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Flashcards in Analgesics Deck (68):
1

How were we supposed to supply pain meds prior to the opioid crisis?

Scheduled

2

What were we supposed to check 1 hour after giving the pain med?

Effectiveness

3

What were two practices used for severe pain pre-opioid crisis?

Provide long acting analgesics ACT
Provide short-acting analgesics PRN for breakthrough pain

4

How were we supposed to address varying levels of pain?

Dose titration

5

What are the current analgesic categories?

Non-opioids
Adjuvants
Opiates
Opioids

6

What is the MOA of NSAIDs?

Inhibition of cyclooxygenase

7

Are NSAIDs mostly selective or non-selective for COX1 and COX2

Non-selective

8

Is COX-1 cyto-protective or inflammatory?

Cyto-protective

9

Is COX-2 cyto-protective or inflammatory?

Inflammatory

10

What kind of pain do NSAIDs treat?

Mild-moderate

11

What is an issue with continued use of NSAIDs?

Ceiling effect (no additional help, just more SEs)

12

What are some standard SEs of NSAIDs?

GI upset
GI irritation/ulceration
Edema
Renal impairment

13

Give two examples of salicylic acid derivative NSAIDs

Aspirin
Salsalate

14

Give 3 examples of propionic acid NSAIDs

Ibuprofen
Ketoprofen
Naproxen

15

Give 4 examples of acetic acid NSAIDs

Ketorolac
Diclofenac
Etodolac
Indomethacin

16

Give 1 example of oxicam NSAIDs

Meolxicam

17

Give 1 example of COX2 inhbitors

Celecoxib

18

What do we do if 1 class of NSAIDs fails

We try another

19

Why do we use dual MOA NSAIDs in synergy?

The efficacy is > than the sum of individual components

20

What is combo therapy usually limited by?

The non-opioid

21

What other effects does the non-opioid have on combo therapy?

Cause of unintended overdose
Most hepatic failure from excessive opiate/APAP use

22

What is the max dose of acetaminophen?

4 g/day (maybe will be 3 soon)

23

What is the max dose of aspirin?

4 g/day (higher for anti-inflammatory)

24

What is the max dose for ibuprofen?

3.2 g/d

25

What kind of anti-inflammatory is aspirin?

A weak anti-inflammatory

26

When is aspirin contraindicated? Why?

< 16 years
Risk of Reye's syndrome

27

What dose form do we give of ASA generally?

Low dose ASA
Not kid's ASA

28

What is the standard dose of ASA for anti-inflammatory purposes?

3.6-5.4 g/day

29

What actions does ibuprofen have?

Anti-inflammatory
Antipyretic
Analgesic

30

What is the max of ibuprofen for inflammatory issues?

3.2 g/day

31

What is the max of ibuprofen for pain/fever/dysmenorreha?

1.2 g/day

32

What kind of drug is ketorolac?

Injectable NSAID

33

What kind of pain does ketorolac treat?

Mod-severe

34

When is ketorolac very useful?

Post-op pain

35

How long can we use ketorolac? Why?

5 days
Risk of GI bleed

36

What is the usual dose of ketorolac?
What is the max?

30 mg IVP q 6
120 mg/d

37

When do you reduce the ketorolac dose?

Pt > 65 years
Body weight < 50 kg
Moderately elevated serum creatinine

38

What kind of pain do we use mefenamic acid for?

Mild-moderate

39

What must we avoid while on mefenamic acid?

Alcohol

40

How frequently is mefenamic acid used?

Little

41

What do we use piroxicam for?

Acute and chronic RA and OA

42

Is the half-life of piroxicam long or short? What does this allow?

Long
Once daily dosing

43

When do you reduce the dosing of piroxicam?

Hepatic dysfunction

44

What is celecoxib?

The only remaining selective COX2 inhibitor

45

Why was a different COX2 inhibitor removed from use in 2004?

Increased # of cardiac events (AMIs)

46

When is celecoxib very useful?

Non-cardiac pts (ortho pts)

47

What kind of action do acetaminophen and APAP have?

Analgesia
Antypyretic

48

Does acetaminophen have significant anti-inflammatory activity?

No -> little

49

What kind of failure comes post acetaminophen overdose?

Hepatic failure

50

When do you avoid acetaminophen?

In pts w/ alcoholic liver disease

51

What is the MOA of acetaminophen at 1000 mg?

Inhibits both COX isozymes

52

Where is COX inhibition more pronounced with acetaminophen?

In the brain

53

What center does acetaminophen inhibit? What does this explain?

Hypothalamic heat-regulating center
It's anti-pyretic activity

54

What do we do with acetaminophen when there is renal impairment and why?

Adjust the doses
Metabolites accumulate

55

What is the adjustment of acetaminophen if CrCl is 10-50

Administer q6 hours

56

What is the adjustment of acetaminophen if CrCl < 10

administer q8 hours

57

What is the ratio of injection of acetaminophen?

1000 mg/100 mL (post op x 4 doses)

58

What is an issue w/ injection acetaminophen?

Very expensive

59

What is the dosing of acetaminophen injection for pts > 50 kg? What is the max

1000 mg q 6
Max: 4 g/day

60

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

61

Review slide 27

acetaminophen dosing

62

Review slide 28

Toxicity of acetaminophen

63

What is the oral therapy for acetaminophen toxicity?

Mucomyst

64

What is the IV therapy for acetaminophen toxicity?

Acetadote

65

How many kids were studied from 1999-2009

114744

66

What was found in this study with long term acetaminophen use during pregnancy?

2 fold increase of ADHD in offspring

67

What was shown with acetaminophen use for < 8 days during pregnancy?

Decrease in ADHD risk

68

What drugs showed a serious decrease in pain when combined with acetaminophen?

Oxycodone
Hydrocodone
Codeine