exam 5 pain rogers

Question 1

How is pain classified?

Answer 1

acute vs chronic
noiceptive or neuropathic or both

Question 2

what are some non-pharmacological therapies for pain?

Answer 2

exercise, correct cause, physical manipulation, heat/ice accupuncture, massage
used in combo with analgesics

Question 3

what is the treatment approach to pain therapy?

Answer 3

step 1: non opioid +/- adjuvant analgesic
step 2 + 3: opioid + nonopioid +/- adjuvant analgesics

Question 4

what are non-opioid analgesics?

Answer 4

APAP
NSAIDs

Question 5

what are adjuvant therapies?

Answer 5

gabapentinoids
SNRIs
TCAs
Skeletal muscle relaxants
antiepileptics
topical agents

Question 6

what are the formulations of APAP?

Answer 6

tablet, capsule, chewable, liquid, IV, suppository

Question 7

what is dosing, side effects, and clinical pearls of APAP?

Answer 7

adults: 325-1000mg PO q4-6h prn max 3-4g/day, max 2g in liver disease pts
PEDs: 10-15mg/kg PO q4h PRN, max dose 3-4g/day
sides: hepatotoxicity likely with >10g dose
pearls: gold standard for OA due to fewer sides than NSAIDs

Question 8

what are side effects and clinical pearls of NSAIDs?

Answer 8

GI bleeding, nephtotoxicity, fluid retention, increased CV events
take with food, caution use in geriatric patients (BEERs), avoid systemic NSAIDs in patients with cardiac history, avoid severe liver or kidney disease

Question 9

what is aspirin formulations?

Answer 9

chew, EC, capsule, ER, suppostitory

Question 10

what are dosing and clinical pearls for aspirin?

Answer 10

adults: 325-1000mg q4-6h PRN (max 4g/day)
PEDs: not recommended due to reyes syndrome
clinical pearls: avoid in blood thinners due to antiplatelet activity

Question 11

what is reyes syndrome?

Answer 11

associated with children and teens when using ASA and they have a viral infection
rare condition causing swelling in brain and liver

Question 12

what are ibuprofen formulations?

Answer 12

suspension, chewable, IV

Question 13

what is ibuprofen dosing?

Answer 13

adults 200-800mg PO q6-8h PRN
max 3200mg
PEDS: 5-10mg PO q4-6h PRN max 2400mg

Question 14

what are diclofenac formulations?

Answer 14

IV, suppository, topical gel, topical solution, opthalmic, patch

Question 15

what are naproxen formulations?

Answer 15

ER tablet, suspension

Question 16

what are ketolroac formulations?

Answer 16

IV/IM, nasal spray, opthalmic solution

Question 17

what is important about ketorolac?

Answer 17

maximam duration of 5 days
oral dosing is only for continuation of IM or IV therapy

Question 18

what are celebrex formulations?

Answer 18

capsule and oral solution

Question 19

what is important about celebrex?

Answer 19

COX 2 selective

Question 20

what are the formulations for gabapentinoids?

Answer 20

ER and liquid

Question 21

what is important a gabapentinoids?

Answer 21

Gabapentin dosing: 100-300mg po TID max dose 3600mg
pregabalin dosing: 75mg PO BID max 600mg/day
titrate up slowly to limit sedation

Question 22

what is are the formulations of SNRIs?

Answer 22

capsule/tab
ER

Question 23

what drug should be avoided in patients with CrCl <30mL/min

Answer 23

duloxetine
renal dose adjustments needed for venlafaxine

Question 24

what are the formualtions for TCAs?

Answer 24

amitriptyline: tablet
nortriptilylin: capsule and oral solution

Question 25

what are the formulations for muscle relaxants?

Answer 25

tablet/capsule (IR/XR)

Question 26

what are the available formulations for carbamazepine?

Answer 26

ER capsule/tablet suspension

Question 27

which drug has increased hypersensitivity with HLAB-1502 allee?

Answer 27

carbamazepine also has autoinduction of enzymes

Question 28

what is important about lidocaine?

Answer 28

tachyphylaxis with continous use 12 hour break between patches less systemic sides

Question 29

what is capsacian used for?

Answer 29

muscle/joint pain neuropathic pain

Question 30

what drugs should be avoided in the elderly?

Answer 30

Non COX2 selective indomethacin + ketorolac skeletal muscle relaxants: carisoprodol, cyclobenzaprine, methocarbamol opioids and BZDs opioids and gabapentinoids anticholinergics combination of these 3 or more

Question 31

what should be used with caution in the elderly?

Answer 31

SNRIs TCAs Carbamazepine

Question 32

what are side effects of opioids?

Answer 32

antitussive, constipation, N/V, itching, orthostatic hypotension, respriratory depression can start stool softener or stimulant laxative

Question 33

what is codeine?

Answer 33

metabolized to morphine via CYP 2D6

Question 34

what is tramadol?

Answer 34

US boxed warning use of 3A4 inducers, inhibitors, 2D6 inhibitors require careful dosing considerations

Question 35

what is morphine?

Answer 35

itching is predominant compared to other opioids morphine and metabolites are renally excreted and can accumulate in renal dysfunction Avoid alcohol when taking capsules

Question 36

what is hydromorphone?

Answer 36

solution for injection, suppository boxed warning: medication errors

Question 37

what is us boxed warning: use with CYP 3A4 inhibitors may increase levels

Answer 37

hydrocodone, oxycodone, fentanyl, tramadol, methadone, merpiridine

Question 38

what can be used in renal impairment?

Answer 38

fentantyl

Question 39

what is important about methadone?

Answer 39

qt prolongation

Question 40

what are natural opioids?

Answer 40

morphine codein

Question 41

what are semi-synthetic opioids?

Answer 41

hydromorphone oxycodone oxymorphone hydrdocodone buprennorphine

Question 42

what are synthetic opioids?

Answer 42

fentanyl methadone meperidine tramadol

Question 43

what should be given in patients with allergies to semi-synthetic or natural opioids?

Answer 43

synthetic opoiods fentanyl methadone mepiridine tramadol

Question 44

how do you reduce/ taper and opioid?

Answer 44

decrease by 10% per month if pt has been on it for 1+ years decrease by 10% per week if patient has been on it for weeks to months

Question 45

what is treatment for acute pain?

Answer 45

PRN analgesia around the clock analgesia

Question 46

what is michigan OPEN?

Answer 46

recommended APAP and ibuprofen q6h while awake

Question 47

what is treatment for acute pain in the hospital?

Answer 47

can only have one order for each severity of pain

Question 48

what is the recommended treatment for low back pain?

Answer 48

nonpharm - exercise, CBT, rehab first line: APAP and NSAIDs second line: SNRIs and TCAs

Question 49

what is the treatment for OA?

Answer 49

nonpharm - excercise, weight loss, education firstline: APAP and NSAIDs second line: intra-articular hyaluronic acid or capsaicin

Question 50

what is treatment for mibromyalgia?

Answer 50

nonpharm: exercise, CBT, rehab medications: FDA pregabalin, duloxetine other options: gabapentin, TCAs, venlafaxine

Question 51

what is treatment for neuropathic pain?

Answer 51

first line: SNRIs, gabaptentin/pregabalin second line: topical lidocain, TCAs

Question 52

what are the hospice medications?

Answer 52

pain relief: morphine anxiety/agitation: lorazepam N/V: ondansetron ODT secretions: atropine, glycopyrrolate, scopalamine