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7262 MS Block 1 > Fleming chronic pain > Flashcards

Fleming chronic pain Flashcards

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1
Q

Do not dose over __ morphine equivalents (MME)

A

90

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2
Q

Use caution dosing over __ morphine equivalents (MME)

A

50

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3
Q

Reassess meds at least every __ months

A

3

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4
Q

Chronic pain dosing start with what?

A

PRN short acting opioid

add long acting opioid in dose equal to 50-75% of 24 hour PRN dose

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5
Q

An alternative for uncontrolled pain on current dosing is to increase long acting med by __ to __ %

A

15, 25

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6
Q

Ensure pain meds are stable for __ hours if discharging from acute setting with pain meds

A

24

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7
Q

Do opioids have a ceiling effect?

A

no

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8
Q

What is first line for osteoarthritis pain?

A

acetaminophen

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9
Q

What nsaid is preferred in the elderly?

A

acetaminophen

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10
Q

2 drug classes for adjuvant cancer pain?

A

steroids

bisphosphonates

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11
Q

4 first line agents for neuropathic pain?

A

gabapentin
amitriptyline
duloxetine
pregabalin

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12
Q

5 second line agents for neuropathic pain?

A 
tramadol
APAP/nsaids
opioids
topiramate
oxcarbazepine
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13
Q

2 TCAs used as pain adjuvant Tx?

A

amitriptyline

nortriptyline

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14
Q

2 SNRIs used as pain adjuvant Tx?

A

duloxetine

venlafaxine

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15
Q

Which adjuvant SNRI is also labeled for chronic musculoskeletal pain?

A

duloxetine

fibromyalgia

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16
Q

4 anticonvulsants used for adjuvant pain?

A

gabapenin
pregabalin
oxcarbazepine
carbamazepine

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17
Q

Opioids are __ line for neuropathic pain.

a. first
b. second

A

b. second

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18
Q

What opioid is used for neuropathic pain rescue therapy?

A

tramadol

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19
Q

Do muscle relaxants have addiction potential?

A

yes

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20
Q

Muscle relaxants are preferred for __ use only

a. short
b. long

A

a. short

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21
Q

What muscle relaxant is also available in IV form?

A

methocarbamol

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22
Q

What muscle relaxant’s absorption is increased by food?

A

metaxalone

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23
Q

4 muscle relaxants:

A

cyclobenzaprine (Flexeril)
carisoprodol (Soma)
methocarbamol (Robin)
metaxalone (Skelaxin)

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24
Q

two alpha2 adrenergic agonists for pain?

A

clonidine

tizanidine

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25
Which alpha 2 adrenergic agonist is used for postoperative or cancer pain, with a possible role in chronic pain or neuropathy?
clonidine 0.1mg BID
26
Which alpha 2 adrenergic agonist is used for pain/discomfort due to spasticity?
tizanidine 2mg TID
27
__ is a NMDA receptor antagonist that is typically used for anesthesia/sedation in the critical care setting
ketamine lower doses can be used for pain
28
What control class is ketamine?
C-III
29
The best evidence for adjuvant agents is for __ pain
neuropathic
30
__ is the therapeutic effect of a med proportionate to the unit strength or volume. In the case of pain management, the ratio of doses or med required to provide an equivalent pain relief
potency
31
__ is the dose at which two different pain meds provide an approximate equivalent pain relief
equianalgesic dose
32
Will sedation and n/v decrease over time with opioids?
yes
33
2 weak full agonists?
codeine | hydrocodone
34
2 agents with most histamine release?
morphine | codeine
35
Is buprenorphine synthetic or semi-synthetic?
semi-synthetic
36
Which opioid has accumulation of active metabolites in renal insufficiency causing agitation, confusion, delirium?
morphine
37
Which opioid is dose reduced in renal dysfunction due to drug accumulation?
hydromorphone
38
Which opioid has an ER formulation for pts needing continuous management of mod to severe pain?
oxycodone
39
___ ER is approved as a stand alone formulation available through REMS program only
Zohydro form of hydrocodone
40
Which opioid has BBW for respiratory depression and death in children following tonsillectomy in ultra rapid metabolizers?
codeine
41
Which opioid should generally not be used in opioid naive pts?
fentanyl
42
Which form of fentanyl is never used for acute pain?
patch
43
Should fentanyl dose be titrated up in the setting of acute pain?
no
44
Does fentanyl have serotonergic actions?
yes caution wit MAOIs and other serotonergic drugs
45
Which opioid has less effects on BP than others?
fentanyl
46
Which opioid is 5-10 times more potent than fentanyl and is used for IV surgical analgesia?
sufentanil
47
Which opioid has a new sublingual formulation for use in medically supervised settings?
sufentanil REMS program
48
What opioid is effective treatment for shivering?
meperidine
49
Which opioid metabolite can induce hyperpyrexia and/or seizures when used with MAOIs?
normeperidine
50
Is meperidine more or less potent than morphine?
less potent shorter duration and greater toxicity
51
Which opioid is a new injection formulation?
oliceridine potential for QT prolongation
52
Avoid methadone dose titrations more frequently than every __ to __ weeks
1, 2 caution with QT prolonging agents
53
Which opioid has IV form d/c as of April 2018?
pentazocine
54
Common AEs of pentazocine include __ and _
hallucination, dysphoria
55
Is pentazocine a full or partial agonist?
partial PO combo product with naloxone to deter misuse
56
What control class is tramadol?
C-IV
57
Tramadol should be used with caution in pts with __ disorders
seizure
58
Two centrally acting alternate agents?
tramadol | tapentadol
59
What control class is tapentadol?
C-II
60
Which centrally acting alternate agetn is used for neuropathy?
tapentanol
61
Pts taking oral morphine __mg daily for >= 1 week are at risk of tolerance?
60
62
Pts taking transdermal fentanyl __ mcg/h for >= 1 week are at risk of tolerance?
25
63
Pts taking oral oxycodone __mg daily for >= 1 week are at risk of tolerance?
30
64
Pts taking oral hydromorphone __mg daily for >= 1 week are at risk of tolerance?
8
65
Pts taking oral oxymorphone __mg daily for >= 1 week are at risk of tolerance?
25
66
When accounting for incomplete cross tolerance reduce equianalgesic dose of new drug by __ to __ %
25, 50
67
A pt tolerant to the effect and side effects of one opioid may not be equally tolerant to the effects and side effects of another opioid a. true b. false
a. true

7262 MS Block 1 (11 decks)

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