Chapter 58: Pain Flashcards
(162 cards)
1
Q
____ pain occurs when sensory nerves identify tissue namage
A
Nociceptive
2
Q
Which drug classes can be given for mild pain (score 1-3)
A
Non-opioid +/- adjuvant
3
Q
Which drug classes can be given for moderate pain (score 4-6)
A
Opioid for mild-moderate pain
+/- non-opioid
+/- adjuvant
4
Q
Which drug classes can be given for severe pain (score 7-10)
A
Opioid for moderate-severe pain
+/- non-opioid
+/- adjuvant
5
Q
Acetaminophen does not provide ____ effect
A
anti-inflammatory
6
Q
Mechanism of APAP
A
inhibits PG synthesis in the CNS
7
Q
APAP brand names
A
Tylenol, FeverAll, Ofirmev
8
Q
FeverAll drug formulation
A
rectal suppository
9
Q
Ofirmev drug formulation
A
Injection
10
Q
APAP + hydrocodone brand names
A
Lorcet, Lortab, Norco, Vicodin
11
Q
APAP + oxycodone brand names
A
Endocet, Percocet
12
Q
APAP + codeine brand names
A
Tylenol #2, #3, #4
13
Q
APAP + caffeine brand name
A
Excedrin Tension Headache
14
Q
APAP + ASA + Caffeine brand names
A
Excedrin Extra Strength, Excedrin Migraine
15
Q
APAP + caffeine + pyrilamine brand name
A
Midol
16
Q
Max APAP per day for adults
A
< 4000 mg/day
17
Q
APAP dosing for children < 12 yrs
A
10-15 mg/kg Q4-6H
18
Q
APAP infants and childrens suspension concentration
A
160 mg/5 ml
19
Q
APAP BW
A
Severe hepatotoxicity with doses > 4 g/day or use of multiple APAP-containing products
20
Q
Antidote for APAP overdose
A
NAC, Acetadote
21
Q
How is NAC administered for APAP overdose
A
IV or PO (using the solution for inhalation or injectable formulation)
22
Q
How does NAC help with APAP overdose
A
restores hepatic glutathione
23
Q
Non-selective NSAIDs block the synthesis of
A
both COX enzymes
24
Q
COX-2 selective NSAIDs block the synthesis of
A
COX-2 only, which decreases GI risk (b/c COX-1 protects the gastric mucosa)
25
Aspirin MOA
irreversible COX-1 & 2 inhibitor
26
All Rx, non-aspirin NSAIDs require a MedGuide with the following info
- GI risk including bleeding and ulceration
- CV risk (MI and stroke)
- CABG surgery: NSAID use is CI after surgery. Antiplatelet therapy is recommended (commonly ASA)
27
NSAID warnings
- Caution in renal failure
- Can increase BP
- Can cause premature closure of the ductus arteriosus (do not use in 3rd trimester)
- Nausea (take with food)
- Photosensitivity
28
If the ductus arteriosus does not close after birth, which NSAIDs can be used
IV NSAIDs (indomethacin, ibuprofen) can be used within 14 days of birth
29
Ibuprofen brand name
Advil, Caldolor, Motrin
30
Which NSAIDs are COX-1 & COX-2 non-selective
Ibuprofen, indomethacin, Naproxen, Ketorolac
31
Adult OTC dosing for Ibuprofen
200-400 mg Q4-6H
32
Pediatric dosing for Ibuprofen
5-10 mg/kg/dose Q6-8H
33
OTC self-treatment with ibuprofen should be limited to
< 10 days
34
Indomethacin brand name
Indocin
35
Indomethacin has a high risk for which side effects
CNS (avoid in psych conditions)
36
Naproxen brand name
Aleve
37
Naproxen + esomeprazole brand name
Vimovo
38
Ketorolac brand name
Toradol
39
How often is naproxen dosed
BID
40
How is Ketorolac nasal spray administered in patients < 65 years
1 spray in each nostril
41
How is Ketorolac nasal spray administered in patients 65+ years
1 spray in one nostril
42
Max combined duration IV/IM and PO/nasal for ketorolac is __ days in adults
5
43
Ketorolac warnings
acute renal failure, liver failure
44
How should ketorolac nasal spray be used
Prime 5x before use
45
Which NSAIDs have increased COX-2 selectivity
Celecoxib, diclofenac, meloxicam, nabumetone
46
Benefit of COX-2 selective NSAIDs
lower risk for GI complications (but increased risk of MI/stroke)
47
Diclofenac brand name
Voltaren
48
Voltaren gel total body max dose
32 g/day
49
Flector patch (diclofenac) is used how many times per day
BID
50
Celecoxib CI
sulfonamide allergy
51
Which COX-2 selective NSAID has the most COX-2 selectivity
celecoxib
52
Diclofenac + misoprostol (Arthrotec) boxed warning
Avoid in women of childbearing potential
53
Why is misoprostol used with diclofenac
Used to replace the gut-protective PG to decrease GI risk
54
Meloxicam brand name
Mobic
55
ASA + omeprazole brand name
Yosprala
56
ASA dose for cardioprotection
81-162 mg once daily
57
ASA side effects
Dyspepsia, heartburn, bleeding
58
What may be used to protect the gut with chronic NSAID use
PPIs
59
Salicylate overdose can cause
tinnitus
60
What ingredient is found in Bengay, Icy Hot and Salonpas
Methyl salicylate
61
How should ASA and ibuprofen be used if taken together
Take ASA one hour before or 8 hours after ibuprofen
62
NSAIDs can increase the levels of which drug
Lithium
63
Opioid MOA
Mu receptor agonists
64
Which opioids cannot be taken with alcohol
Kadian, Nucynta ER, Oxymorphone ER & Zohydro
65
What drug class (DEA) is codeine solution combination products (e.g, cough syrups)
C-V
66
Respiratory depression and death have occurred in children following tonsillectomy and/or adeoidectomy found to have evidence of being ultra-rapid metabolizers of codeine due to what polymorphism
2D6
67
Codeine should be avoided in children < __ years for any indication & < __ years following tonsillectomy/adenoidectomy surgery
12
| 18
68
Brand name of fentanyl oral transmucosal lozenge ("lollipop on a stick")
Actiq
69
How often is fentanyl patch applied
Q72H
70
Fentanyl should be avoided with CYP450 ____
3A4 inhibitors
71
A patient who has been using morphine ___ mg/day or equivalent for at least ___ days can be converted to fentanyl patch
60
| 7
72
Similar drug (IV) to fentanyl
remifentanil
73
Fentanyl patch can be covered with
Only the permitted adhesive film dressings: Bioclusive or Tegaderm
74
How should fentanyl patch be disposed
In toilet
75
Hydrocodone should be avoided with CYP450 ____
3A4 inhibitors
76
Hydromorphone oral dose
2-4 mg Q4-6H PRN
77
Hydromorphone IV dose
0.2-1 mg Q2-3H PRN
78
Hydromorphone should only be used in:
Opioid-tolerant patients only
79
Hydromorphone has a high risk for
overdose
80
Methadone brand name
Dolophine
81
Methadone BW
QT prolongation (life-threatening)
82
Which C2 opioid has a variable half-life and is hard to dose safely
Methadone
83
Which C2 opioid can decrease testosterone levels and lead to sexual dysfunction
Methadone
84
Methadone is a major ____ substrate
3A4
85
Meperidine brand name
Demerol
86
Meperidine warning
Renal impairment/elderly at risk for CNS toxicity
87
Which C2 opioid is no longer recommended as an analgesic
Meperidine
88
Which C2 opioid has a short duration of action
Meperidine
89
What is the metabolite of Meperidine and how is it cleared
Normeperidine
| Renally (can accumulate and cause seizures)
90
Meperidine, when combined with other drugs, can be
serotonergic
91
Morphine ER brand name
MS Contin, Kadian
92
Morphine injection brand name
Duramorph, Infumorph
93
Morphine SE
pruritis
94
What can be given to block histamine-induced pruritis with morphine
Diphenhydramine
95
Oxycodone IR brand name
Roxicodone
96
Oxycodone CR brand name
OxyContin
97
Oxycodone initiation with CYP450 ____ can cause fatal overdose
3A4
98
Oxycodone side effect
Pruritis
99
How should oxymorphone be taken
On empty stomach
100
Which opioids are 3A4 substrates
Hydrocodone, fentanyl, methadone, and oxycodone
101
How should opioid conversions be rounded
Round down to reduce risk of OD
102
If an exam question says to reduce the dose of an equivalent opioid, how much do you reduce it by
25%
103
Morphine & hydromorphone conversions (IV and PO)
Morphine: IV/IM 10 mg = PO 30 mg
Hydromorphone: IV/IM 1.5 mg = PO 7.5 mg
104
If using opioids, which formulation should be started first
IR
105
What should be done in a true opioid allergy
Use an agent in a different chemical class
106
The common drugs in the same chemical class that cross-react with each other have which words in their names
cod or morph (or norph)
107
What is the first line laxative for OIC
Stimulant laxatives (like Senna)
108
If laxatives are not sufficient for OIC, what can be used
PAMORAs
109
If PAMORAs are not effective for OIC, what can be used
Lubiprostone
110
PAMORA MOA
block opioid receptors in the gut to reduce constipation without affecting analgesia
111
Which meds are PAMORAs
Methylnaltrexone, Naloxegol
112
Methylnaltrexone brand name
Relistor
113
Naloxegol brand name
Movantik
114
Methylnaltrexone & Naloxegol warning
Risk of GI perforation
115
Methylnaltrexone & Naloxegol SE
Abdominal pain, flatulence
116
Lubiprostone brand name
Amitiza
117
Tramadol and tapentadol MOA
mu-opioid receptor agonists - inhibit NE reuptake (tramadol also inhibits reuptake of serotonin)
118
Tapentadol DEA drug class
C2
119
Tramadol DEA drug class
C-IV
120
Tramadol warnings
Seizure risk, risk of serotonin syndrome when used alone or with other serotonergic drugs or inhibitors of 2D6 or 3A4
121
Tramadol CI
Do not use in children < 12 years of age or in children < 18 years of age following tonsillectomy or adenoidectomy surgery
Do not use with MAOi or within 14 days
122
Tramadol & Tapentadol side effects
dizziness, constipation, nausea, somnolence
123
Tramadol requires conversion to active metabolite by which CYP enzyme
2D6
124
Tapentadol warnings
Can increase seizure risk
| Risk of serotonin syndrome
125
Suboxone is formulated with which abuse deterrent medication
Naloxone
126
Which two opioids are manufactured using specific technology designed to deter crushing, dissolving or other modifications
OxyContin & Hysingla ER
127
Buprenorphine MOA
partial mu-opioid agonist (agonist at low doses and antagonist at high doses)
128
Given by itself, naloxone is used for
opioid overdose
129
Buprenorphine/naloxone combination products are used as alternatives to
methadone (buprenorphine suppresses withdrawal symptoms and naloxone helps prevent misuse)
130
Which 3 formulations does naloxone come in
Evzio (auto-injector)
Narcan (nasal spray)
Naloxone (injection)
131
Naloxone SE
acute withdrawal symptoms (pain)
132
Buprenorphine drug schedule
C3
133
Buprenorphine + naloxone brand name
Suboxone
134
Buprenorphine patch (Butrans) should be changed how often
weekly
135
How should Buprenorphine patch be disposed
fold sticky sides together and flush
136
side effects from Buprenorphine patch
dizziness, HA, application site reactions, nausea
137
To prescribe for opioid dependence, prescribers need a ____ waiver
Drug Addiction Treatment Act (DATA 2000)
138
If a prescriber has authorization from the DEA to prescribe for opioid dependence, what will the DEA number start with
X
139
Butrans patch can be covered with:
permitted adhesive film dressings: Bioclusive or Tegaderm
140
Gabapentin brand name for post herpetic neuralgia and RLS
Horizant
141
Gabapentin SE
Dizziness, somnolence, peripheral edema
142
Pregabalin DEA drug class
C-V
143
Pregabalin SE
Dizziness, somnolence, peripheral edema, weight gain, mild anxiolytic
144
Pregabalin is approved for which conditions
fibromyalgia, post herpatic neuralgia, and neuropathic pain
145
What is the only FDA-approved medication for trigeminal neurlgia
Carbamazepine (tegretol)
146
Baclofen brand name
Liosesal
147
SE for all muscle relaxants
excessive sedation, dizziness, confusion, asthenia (muscle weakness)
148
Cyclobenzaprine brand names
Amrix, Fexmid, Flexeril
149
Cyclobenzaprine side effect
dry mouth
| Serotonergic
150
Tizanidine SE
Hypotension, dry mouth
151
Carisoprodol brand name
Soma
152
Carisoprodol DEA class
C-IV
153
Poor ____ metaboilizers will have increased Carisoprodol concentrations
2C19
154
Which muscle relaxant is used for malignant hyperthermia
Dantrolene (Dantrium)
155
How long can lidoderm patches be used per day
12 hours/day
156
Which topical patch is approved for PHN (shingles) pain
Lidoderm
157
Which topical patch can be cut into smaller pieces
Lidoderm
158
Do not apply more than __ patched of Lidoderm at a time
3
159
How often can Capsaicin be used
TID-QID
160
Capsaicin brand names
Zotrix, Zostrix HP
161
Capsaicin counseling
Do not touch genitals, nasal area, mouth or eyes after application & wash hands after applying
162
Trolamine brand name
Aspercreme
