Chapter 58: Pain Flashcards
(156 cards)
1
Q
What is Chronic Pain?
A
Pain that persists for three months or longer.
2
Q
What is Acute Pain?
A
Pain that begins suddenly and usually feels sharp; it typically lasts until the cause is resolved.
3
Q
What is Nociceptive Pain?
A
Pain that occurs when tissue damage causes stimulation of sensory nerves (nociceptors).
4
Q
What is Neuropathic Pain?
A
Pain that results from damage or malfunction of the nervous system, not from tissue injury.
5
Q
What is Visceral Pain?
A
Nociceptive pain that results from injury to internal organs.
6
Q
What is Musculoskeletal Pain?
A
Nociceptive pain that results from injury to the skin, muscles, bones, joints, or ligaments.
7
Q
What are examples of Neuropathic Pain conditions?
A
Fibromyalgia, diabetic neuropathy, chronic headaches, and certain drug-induced toxicities.
8
Q
How is Pain Intensity measured?
A
Pain is commonly rated using a numeric scale (0 no pain, 10 worst pain) or with the visual analog scale.
9
Q
How did Pavli classify pain?
A
Pavli classified pain as ‘mild’ (1-3), ‘moderate’ (4-6), and ‘severe’ (7-10) on a numeric scale.
10
Q
What is the effect of Acetaminophen?
A
Acetaminophen reduces pain and fever but does not provide an anti-inflammatory effect; mechanism involves inhibition of PG synthesis in the CNS.
11
Q
What is the maximum Acetaminophen dosing for adults?
A
The maximum is 4,000 mg/day from all sources;
12
Q
What is the pediatric dosing for acetaminophen?
A
10-15 mg/kg every 4-6 hours with a maximum of 5 doses/day.
13
Q
What are the drug interactions for acetaminophen and warfarin?
A
Can be used with warfarin, but chronic use (>2 grams/day) can increase INR.
14
Q
What are boxed warnings for acetaminophen?
A
Severe hepatotoxicity associated with doses of 4 grams/day or use of multiple acetaminophen-containing products.
15
Q
What is the combination of acetaminophen and hydrocodone known as?
A
Norco and vicodin
16
Q
What are the brand names for acetaminophen combined with oxycodone?
A
endocet, percocet
17
Q
What is the brand name for the combination of acetaminophen and caffeine used for tension headaches?
A
exedrine tension headache
18
Q
What does the combination of acetaminophen, caffeine, and aspirin produce?
A
Exedrin extra strength
19
Q
What is the brand name for the combination of acetaminophen, caffeine, and pyrilamine?
A
midol complete
20
Q
Acetaminophen antidote
A
N-acetylcysteine
21
Q
What are the side effects of all NSAIDs?
A
- Decreased renal clearance
- Increased blood pressure
- Premature closure of ductus arteriosus
- Nausea
- Photosensitivity
22
Q
What condition should NSAIDs be avoided in?
A
Renal failure
23
Q
What is the risk associated with NSAIDs in pregnant women during the third trimester?
A
Premature closure of the ductus arteriosus
24
Q
What is a boxed warning for non-aspirin NSAIDs?
A
GI risk, CV risk, contraindication after CABG surgery
25
What increases the risk of serious GI adverse events with NSAIDs?
Elderly patients, history of GI bleed, systemic steroids, SSRIs, SNRIs
26
What can be used to help close a patent ductus arteriosus (PDA) after birth?
IV NSAIDs (indomethacin, ibuprofen)
27
Fill in the blank: NSAIDs should be avoided in the _______ trimester of pregnancy.
third
28
What is the adult dosing for Ibuprofen when OTC?
200-400 mg Q6-8H
## Footnote
Q6-8H means every 6 to 8 hours.
29
What is the pediatric dosing for Ibuprofen as an antipyretic?
5-10 mg/kg/dose Q6-8H, Max: 40 mg/kg/day
30
List some common side effects of all NSAIDs.
* Dyspepsia
* Abdominal pain
* Nausea
31
Which NSAID should be avoided in psych patients due to CNS effects?
Indomethacin
32
What is the brand name of Naproxen?
Aleve
33
What is the OTC dose for Naproxen?
220 mg Q8-12H
34
What is the brand name for the combination of Naproxen and Esomeprazole?
Vimovo
35
What is the maximum duration of use for ketorolac?
5 days
36
What are the warnings associated with ketorolac?
* increased bleeding
* acute renal failure
* liver failure
37
How many times should the ketorolac nasal spray be primed before use?
5 times
38
What is the GI risk & CV risk associated with COX-2 selective agents?
* Decreased GI risk
* Increased risk of MI/stroke
39
What is the brand name of Celecoxib?
Celebrex
40
In which patients is Celecoxib contraindicated?
Patients with sulfanomide allergy
41
What is the maximum dose of Diclofenac gel for total body?
32g/day
42
In which population should Arthrotec (diclofenac + misoprostol) be avoided?
Female patients of childbearing potential
43
What is the brand name of Meloxicam?
Mobic
44
What are some brand names of aspirin?
Ascriptin, bufferin, ecotrin
45
What is the recommended dosing of aspirin for cardioprotection?
81-162 mg once daily
46
Why should aspirin be avoided in children and teenagers with viral infections?
Due to potential risk of Reye's syndrome
47
What are common side effects of aspirin?
Dyspepsia, heartburn, and bleeding
48
What symptom can indicate a salicylate overdose?
Tinnitus (Tinnitus is a ringing or buzzing noise in the ears.)
49
What are popular OTC topicals that contains methyl salicylate?
Bengay, Icyhot, and Salonpas
50
What is the brand name of magnesium salicylate?
Doan's Extra Strength
51
When taking aspirin for cardioprotection and ibuprofen for pain, when should aspirin be taken?
One hour before or eight hours after ibuprofen
52
NSAIDs can ____ the levels of lithium.
Increase
53
What is the MOA of opioids?
Mu receptor agonists that have CNS effect. Opioids primarily result in pain relief, euphoria, and respiratory depression.
54
What type of agonist is buprenorphine?
Partial mu-opioid agonist
55
What is the effect of buprenorphine at low doses?
Agonist
56
What is the effect of buprenorphine at higher doses?
Antagonist
57
What is one of the primary uses of buprenorphine at lower doses?
To treat pain
58
What are some risks associated with opioid use?
* Constipation
* Nausea/vomiting (especially with acute, high-dose use)
* Somnolence
* Dizziness/lightheadedness
* Seizures
* Opioid-induced hyperalgesia
* Respiratory depression
* Overdose
59
What can be used to reduce rash and itching caused by opioids?
Diphenhydramine
60
What is the classification of Codeine?
C-II
61
What is the classification of Codeine combined with acetaminophen?
C-III
62
What is the classification of Codeine oral solution combination products?
C-V
63
What are the boxed warnings associated with codeine products?
Respiratory depression and death
64
In which age groups are codeine products contraindicated?
Children < 12 years old and < 18 years old following tonsillectomy
65
What is the most common side effect of opioids?
Constipation
66
What is the metabolism pathway of Codeine?
Codeine is a prodrug that metabolizes to morphine
67
What is the brand name of Fentanyl?
Sublimaze
68
What is the dosing schedule for a Fentanyl patch?
Apply 1 patch every 72 hours
69
Who should not use Fentanyl patches and lozenges?
Opioid-naive patients
70
What is required for conversion to a fentanyl patch?
A patient who has been using equivalent to morphine 60 mg/day or more for at least 7 days
71
What is one key patient counseling point for using a Fentanyl patch?
Apply to hairless skin
72
What should not be used to cover a Fentanyl patch?
Heating pad
73
How should a used Fentanyl patch be disposed of?
By flushing down the toilet
74
What is the control classification of Buprenorphine?
C-III
75
What are the brand names of Buprenorphine?
Belbuca and Butrans
76
How often is Butrans applied?
Once weekly
77
Where should Belbuca be inserted?
Between gum and cheek tissue
78
What are the common side effects of Buprenorphine?
Dizziness and nausea
79
What is Hydrocodone IR available in combination with?
325mg acetaminophen
80
What is the brand name of Hydromorphone?
Dilaudid
81
What is the oral dosing for Hydromorphone?
2-4 mg q4-6h prn
82
What is the IV dosing for Hydromorphone?
0.2-1mg q2-3h prn
83
What is the boxed warning for Hydromorphone?
Risk of medication error with high potency
84
What warning does Methadone have?
Boxed warning for QT prolongation
85
How does Methadone affect testosterone levels?
It can decrease testosterone and contribute to sexual dysfunction
86
What is Methadone a major substrate of?
CYP3A4
87
What is the brand name of Meperidine?
Demerol
## Footnote
Meperidine is an opioid analgesic used for pain relief.
88
What is the brand name for Morphine ER?
MS Contin
89
What are the brand names for Morphine injection?
Duramorph and Infumorph
90
What is a common side effect of Morphine?
Pruritus
91
What is the brand name for Oxycodone IR?
Roxicodone
92
What is the brand name for Oxycodone CR?
OxyContin
93
When should Oxymorphone be taken?
On an empty stomach
94
What should be avoided with all opioids?
Alcohol
95
True or False: Opioids have an increased risk of hypoxemia with underlying respiratory diseases.
True
96
How much IV Morphine is equal to 30 mg of oral morphine?
10 mg IV
97
How much IV Hydromorphone is equal to 7.5 mg of oral hydromorphone?
1.5 mg IV
98
Does Oxycodone come in oral formulation only?
Yes
99
How much oral Oxycodone is equal to 30 mg of oral morphine?
20 mg oral
100
Conversion from morphine to fentanyl patch?
Morphine 60mg total daily dose = 25 mcg/h fentanyl patch
101
Risk factors for Opioid-induced respiratory depression
* History of OD
* Substance use disorder
* Using large doses
* Use with BZD, gabapentin and pregabalin
* Comorbid diseases such as respiratory or psych
102
How should all opioids (except oxymorphone) be taken to decrease nausea?
With Food
103
First line treatment for OIC?
1. Sitmulants (bisacodyl and senna)
2. Osmotic (PEG)
104
What is the drug class that is designed for OIC?
Peripherally acting mu opioid receptor antagonist
105
Name 3 drugs in PAMORA class
* Methylnaltrexone (Relistor)
* Naloxegol (Mavantic)
* Naldemedine
106
Warning associated with PAMORAs?
GI perforation
107
Pamoras common side effect
Abdominal pain
108
Who is indicated to receive PAMORAs?
Only patients on opioids who have failed OTC laxatives
109
Name 2 centrally acting analgesics
* Tramadol
* Tapentadol
110
Tramadol MOA
* Mu-receptor agonist
* Buprenorphine reuptake inhibitor
* Serotonin reuptake inhibitor
111
What is the classification of Tramadol?
C-IV
112
What is the classification of Tapentadol?
C-II
113
What boxed warning does Tramadol have?
Respiratory depression and death
114
List the warnings associated with Tramadol.
* Seizure risk
* Serotonin syndrom
* Hypoglycemia
115
What are the side effects of Tramadol?
Dizziness, constipation, nausea, somnolence
116
What enzyme is required for Tramadol to convert to its active metabolite?
CYP2D6
117
Fill in the blank: Tramadol has a boxed warning for ______ and death.
respiratory depression
118
What is naloxone?
Naloxone is an opioid antagonist that replaces the opioid on the mu receptor.
119
What is the primary use of naloxone?
Used for opioid overdose.
120
How does buprenorphine act at high doses?
At high doses, buprenorphine acts as an opioid antagonist.
121
What are buprenorphine/naloxone combination products used for?
Used as alternatives to methadone for opioid use disorder (OUD).
## Footnote
Buprenorphine suppresses withdrawal symptoms while naloxone helps prevent misuse.
122
What is naltrexone?
An opioid antagonist used to help treat alcohol and opioid use disorders.
123
What schedule classification is Buprenorphine?
C-III
124
What is the brand name for Buprenorphine combined with naloxone?
Suboxone
125
What is a common side effect of Buprenorphine?
Dizziness
126
What are common uses for adjuvants in pain management?
Adjuvants are commonly used for pain associated with:
* Neuropathy (from diabetes or spinal cord injury)
* Postherpetic neuralgia (PHN)
* Fibromyalgia
* Osteoarthritis (OA)
127
What medication can be added to opioids in intrathecal pain infusion pumps for cancer pain?
Clonidine injection can be added to opioids in intrathecal pain infusion pumps for patients with cancer pain when other agents are insufficient.
128
What is the brand name of Gabapentin?
Neurontin
129
What are common side effects of Gabapentin?
Common side effects of Gabapentin include:
* Dizziness
* Somnolence
* Peripheral edema/weight gain
130
What conditions is Gabapentin enacarbil used to treat?
Gabapentin enacarbil is used for:
* Postherpetic neuralgia (PHN)
* Restless legs syndrome
131
What is the brand name of Pregabalin?
Lyrica
132
What schedule is Pregabalin classified under?
C-V
133
What are common side effects of Pregabalin?
Common side effects of Pregabalin include:
* Dizziness
* Somnolence
* Peripheral edema/weight gain
* Mild anxiolytic
134
What conditions is Pregabalin approved to treat?
Pregabalin is approved for:
* Fibromyalgia
* Postherpetic neuralgia (PHN)
* Neuropathic pain
135
What is Carbamezapine used for?
Approved for the treatment of trigeminal neuralgia
136
Which antidepressants are used for neuropathic pain?
Amitriptyline and duloxetine
137
Name a muscle relaxant with analgesic effects
* Baclofen,
* Cyclobenzaprine
* Tizanidine
138
What is the brand name of Baclofen?
Lioresal
139
What are the brand names of Cyclobenzaprine?
Amrix, Fexmid
140
What is the brand name of Tizanidine?
Zanaflex
141
Name muscle relaxants that have sedation effect
Carisoprodol, Methocarbamol
142
What is the brand name of Carisoprodol?
Soma
143
What is the brand name of Methocarbamol?
Robaxin
144
What are the common side effects for all muscle relaxers?
Excessive sedation, dizziness, confusion, asthenia (muscle weakness)
145
What specific side effect is associated with Cyclobenzaprine?
Dry mouth
## Footnote
This side effect can lead to discomfort and difficulty in swallowing.
146
What type of effects does Cyclobenzaprine have?
Serotonergic effects
147
What are the side effects of Tizanidine?
Hypotension and dry mouth
148
What happens to carisoprodol concentrations in poor CYP2C19 metabolizers?
Increased carisoprodol concentrations
149
What is a rarely used muscle relaxant?
Dantrolene (Dantrium)
## Footnote
Dantrolene is specifically used for malignant hyperthermia.
150
What is the brand name of Lidocaine 5% patch?
Lidoderm
151
How many Lidoderm patches can be applied at one time?
No more than 3 patches
152
What is the maximum duration for wearing Lidoderm patches?
Up to 12 hours per day
153
What type of pain is Lidocaine approved to treat?
PHN (Postherpetic Neuralgia) pain
154
What is the brand name of Capsaicin?
Zostrix
155
What are the available concentrations of Capsaicin over the counter?
0.025% and 0.075%
156
How many times per day can Capsaicin be applied?
3-4 times per day
