analgesics Flashcards
(75 cards)
1
Q
muscul/o, my/o, myos/o
A
bone
2
Q
fasci/o
A
fascia
3
Q
ten/o, tend/o, tendin/o
A
tendons
4
Q
oss/e, oss/i, oste/o, ost/o
A
bone
5
Q
myel/o
A
bone marrow
6
Q
chondr/o
A
cartilage
7
Q
arthr/o
A
joints
8
Q
ligament/o
A
ligaments
9
Q
synovi/o, synov/o
A
synovial membrane, synovial fluid
10
Q
burs/o
A
bursa
11
Q
NSAID drugs
A
all OTC, Aspirin, diclofenac, etodolac, ibuprofen, indomethacin, meloxicam, nabumetone, naproxen, ketorolac
12
Q
NSAIDs MOA
A
Inhibition of cyclooxygenase (COX) enzymes 1 and 2 reduction in prostaglandin precursors associated with inflammation and pain
Anti-inflammatory and anti-pyretic
13
Q
NSAIDs indications
A
Mild to moderate pain, inflammation, and fever
14
Q
NSAIDs adverse effects
A
** gastrointestinal, cardiovasculat*** renal reye’s syndrome
15
Q
NSAIDs interactions
A
Anti-hypertensive agents
Diuretics
Anticoagulants
16
Q
NSAIDs counseling
A
Make aware of signs and symptoms of GI bleeding
17
Q
Aspirin individual characteristics
A
Also indicated for prevention and treatment of MI and acute ischemic stroke/TIA
Other NSAIDs may diminish cardioprotective effects
18
Q
Indomethacin, Ibuprofen individual characteristics
A
Also utilized for patent ductus arteriosus in infants
Maximum daily dose IBU – 1200 mg to 3200 mg
19
Q
Ketorolac (IV, IM, PO) individual characteristics
A
Dose adjustment required for geriatric, renal insufficiency, low body weight
Maximum daily dose
Maximum duration of treatment is 5 days
20
Q
Selective COX-2 Inhibitors drugs
A
Celecoxib
21
Q
Celecoxib indications
A
osteoarthritis, rheumatoid arthritis
22
Q
Celecoxib lower risk?
A
gastrointestinal adverse effects
23
Q
Celecoxib class
A
Selective COX-2 Inhibitors
24
Q
Acetaminophen MOA
A
Inhibits CNS prostaglandin synthesis
25
Acetaminophen indications
Mild pain
Severe pain in combination
Fever
26
Acetaminophen adverse effects
Hepatotoxicity
27
Acetaminophen dosing
Usual dose: 500-650 mg PO Q 4-6H prn
| Children: 10-15 mg/kg PO Q 4-6H prn
28
Acetaminophen max daily dose
Maximum daily dose: 3 grams
| Hepatic dosage adjustment: limit to 2 grams/day
29
Acetaminophen BB warning
Hepatotoxicity
30
Acetaminophen contraindications
Hypersensitivity
| Severe hepatic impairment/ Severe active liver disease
31
Acetaminophen interactions
Concomitant hepatotoxins
| Ethanol
32
Acetaminophen counseling
Maximum daily dose
Warn against inadvertent overdose
Report unresolved pain or fevers
33
Butalbital/Caffeine/APAP drugs
Fioricet
34
Fioricet MOA
Butalbital – barbiturate – sensory cortex and motor activity depression, sedation/drowsiness
Caffeine – increase in cAMP, vasoconstriction, CNS stimulation
35
Fioricet indications
headache
36
Fioricet dosing
50 mg butalbital/40 mg caffeine/325-750 mg APAP
| 1-2 tabs/caps (15-30 mL soln) Q4H prn
37
Fioricet adverse effects
Nausea
CNS depression, drowsiness, depression, respiratory depression, nervousness, insomnia, nightmares, hallucinations, tachycardia
Hepatotoxicity
38
Fioricet interactions
CNS depressants
| Alcohol
39
Fioricet counseling
Contains APAP, avoid inadvertent overdose
40
Tramadol MOA
Opioid receptor agonist
| Inhibits reuptake of serotonin and norepinephrine
41
Tramadol indications
moderate to severe pain
42
Tramadol max daily dose
Maximum daily dose 400 mg (300 mg extended-release products)
43
Tramadol adverse effects
Nausea, vomiting, constipation
Sedation, somnolence, dizziness, euphoria, dysphoria
Hypotension, seizures, abstinence syndrome with abrupt discontinuation
44
Tramadol interactions
CNS depressants
| Antidepressants may increase risk of seizures and serotonin syndrome
45
Tramadol counseling
May cause drowsiness
| Abrupt discontinuation may result in withdrawal symptoms
46
CSA Act of 1970 as Amended
Comprehensive Drug Abuse Prevention and Control Act (Controlled Substances Act [CSA]) of 1970 as amended
Replaced Harrison Narcotics Act of 1914
Established the Drug Enforcement Agency (DEA) with enforcement powers
Defined 5 Schedules of controlled substances
47
Schedule I
The drug or other substance has a high potential for abuse.
The drug or other substance has no currently accepted medical use in treatment in the United States.
There is a lack of accepted safety for use of the drug or other substance under medical supervision.
Examples of Schedule I substances include heroin, lysergic acid diethylamide (LSD), marijuana, and methaqualone
48
Schedule II
The drug or other substance has a high potential for abuse.
The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
Abuse of the drug or other substance may lead to severe psychological or physical dependence.
Examples of Schedule II substances include morphine, phencyclidine (PCP), cocaine, methadone, and methamphetamine
49
Schedule III
The drug or other substance has less potential for abuse than the drugs or other substances in schedule II.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
Anabolic steroids, codeine and hydrocodone with aspirin or Tylenol®, and some barbiturates are examples of Schedule III substances.
50
Schedule IV
The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule III.
Examples of drugs included in schedule IV are Darvon®, Talwin®, Equanil®, Valium®, and Xanax
51
Schedule V
The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule IV.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substances may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule IV.
Cough medicines with codeine are examples of Schedule V drugs.
52
Narcotics facts and exaples
Opioids
Variety of different routes of administration and formulations
Fentanyl, hydromorphone, methadone, morphine, oxycodone
53
Narcotics MOA
µ opioid receptor agonist activity alteration in perception and response to pain centrally and peripherally
54
Narcotics indications
Moderate pain, severe pain
55
Narcotics dosing
Titrate to response
56
Narcotics adverse effects
```
Rash, pruritis
Gastrointestinal
Nausea, vomiting
Constipation
CNS depression
Sedation , dizziness
Respiratory depression
```
57
Narcotics BB warnings **
High potential for abuse, misuse, and diversion
| May cause potentially life-threatening hypoventilation, respiratory depression, and/or death
58
Narcotics contraindications
Paralytic ileus
59
Narcotics interactions
CNS depressants
| Alcohol
60
Narcotics counseling
May cause constipation requiring laxatives
May cause drowsiness and impair your ability to operate machinery
Avoid alcohol use
May cause physical or psychological dependence with prolonged use
After prolonged use, abrupt discontinuation may result in abstinence syndrome
A new prescription is required for all C-II refills
61
Morphine dosage forms
immediate and sustained-release tablets, injection, oral solution, suppositories
62
Morphine counseling
do not crush or chew the controlled-release products
63
Oxycodone dosage forms
capsules, oral liquid, oral concentrate, immediate and controlled-release tablets
64
Oxycodone counseling
do not crush or chew the controlled-release products
65
Oxycodone adverse effects
Deaths due to overdose have been reported due to misuse/abuse after crushing the sustained-release tablets
66
Fentanyl dosage forms
transdermal patch, buccal tablets, film, lozenges, injection
67
Fentanyl adverse effects
Transdermal patch – skin rash
68
Fentanyl counseling
Transdermal patch – rotate application site to reduce skin irritation, may take up to 12 hours for onset of effect, never cut patches, discard properly
69
Hydromorphone dosage forms
Dosage forms: oral liquid, immediate-release tablets, injection, suppository
70
Methadone indications
Pain – multiple daily doses
| Addiction – single daily dose
71
Narcotic/Non-narcotic Combinations
Introduction:
Commonly combined with APAP or ibuprofen as coanalgesics
Codeine/APAP, hydrocodone/APAP, hydrocodone/IBU, oxycodone/APAP
Indications: moderate pain
72
Codeine/APAP
Also used for cough
| C-III
73
Hydrocodone/APAP
Dosage forms: tablets, elixir, solution
| C-III
74
Hydrocodone/IBU
Dosage forms: tablets
| C-III
75
Oxycodone/APAP
Dosage forms: capsules, tablets, oral liquid
Indicated for moderate or severe pain
C-II
