NMDA receptors

33
Q

orphenadrine citrate (norflex)- Contraindications

A

glaucoma, pyloric or duodenal obstruction, stenosing peptic ulcer, prostate hypertrophy or bladder obstruction, megaesophagus, myasthenia gravis

34
Q

Tizanidine (zanaflex)- Indications

A

acute and intermittent pain of increased muscle tone associated with spasticity

35
Q

Tizanidine (zanaflex)- MOA

A

centrally acting muscle relaxant, binds to central alpha-2 adrenergic receptors, increasing presynaptic motor neuron inhibition and reducing spasticity

36
Q

Tizanidine (zanaflex)- contraindications

A

Risk of liver injury, hypotension, sedation, hallucinations , QT prolongation, stevensjohnson

37
Q

tizanidine (zanaflex)- dosing

A

start low, titrate slowly; 4mg: 4-8mg q 6-24hr, daily max 36mg

38
Q

Gabapentin (neurontin)- Indications

A

post-herpatic neuralgia, neuropathic pain, seizures

39
Q

gabapentin (neurontin)- MOA

A

neurologic- blocks voltage-dependent calcium channels, modulating excitatory neurotransmitter release

40
Q

gabapentin (neurontin)- contraindications

A

dizziness, somnolence, , and other CNS effects. Concomitant use of morphine increases gabapentin concentrations. Cannot be immediately stopped (precipitate status epileptics)

41
Q

gabapentin (neurontin) SE

A

suicidal ideation, mood or behavioral changes, somnolence

42
Q

Topiramate (topamax)- indications

A

migraine prophylaxis

43
Q

topiramate contraindications

A

increased risk of metabolic acidosis, secondary angle closure glaucoma, acute myopia, oligohydrosis, hyperthermia. Should not be stopped abruptly

44
Q

topiramate dosing

A

25mg gradually, titrate over 4 weeks to 100mg/day using split doses (q12)

45
Q

topiramate MOA

A

blocks voltage dependent sodium channels, augments GABA activity, antagonizes glutamate receptors; inhibits carbonic anhydrase

46
Q

pregabalin (lyrica) indications

A

painful diabetic neuropathy, post-herpatic neuralgia, fibromylagia

47
Q

pregabalin MOA

A

binds to alpha2-depta subunit of calcium channels reducing neurotransmitter release; produces antinociceptive and antiseizure effects

48
Q

pregabalin contraindications

A

May cause dizziness, somnolence, other CNS effects and edema. Limited potential for abuse. Should not be stopped abruptly

49
Q

All anticonvulsant warning

A

anti epileptic drugs should not be stopped abruptly because of the possibility of seizures in patients with history of seizure disorder

50
Q

what is the first line for neuropathic pain

A

TCAs

51
Q

Amitriptyline (elavil)- class and MOA

A

TCA, inhibits norepinephrine and serotonin reuptake

52
Q

Amitriptyline- indications

A

Migraine, HA, neuropathic pain

53
Q

Amitriptyline- Dosing

A

50mg HS or 25mg 2-4times per day, daily max 150mg

54
Q

Amitriptyline- contraindications

A

Use in caution in patients with hx sz, urinary retention, angle closure glaucoma, or increased IO pressure. Suicidal ideation. QT prolongation

55
Q

Duloxetine (cymbalta)- indications

A

diabetic neuropathy, fibromyalgia, musculoskeletal pain (chronic)

56
Q

Duloxetine- class and MOA

A

Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs), inhibits norepinephrine and serotonin reuptake

57
Q

Duloxetine- dosing

A

60mg qd or BID

58
Q

duloxetine- contraindications

A

Do not use with an MAOI or within 14 days of an MAOI. May increase HR, cause SZ or confusion, mania or hypomania or eye problems. Suicidal ideation

59
Q

Nortriptyline (pamelor)- indications

A

neuropathic pain

60
Q

Nortriptyline- Class and MOA

A

TCA, inhibits norepinephrine and serotonin reuptake

61
Q

Nortriptyline- contraindication

A

Single doses frequently given at bedtime because of a sedative effect. Use with caution in patients with a hx of cardiovascular disease, urinary rtn and angle-closure glaucoma. Suicidal ideation

62
Q

nortriptyline- dosing

A

25mg TID or QID at HS, start low and titrate as needed to daily max 150mg

63
Q

Venlafaxine (effexor XR)- indications

A

diabetic neuropathy, migraine prevention

64
Q

venlafaxine (effexor XR)- MOA and class

A

SNRI, inhibits norepinephrine, serotonin and dopamine reuptake

65
Q

venlafaxine (effexor XR)- contraindications

A

Do not use with an MAOI or within 14 days of an MAOI. May increase HR, cause SZ, or confusion or mania or hypomania. Suicidal ideation

66
Q

Venlafaxine (effexor XR) dosing

A

IR: 75/d as 37.5 BID or 25mg TID
May increase to 150/d in 4-day intervals
Daily max 225
XR: 75mg/d in a single dose 75-150mg qd daily max 225mg

General work (7 decks)

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