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PHRM 845 > L 77-79 Rogers- Non-malignant pain > Flashcards

L 77-79 Rogers- Non-malignant pain Flashcards

1
Q

what is the PQRSTU acronym for? list it after you answer that.

A

subjective questions to ask pt to assess pain.
- Palliative or Precipitating Factors
- Quality of pain
- Region of pain
- Severity of pain
- Time-related nature of pain
- U- impact on yoU

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2
Q

5 physio changes for assessment of pain slide

A

dilated pupils (mydriasis)
paleness
sweating
tachycardia
tachypnea

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3
Q

4 pain intensity scales, which one is special

A

verbal
numeric
visual
wong-baker (for kids*)

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4
Q

step 1 of WHO treatment approach *

A

non-opioid with or without adjuvant analgesic

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5
Q

step 2 of WHO treatment approach *

A

Opioid for mild-moderate pain, + non-opioid, with or without adjuvant analgesic

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6
Q

Step 3 of WHO treatment approach *

A

Opioid for moderate-severe, +non-opioid, with out without adjuvant analgesic

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7
Q

what meds/med classes are considered adjuvant therapies to opioids
(6)

A

gaba
snris
tca
skeletal muscle relaxants
antiepileptics
topical agents

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8
Q

Recommended dosing tylenol:
Adult: (regimen) (max dose)
Kids: (regimen) (max dose)

A

Adult: 325-1000mg po q4-6h, max dose 3-4 g/day
Kids: 10-15 mg/kg po q4h, max 75 mg/kg/day or 3-4 g/day

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9
Q

if a pt has liver disease, what is the max dose of tylenol?

A

2 or less g/day

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10
Q

1 side effect listed on tylenol slide

A

hepatotoxicity (most likely doses above 10g)

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11
Q

2 clinical pearls listed with tylenol *

A

injection is super expensive
gold standard for osteoarthritis

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12
Q

4 side effects listed with NSAIDs

A

GI bleed
nephrotoxicity
fluid retention
increase CV events

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13
Q

4 clinical pearls listed with NSAIDs

A

take with food
caution in old farts
avoid in pts with cardiac history
avoid in liver and kidney disease

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14
Q

aspirin adult dosing with max dose

A

325-1000mg po q4-6h prn
max - 4g/day

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15
Q

aspirin pediatric dosing with max dose

A

sike, dont give it to kids dumbass (bc of reye’s)

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16
Q

2 clinical pearls on aspirin slide

A

avoid in pts taking blood thinners
some formulations available OTC (no shit)

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17
Q

Ibuprofen adult dosing with max

A

200-800mg po q6-8h prn
max- 3200 mg/day

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18
Q

Ibuprofen pediatric dosing with max (under 6 months)

A

5-10 mg/kg po q4-6h prn
max - 40mg/kg/day or 2400 mg

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19
Q

2 interesting/different formulations of diclofenac that might catch you off guard

A

ophthalmic solution
patch

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20
Q

adult dosing of diclofenac

A

50 mg po q8h or 2-4 g applied topically 4 times/day

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21
Q

2 clinical pearls for diclofenac

A

minimal systemic side effects with gel (duh)
some available OTC (duh)

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22
Q

Naproxen adult dosing with max

A

220-500 mg po q6-12hr
max - 1,000mg/day

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23
Q

two weird formulations of ketorolac

A

nasal spray
ophthalmic

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24
Q

ketorolac adult dosing

A

15-30 mg IV q6h or 10 mg po q6h

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25
Q

ketorolac pediatric dosing

A

0.5mg/kg dose IM/IV q6h

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26
Q

2 clinical pearls for ketorolac (first one is underlined)

A
  • maximum duration is 5 days ** bc increased risk of GI bleed
  • oral dosing is continuation of IM or IV
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27
Q

Celecoxib adult dosing

A

200 mg po bid

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28
Q

clinical pearl celecoxib

A

Cox 2 selective -> less GI toxicity

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29
Q

3 uses of gabapentinoids

A

fibromyalgia
neuropathies
post-op pain

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30
Q

gabapentin recommended dosing and max

A

100-300 mg po tid
max - 3600 mg/day

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31
Q

pregabalin recommended dosing and max

A

75 mg po bid
max - 600mg/day

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32
Q

3 side effects listed with gabapentinoids

A

sedation
dizziness
peripheral edema

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33
Q

4 clinical pearls for gabapentinoids

A
  • renally dose adjusted
  • titrate up to limit sedation
  • use in combo to lower requirements of other analgesics
  • pregab is schedule V, gaba is not scheduled
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34
Q

2 SNRIs used in pain

A

venlafaxine and duloxetine

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35
Q

2 uses for SNRIs in pain

A

fibromyalgia
neuropathy

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36
Q

venlafaxine rec dosing and max

A

37.5-75 mg po qd
max - 225 mg/day

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37
Q

duloxetine rec dosing and max

A

30 mg po qd x 1 week, then up to 60 mg po qd daily
max- 60 mg/day

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38
Q

5 side effects with SNRIs

A

nausea
headache
htn
sedation
weakness

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39
Q

2 clinical pearls with SNRIs

A
  • start low dose and titrate up
  • renally dose adjust venlafaxine and avoid duloxetine w/ CrCl <30 * (might come up on exam tbh)
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40
Q

2 TCAs used in pain

A

amitriptyline and nortriptyline

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41
Q

3 uses of TCAs in pain (all off label btw)

A

fibromyalgia
neuropathy
migraine prophylaxis *

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42
Q

amitriptyline/nortriptyline rec dose and max

A

10 mg po qhs
max- 150 mg/day

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43
Q

2 side effects on TCA slide

A

anticholinergic
sedation

44
Q

1 clinical pearl under TCAs for pain

A

last line option for neuropathy and fibromyalgia bc of bad side effects

45
Q

5 muscle relaxants used in pain management

A

cyclobenzaprine
baclofen
methocarbamol
carisoprodol
tizanidine

46
Q

1 use listed for muscle relaxants

A

musculoskeletal pain/ spasms

47
Q

cyclobenzaprine rec dosing with max

A

5 mg po tid
max - 30 mg/day

48
Q

baclofen rec dosing with max

A

5 mg po tid
max - 80mg/day

49
Q

carisoprodol rec dose and max

A

250-350 mg po tid
max- 1050 mg/day

50
Q

methocarbamol rec dose and max

A

1.5 g po 3-4 times/day
max- 8g/day

51
Q

tizanidine rec dosing and max

A

2-4 mg po q8-12hr
max - 24 mg/day

52
Q

4 side effects listed under muscle relaxants

A

sedation/drowsiness
dizziness
dry mouth
vision changes

53
Q

2 clinical pearls for muscle relaxants

A

short term use (3 or less weeks)
carisoprodol is schedule IV

54
Q

1 antiepileptic used for pain management

A

carbamazepine

55
Q

1 use of carbamazepine for pain

A

neuropathic pain

56
Q

carbamazepine rec dosing and max

A

200-400 mg po qd in 2-4 divided doses (tf)
max- 1200 mg/day

57
Q

2 clinical pearls with carbamazepine

A
  • increased risk of hypersensitivity reaction in patient with HLA-B*1502
  • Autoinduction of hepatic enzymes
58
Q

rec dosing of lidocaine patch

A

apply 1 patch daily and remove 12 hours later

59
Q

2 side effects with lidocaine patch

A

hypotension
arrhythmia (but minimal risk with patch)

60
Q

3 clinical pearls with topical lidocaine

A

tachyphylaxis with continuous use
12 hour break between patches
local effect- apply to site of pain (no fucking way bro fr?)

61
Q

2 uses for capsaicin topical

A

muscle/joint pain
neuropathic pain (how tf)

62
Q

1 side effect listed on capsaicin slide

A

skin irritation/pain

63
Q

3 clinical pearls with capsaicin

A
  • dont get in eyes (ok)
  • wash hands after applying
  • some otc options
64
Q

what are the primary pain management options you should aim to use in elderly?

A

tylenol
topicals
SNRis
gabapentinoids

65
Q

what are the two weak opioid agonist

A

codeine and tramadol

66
Q

Medication becomes less effective over time and it takes a higher dose of the drug to achieve the same effect

A. Tolerance
B. Dependence
C. Addiction

A

a

67
Q

When a patient stops using a drug, their body goes through withdrawal

A. Tolerance
B. Dependence
C. Addiction

A

b

68
Q

Continued use of a drug despite negative consequences

A. Tolerance
B. Dependence
C. Addiction

A

c

69
Q

Overdose or Withdrawal?
insomnia/agitation

A

withdrawal

70
Q

Overdose or Withdrawal?
pinpoint pupils

A

overdose

71
Q

Overdose or Withdrawal?
dilated pupils

A

withdrawal

72
Q

Overdose or Withdrawal?
tachycardia

A

withdrawal

73
Q

Overdose or Withdrawal?
bradycardia

A

overdose

74
Q

Overdose or Withdrawal?
pale/clammy skin

A

overdose

75
Q

3 treatments for opioid withdrawal

A

clonidine -> helps w/ sxs such as htn, sweating, vomiting
buprenorphine -> duh
methadone -> interesting

76
Q

3 clinical pearls for opioids

A
  • consider starting a stool softener and/or stim lax
  • potential for tolerance, dependence and addiction
  • schedule II (except tramadol and codeine)
77
Q

4 clinical pearls for tramadol

A
  • risk of serotonin syndrome
  • renally dose adjusted
  • box warning for use of 3A4 and 2D6 shit
  • schedule IV
78
Q

3 clincial pearls for morphine

A
  • itching more prominent **
  • morphine and its metabolites are renally excreted and accumulate in renal dysfxn
  • box warning for avoiding alcohol while taking ER formulation bc of possible fatal overdose
79
Q

1 clinical pearl for hydromorphone

A

box warning about dosing errors when prescribing:
oral solution -> do not confuse mg and mL
IV solution -> do not confuse high potency solution (10mg/mL) with other solutions (lower strengths)

80
Q

2 clinical pearls for hydrocodone/acetaminophen

A

counsel patient on tylenol use
box warning for use with 3A4 inhibitors may increase plasma concentrations

81
Q

3 clinical pearls oxycodone/acetaminophen

A
  • counsel pts on tylenol use
  • ER capsule/tabs are abuse-deterrent
  • box warning for use with 3A4 inhibitors may increase plasma concentrations
82
Q

4 box warnings fentanyl

A
  • box warning to monitor pts receiving 3A4 interacting meds
  • CAN use in renal impairment
  • less hypotension than morphine or hydromorphone
  • non-injectable forms are ONLY indicated for pts who are opioid tolerant
    - (defined as taking morphine 60 mg/day for at least 1 week)
83
Q

how often to apply fentanyl patch

A

every 3 days

84
Q

where can you apply fentanyl patch?

A

chest
back
flank
upper arm

85
Q

can you cut the fentanyl patches

A

no

86
Q

2 uses of methadone in pain management

A

last line tx of chronic pain
opioid detox

87
Q

3 clinical pearls of methadone

A

box warning for QTc prolongation
box warning for 3A4 interactions
long half-life (8-59 hours)

88
Q

Meperidine (demerol) 5 clinical pearls

A
  • avoid in elderly, renal impairment, caution in hepatic
  • box warning for 3A4
  • box warning for not using within 14 days of MAOi ***
  • metabolized by liver into active metabolite (accumulation can cause delirium and seizures)
  • not commonly used bc of adverse effects
89
Q

what are the 4 synthetic opioids that can be used that avoids allergic cross reaction

A

fentanyl
methadone
meperidine
tramadol

90
Q

opioid equivalents:
fentanyl
parenteral and oral

A

p: 0.1
o: —

91
Q

opioid equivalents
hydrocodone
parenteral and oral

A

p: —
o: 30

92
Q

opioid equivalents
hydromorphone
parenteral and oral

A

p: 1.5
o: 7.5

93
Q

opioid equivalents
morphine
parenteral and oral

A

p: 10
o: 30

94
Q

opioid equivalents
oxycodone
parenteral and oral

A

p: —
o: 20

95
Q

do we need to know the naive dosing?

A

hopefully theres two options and we just think to hit the lower one

96
Q

T or F: One of the CDC Recs for prescribing opioids is to prefer ER formulations over IR ones

A

false, they want to prescribe IR

97
Q

what are the 4 exceptions to the 7 day prescribing limit opioid law?

A

cancer
medication assisted tx for a substance-abuse disorder
palliative care
professional judgement with documentation supporting it

98
Q

Michigan law thing with opioid prescribing after procedures:
how many oxycodone 5 mg tablets for each of the following?
Dental extraction:
Thyroidectomy:
Caesarean Section:
Total Hip Arthoplasty:

A

0
0-5
0-20
0-30

99
Q

In the tx of acute pain, you can only have one med order for each severity of pain**, what is the regimen for each severity?
mild:
moderate:
severe:

A

mild: tramadol 25 mg po q6h
moderate: oxycodone 5 mg po q4h
severe: fentanyl 25 mcg IV q1h

100
Q

first line for lower back pain

A

tylenol or NSAIDs

101
Q

2nd line for lower back pain

A

SNRis and TCAs

102
Q

first line for osteoarthritis pain

A

tylenol, NSAIDs

103
Q

second line for osteoarthritis

A

intra-articular hyaluronic acid
capsaicin

104
Q

2 FDA approved meds for fibromyalgia **

A

pregabalin and duloxetine

105
Q

first line for neuropathic pain

A

snris and gabapentinoids

106
Q

second line for neuropathic pain

A

topical lidocaine and TCAs

107
Q
A

PHRM 845 (34 decks)

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