Flashcards in Analgesics Deck (68):
How were we supposed to supply pain meds prior to the opioid crisis?
What were we supposed to check 1 hour after giving the pain med?
What were two practices used for severe pain pre-opioid crisis?
Provide long acting analgesics ACT
Provide short-acting analgesics PRN for breakthrough pain
How were we supposed to address varying levels of pain?
What are the current analgesic categories?
What is the MOA of NSAIDs?
Inhibition of cyclooxygenase
Are NSAIDs mostly selective or non-selective for COX1 and COX2
Is COX-1 cyto-protective or inflammatory?
Is COX-2 cyto-protective or inflammatory?
What kind of pain do NSAIDs treat?
What is an issue with continued use of NSAIDs?
Ceiling effect (no additional help, just more SEs)
What are some standard SEs of NSAIDs?
Give two examples of salicylic acid derivative NSAIDs
Give 3 examples of propionic acid NSAIDs
Give 4 examples of acetic acid NSAIDs
Give 1 example of oxicam NSAIDs
Give 1 example of COX2 inhbitors
What do we do if 1 class of NSAIDs fails
We try another
Why do we use dual MOA NSAIDs in synergy?
The efficacy is > than the sum of individual components
What is combo therapy usually limited by?
What other effects does the non-opioid have on combo therapy?
Cause of unintended overdose
Most hepatic failure from excessive opiate/APAP use
What is the max dose of acetaminophen?
4 g/day (maybe will be 3 soon)
What is the max dose of aspirin?
4 g/day (higher for anti-inflammatory)
What is the max dose for ibuprofen?
What kind of anti-inflammatory is aspirin?
A weak anti-inflammatory
When is aspirin contraindicated? Why?
< 16 years
Risk of Reye's syndrome
What dose form do we give of ASA generally?
Low dose ASA
Not kid's ASA
What is the standard dose of ASA for anti-inflammatory purposes?
What actions does ibuprofen have?
What is the max of ibuprofen for inflammatory issues?
What is the max of ibuprofen for pain/fever/dysmenorreha?
What kind of drug is ketorolac?
What kind of pain does ketorolac treat?
When is ketorolac very useful?
How long can we use ketorolac? Why?
Risk of GI bleed
What is the usual dose of ketorolac?
What is the max?
30 mg IVP q 6
When do you reduce the ketorolac dose?
Pt > 65 years
Body weight < 50 kg
Moderately elevated serum creatinine
What kind of pain do we use mefenamic acid for?
What must we avoid while on mefenamic acid?
How frequently is mefenamic acid used?
What do we use piroxicam for?
Acute and chronic RA and OA
Is the half-life of piroxicam long or short? What does this allow?
Once daily dosing
When do you reduce the dosing of piroxicam?
What is celecoxib?
The only remaining selective COX2 inhibitor
Why was a different COX2 inhibitor removed from use in 2004?
Increased # of cardiac events (AMIs)
When is celecoxib very useful?
Non-cardiac pts (ortho pts)
What kind of action do acetaminophen and APAP have?
Does acetaminophen have significant anti-inflammatory activity?
No -> little
What kind of failure comes post acetaminophen overdose?
When do you avoid acetaminophen?
In pts w/ alcoholic liver disease
What is the MOA of acetaminophen at 1000 mg?
Inhibits both COX isozymes
Where is COX inhibition more pronounced with acetaminophen?
In the brain
What center does acetaminophen inhibit? What does this explain?
Hypothalamic heat-regulating center
It's anti-pyretic activity
What do we do with acetaminophen when there is renal impairment and why?
Adjust the doses
What is the adjustment of acetaminophen if CrCl is 10-50
Administer q6 hours
What is the adjustment of acetaminophen if CrCl < 10
administer q8 hours
What is the ratio of injection of acetaminophen?
1000 mg/100 mL (post op x 4 doses)
What is an issue w/ injection acetaminophen?
What is the dosing of acetaminophen injection for pts > 50 kg? What is the max
1000 mg q 6
Max: 4 g/day
What is the dosing of acetaminophen injection for pts < 50 kg? What is the max?
15 mg/kg q6 hours
or 12.5 mg/kg q4 hours
Max: 75 mg/kg
Review slide 27
Review slide 28
Toxicity of acetaminophen
What is the oral therapy for acetaminophen toxicity?
What is the IV therapy for acetaminophen toxicity?
How many kids were studied from 1999-2009
What was found in this study with long term acetaminophen use during pregnancy?
2 fold increase of ADHD in offspring
What was shown with acetaminophen use for < 8 days during pregnancy?
Decrease in ADHD risk