Opioids and the Principles of Pain Management (NEURO) Flashcards
1
Q
Asprin
- Inhibiits
_ antiplatelet effect lasts?
- WHich condition occurs in children associated with asprin
A
- COX1 inhibitor
- Antiplatelet effect lasts 10-14 days
- Reyes syndrome
2
Q
- Ibuprofen
- Class
- Avoid in which patient population (3)
- Inhibits which enzyme
- DD interactions with
- SE (high & low dose)
A
PROPIONIC ACIDS
Pregnant women after 32 weeks, elderly (hypalbuminia) & cardiac patients
- COX2
- SSRIs, steriods, anticoagulants, lithium
- SE
• Kidney function
• Prothrombotic state (high dose)
• Inhibit platelet state (low dose)
3
Q
- Naproxen VS ibuprofen
A
- Absorbed quickly
- Less GI irritation
- Less CV risk
4
Q
Oxaprozin
- Most effective where in the body
Inhibits which enzyme
A
PROPIONIC ACIDS
• Non-selective inhibitor
• Inflamed synovial fluid
• Superior to diclofenac
5
Q
- Meloxicam
- class
- Inhibits which enzyme
- Good in which population
A
COX2
Enoic acid
Well tolerated in patients with hepatic or renal insufficiency & elderly
6
Q
- Celecoxib
- class
- Inhibits what
- SE
- Drug-drug interactions (2)
A
Selective COX2 inhibitor
• Selective COX2 inhibitors
• Sulfa allergy
• Decreases effect of angiotensin & diuretics
Increases lithium
7
Q
- Ketorolac
- Class
- Indication
- Special consideration about duration of use in which population
- SE/DDI
- Not good after which type of procedure?
A
- Acetic acid derivative
• Non-selective COX inhibitor
• Post-operative pain relied
• Use for less than 5 days in patients with asthma
• Hepatoxicity & renal failure especially if used with acetaminophen
• Prevents bone healing so not used after orthopedic procedures
8
Q
Indomehican
- Good in which 2 conditions
A
- Concentrates in synovial fluid so good for gout & osteoarthritis
- Short term dosing for SE
- Closure of ductus arteriosus
9
Q
Diclofenac
- mechanism
- Where doe sit accumulate
- WHen is it used
A
- COX-2 selective
- Hepatotoxic
- Accumulates in synovial fluid
- Post-operative pain relief
10
Q
- Acetaminophen
- class
- Side effect
- Contraindicated in which population
A
Aniline derivative
Acetaminophen • Not an anti-inflammatory • Good for chronic pain • Used with NSAIDS • Narrow therapeutic window • Hepatotoxicity (enhanced in people taking NSAIDS) • Contraindicated in people who drink
11
Q
Morphine
- Class
- SE
- DDI
- COncentrated in ?
A
- Interactions with MAO-I & Demerol
- Hepatotoxicity (half-life doubled in liver disease)
- Renal disease (metabolized M-6-G accumulates and is toxic)
- Concentrated in breast milk
12
Q
- Methadone
- Where do the L and D enantomers work
- Use
- SE and what you must do before staring the drug
- Contraindicated with which 2 substances
A
- L enantiomers: opioid receptor agonist
- D enantiomers: Acts at NMDA receptor to prevent central sensitization
- Effective against neuropathic pain
- Prolong QTc interval
- EKG before initiating treatment
- Long half-life so takes 10 days for effect
- Contraindicated with benzodiazepines & alcohol)
13
Q
- Fentanyl
- Potency compared to morphine
- Administartaion?
Safe in which condition but aviod in ?
A
- IV in OR
- Patch
- 80-X as strong as morphine
- Not as potent an analgesic
- Safe in renal disease
- Avoid in hepatic disease
14
Q
Meperidine
A
Large pupils
15
Q
Oxycodone
- Efficacy compared to morphine
A
- Metabolized to Oxymorphone in liver
- 2-3 hour half life
- Concentrated in breast milk
- Similar efficacy similar to morphine
- Hepatic disease increases potency
