Clinical Perals

Question 1

the prototype of pure mu agonist

Answer 1

morphine

Question 2

pruritis is common

Answer 2

morphine

Question 3

5-7x more potent than morphine

Answer 3

hydromorphone

Question 4

less pruritis, sedation and nausea

Answer 4

hydromorphone

Question 5

better analgesic option than morphine in patients with renal impairment

Answer 5

hydromorphone

Question 6

1.5-2x more potent than morphine

Answer 6

oxycodone

Question 7

black box warning for concomitant use with 3A4 inhibitors of discontinuation of 3A4 inducers could increase levels

Answer 7

oxycodone

Question 8

don’t use IM formulation

Answer 8

morphine, hydromorphone

Question 9

oxycodone ER products: abuse-deterrent formulation

Answer 9

Xtampza

Question 10

indication for xtampza

counseling point

Answer 10

the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Do not use prn

must be taken with food

Question 11

take on an empty stomach; bioavailability increases with food administer 1 hour before or 2 hours after eating

Answer 11

oxymorphone

Question 12

black box: do not use with alcohol

Answer 12

oxymorphone

Question 13

doses greater than 5mg q12h are for opioid-tolerant patients only

Answer 13

oxymorphone

Question 14

dual action opioid: centrally acting mu agonist + inhibits NE uptake

Answer 14

tapentadol

Question 15

FDA indicated for the treatment of DPN and treatment of moderate to severe pain

Answer 15

tapentadol

Question 16

do not use concurrently with MOA inhibitors or within 14 days

Answer 16

tapentadol

Question 17

doses greater than 50mg po 12h are for opioid-tolerant patients only

Answer 17

tapentadol

Question 18

centrally acting weak mu partial agonist + inhibits NE and 5HT

Answer 18

tramadol

Question 19

naloxone only partially effective

Answer 19

tramadol

Question 20

seizure risk for at-risk pts, reports of increased risk of hypoglycemia and hyponatremia

Answer 20

tramadol

Question 21

tramadol CIs

Answer 21

children <12
children <18 post op from tonsillectomy or adenoidectomy
do not use with MOAs or within 14 days
12-18 obese
strong warning: breast feeding mothers

Question 22

analgesic activity of tramadol comes from

Answer 22

metabolite

Question 23

analgesic activity of tapentadol comes from

Answer 23

parent

Question 24

FDA approvals: OUD & moderate to severe pain

Answer 24

buprenorphine

Question 25

starting this drug when a pt is opioid-tolerant increases risk of possible withdrawal reactions

Answer 25

buprenorphine

Question 26

taper in a physically dependent patient

Answer 26

butrans

Question 27

mu agonist, SNRI, NMDA receptor antagonist

Answer 27

methadone

Question 28

QTc prolongation: ECG recommendations

Answer 28

methadone

Question 29

watch out for amiodarone anti-infectives and antidepressant

Answer 29

methadone

Question 30

elimination half life of methadone

Answer 30

15-130 hours mean 15-40 4-10 days steady stte

Question 31

possible methadone candidates

Answer 31

pts with true morphine allergy pts with significant renal impairment pts with significant neuropathic pain pts who have failed other opioids; ADRs to other opioids cost issues with other opioids long-acting opioid requirement

Question 32

patients who may not be candidates for methadone therapy

Answer 32

poor prognosis, end of life polypharmacy, risk of numerous drug interactions risk of QT prolongation, hx of arrhythmias/syncope hx of poor adherence, lives alone hx of substance abuse

Question 33

80-110 times more potent than morphine

Answer 33

fentanyl

Question 34

BBW: 25 mcg patch use in tolerant patients only do NOT use in acute pain concomitant use of potent cyp3a4 inhibitors can increase fentanyl levels

Answer 34

fentanyl

Question 35

minimal conc of fentanyl maximal conc ave steady state

Answer 35

12 36 3-6 days

Question 36

active metabolite can accumulate in 2 days leading to significant neurotoxic ADRs which are not reversible by naloxone

Answer 36

meperidine

Question 37

do not use greater than 48 hours avoid in patient with renal dysfunction do not use for chronic pain management

Answer 37

meperidine

Question 38

metabolized in liver prodrug: requires metabolism via CYP2D6 to morphine

Answer 38

codeine

Question 39

codeine CI

Answer 39

should not be used to treat cough in children younger than 12 years