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Analgesics Flashcards

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1
Q

What are 3 boxed warnings for all NSAIDS?

A
  • GI risk (bleeding & ulceration)
  • CV risk (increased MI & stroke)
  • CI after CABG

All RX NSAIDs require MED GUIDES

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2
Q

What are 4 side effects of NSAIDs?

A
  1. Decreased renal clearance
  2. Increased BP
  3. Premature closure of DA in fetus (avoid in 3rd tri of pregnancy)
  4. Photosensitivity
  5. GI - dyspepsia, abd pain, nausea
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3
Q

What is the brand name for ibuprofen?

4 brands

A
  1. Advil
  2. Caldolor
  3. Motrin IB
  4. NeoProfen (indicated for closure of PDA in premature infants)
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4
Q

What is the usual dose of ibuprofen?
The max dose in Rx & OTC?

A

200-400 mg Q4-6H
OTC: 1.2 g/day
Rx: 400-800 mg Q6-8H
3.2 g/day

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5
Q

What is the peds dosing for ibuprofen?

A

5-10 mg/kg/dose Q6-8H
Max: 40 mg/kg/day

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6
Q

What is the brand name for indomethacin?

A

Indocin, Tivorbex

Available as capsule, suspension, suppository, injection

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7
Q

What is the dosing for indomethacin?

A

IR: 25-50 mg BID-TID
CR: 75 mg daily - BID
Tivorbex: 20 mg TID or 40 mg BID-TID (micronized for faster dissolution

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8
Q

What is an unusual SE in indomethacin?

A

High risk for CNS side effects (avoid in psych conditions)

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9
Q

What are notable NSAIDs DI?

A
  • bleeding risk
  • ototoxicity (with ASA - tinnitus)
  • increase the levels of lithium & MTX
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10
Q

What is the brand name for Naproxen?

A
  1. Aleve
  2. Naprelan
  3. Naprosyn
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11
Q

What is the OTC dosing for naproxen?

A

200 mg Q8-12H
Max: 3 tabs in 24 hours (600 mg)

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12
Q

What is the brand name for ketorolac?

A
  1. Toradol
  2. Acular (opthalmic)
  3. Sprix (nasal spray)
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13
Q

Boxed warning for ketolorac?

5 boxed warnings

A
  1. PO use for short-term mod-severe acute pain only as continuation of IV or IM (max combo duration is 5 days in adults)
  2. Avoid in advanced renal disease or risk for renal impairment due to volume depetion
  3. avoid use in L&D
  4. avoid use with ASA or NSAIDs
  5. Dose adjustments needed in elderly 65 yrs + or <50 kg
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14
Q

Max dose of ketorolac?

A

40 mg/day (PO)

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15
Q

Piroxicam brand, dose, & special notes

A

Brand: Feldene
Dose: 10-20 mg daily
Notes: high risk for GI tox, SJS/TEN
Used when other nsaids fail
May need protective agent for gut (PPI, misoprostol)

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16
Q

Sulindac brand, dose, special notes?

A

Brand: Clinoril, Sulin
Dose: 150-200 mg BID
Notes: sometimes used in reduced renal fxn, pts on lithium

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17
Q

Misc NSAIDs?

A
  • meclofenamate (Meclomen)
  • mefenamic acid (Ponstel)
  • ketoprofen (Orudis, Oruvail)
  • fenoprofen (Nalfon)
  • flurbiprofen (Ansaid)
  • oxaprozin (Daypro)
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18
Q

What is the OA dose for celecoxib?

Highest COX-2 selectivity

A

100 mg BID or 200 mg daily

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19
Q

What is the RA dose for celecoxib?

Study These Flashcards
A

100-200 mg BID

20
Q

What is Consensi and what is it used for?

Study These Flashcards
A

celecoxib + amlodipine
OA pain & HTN

21
Q

Contraindication for celecoxib use?

Study These Flashcards
A

Sulfonamide allergy

22
Q

What forms does diclofenac come in?

Study These Flashcards
A
  1. Gel (Voltaren)
  2. Patch (Flector)
  3. Packet (Cambia)
  4. Topical solution (Pennsaid, Xrylix)
  5. Capsule (Zorvolex)
  6. Capsule (Zipsor)
  7. Tablet (Voltaren)
23
Q

What is Arthrotec and who should not use it?

Study These Flashcards
A

Voltaren + misoprostol (gut protective)
Women who are of childbearing potential unless capable of complying with effective contraceptive measures

24
Q

Dosing Conversions

Morphine IV/IM to PO

25
# Dosing Conversion Hydromorphone IV to PO
1.5 to 7.5
26
# Dosing Conversion Oxycodone
No IV/IM 20 mg (PO)
27
# Dosing Conversion Hydrocodone
No IV/IM 30 mg
28
# Dosing Conversion Codeine IV to PO
130 to 200
29
# Dosing Conversion Fentanyl
No PO IV/IM: 0.1
30
# Dosing Conversion Meperidine
75 to 300
31
# Dosing Conversion Oxymorphone
1 to 10
32
Which opioids should you take on an empty stomach?
Oxymorphone (Opana)
33
Which 2 opioids are CI in children <12 and <18 following tonsillectomy/adenoidectomy?
Tramadol (CIV), codeine (CII, CIII,CV)
34
Common SE of opioids?
1. Constipation 2. N/V 3. somnolence 4. Dizziness/lightheadedness 5. Risk of respiratory depression
35
Dosage strengths of Fentanyl Patch? | 5 strengths
12, 25, 50, 75, 100 mcg/hr
36
What forms of Fentanyl are available?
1. Patch (Duragesic) 2. Lollipop (Actiq) - only for BTP in cancer 3. Nasal Spray (Lazanda) 4. Buccal tabs (Fentora) 5. SL spray (Subsys)
37
Common SE of Fentanyl
1. Hyperhidrosis (excessive sweating) 2. Dry mouth 3. asthenia 4. Loss of appetite 5. Application site redness/erythema (patch)
38
Special notes for Actiq?
1. Only for cancer BTP 2. REMS program
39
How much morphine should a patient be using before switching to fentanyl patch?
60 mg/day or more for at least 7 days
40
Which opioids do we want to watch out for QT prolongation?
1. Methadone 2. Hysingla ER (hydrocodone) doses >160 mg/day 3. Olieridine (Olinvyk) doses >27 mg/day
41
Which opioids should you avoid with CYP3A4i?
1. hydrocodone 2. oxycodone 3. methadone 4. Fentanyl
42
Which opioids can be opened and sprinkled on soft food?
Kadian (morphine) Xtampza ER (oxycodone)
43
Which 2 opioids do you want to avoid with MAOi or have at least 2 week washout?
1. Meperidine 2. Hydromorphone
44
What are 2 important points with meperidine?
1. Renally cleared - normeperidine can accumulate and cause CNS toxicity (seizures) 2. Serotonergic 3. Elderly at risk
45
Which opioids should you watch out for with renal impairment?
1. Morphine 2. meperidine 3. oxycodone
46
Which oxycodone formulations are abuse deterrent?
1. Oxaydo 2. OxyContin 3. Xtampza ER

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