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NAPLEX 21 > Pain > Flashcards

Pain Flashcards

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1
Q

this type of pain occurs when sensory nerves (nocipetors) identify tissue damage

A

nociceptive pain

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2
Q

What is the treatment for mild pain (score 1-3)

A

non-opioid +/- adjuvant

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3
Q

What is the treatment for moderate pain? (score 6-4)

A

opioid for mild-moderate pain
+- non opioid
+- adjuvant

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4
Q

What is the treatment for severe pain?

A

opioid for moderate-severe pain
+- non opioid
+- adjuvant

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5
Q

APAP reduces pain and fever but it does not provide _____ effect

A

anti-inflammatory

inhibition of PG synthesis

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6
Q

Brand: Ofirmev

A

generic: APAP

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7
Q

What ist he recital suppository for APAP?

A

FeverAll

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8
Q

What is the pediatrics dose <12y

A

10-15mg/kg Q4-6H

infants –160mg/5mL

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9
Q

What is the antidote for APAP overdose?

A

NAC/Acetadote

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10
Q

How does NAC/Acetadote work?

A

restores hepatic glutathione

administered IV or PO

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11
Q

What nomogram uses the serum APAP Level and the time since ingestion to determine whether hepatoxocity is likely (and for the need of NAC)?

A

rumack-matthew nomogram

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12
Q

When should a pregnant patient not use an NSAID to avoid premature closing of the ductus arteriosus?

A

third trimester

IV NSAIDS can be used within 14 days of birth to close a patient ductus arteriosus (PDA)

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13
Q

Brand: Caldolor

A

generic: ibuprofen

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14
Q

OTC dosing for ibuprofen adults

A

200-400mg Q4-6H

peds: 5-10mg/kg/dose Q6-8h

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15
Q

What are the side effects of all NSAIDs?

A

dyspepsia, abdominal pain, nausea

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16
Q

What NSAID should you avoid in psych patients?

A

Indomethacin (Indocin) high risk for CNS side effects

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17
Q

Wit the Ketorolac nasal spray when the patient is <65, how is it administered?

A

in EACH nostril (prime five times before use)

> 65, in one nostril

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18
Q

What is the MAX duration of ketorolac in adults?

A

5 days

warnings - acute renal failure, liver failure

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19
Q

This COX2 selective NSAID has a contraindication for sulfa allergy

A

celecoxib

highest cox 2 selectivity

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20
Q

Brand: Voltaren

A

generic: diclofenac

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21
Q

What is the total body max of dicloenac per day? (for gel)

A

32g/day

patch is applied BID

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22
Q

What is arthrotec?

A

diclofenac + misoprostol – used to replace the gut protective PG to decrease GI risk (also used for abortions)

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23
Q

Brand: Mobic

A

generic: meloxicam

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24
Q

What is the cardio protection dose for aspirin?

A

81-162mg once daily

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25
Methyl salicylate is a popular OTC topical found in what agents?
Bengay Icy Hot Salonpas
26
What is an example of non-acetylated salicylates?
Mg salicylate (Doans)
27
What if a patient is taking ibuprofen for pain and aspirin for protection? How should they take their doses?
aspirin one hour before or eight hours after ibuprofen
28
NSAIDs can increase the level of
lithium and methotrexate
29
Which opioids should you not consume alcohol with?
Kadian Nucynta ER oxymorphone ER Zohydro FATAL OVERDOSE
30
Where do opioids act?
mu receptor agonists
31
Which opioids have REMS?
ALL!
32
What are side effects of all opioids?
constipation n/v somnolence dizziness/lightheadedness respiratory depression
33
What control is codeine tablets?
CII
34
What control is codeine tablet/capsule combinations products?
CIII
35
What control is codeine oral solution combination products?
CV
36
Do not use codeine in children in tonsillectomy/adenoitecomy surgery
<12 <18
37
Brand: Sublimaze
generic: Fentanyl
38
Brand: Actiq
generic: fentanyl oral trans mucosal lozenge
39
A patient was newly started on opioids. when can they start using the fentanyl patch?
a patient who has been using 60mg/day or equivalent for at least 7 days can be converted to a fentanyl patch
40
Can a fentanyl patch be covered with an adhesive or dressing?
only with Bioclusive or tegaderm
41
Where do you dispose a fentanyl patch?
toilet
42
Brand: Lorcet, Lortab
generic: hydrocodone IR + APAP
43
Which opioid has a BBW for initiation of CYP3AF inhibitors due to a potential fatal overdose?
hydrocodone IR and ER oxycodone fentanyl methadone
44
Dosing for hydromorphone
2-4mg Q4-6H PRN IV: 0.2-1mg Q2-3H PRN
45
Due to variability, this opioid is hard to dose safely
methadone also, QT!!!
46
Brand: Demerol
generic: meperidine * serotonergic not really used anymore
47
What can be used with morphine to block histamine induced pruritus
benadryl
48
Brand: Kadian
generic: morphine ER
49
which opioid do you take on an empty stomach?
oxymorphone (Opana)
50
What is morphine IV/IM (in mg)
10mg
51
What is morphine PO (in mg)
30mg
52
What is hydromorphone IV/IM
1.5mg
53
what is hydromorphone PO in mg
7.5
54
when converting opioids, do you round up or down?
down! to reduce OD
55
after calculating the 24 hour dose of the new drug, how much do you reduce it by?
25% for cross tolerance
56
The common drugs in the same chemical class that cross-react with each other have ____ or ____ in the name
cod or morph | codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, buprenorphine, heroin -diacetyl-morphine
57
if using opioids - what formulation should you start with?
IR - start low and go slow
58
what is the first line treatment for OIC?
stimulant laxatives (including Senna) with or without a stool softener bisacodyl
59
If laxatives are not sufficient, specific medications for IOC that counteract the effects of the opioid receptor in the gut can be used - called
PAMORAs - methylnaltrexone (Registro) - naloxogel (Movantik)
60
Brand: Amitiza
generic: lubiprostone | * can be used after trial of laxatives or PAMORAs
61
Tramadol control
C-IV
62
What opioid? - seizure risk - risk of serotonin syndrome - do not use with MAO inhibitors (14 days) - requires conversion to active metabolite by CYP2D6
tramadol tapentadol * cross reactivity, if allergy to one, allergy to the other * caution with seizures!!!
63
What control is tapentadol?
CII
64
At what dose of an opioid would a patient require naloxone?
greater than or equal to 50 morphine milligram equivalent dose
65
What opioid abuse detterant is an agonist at low doses and an antagonist at high doses?
buprenorphine
66
What is naloxone called as an auto injector?
Evzio - provides one dose
67
What is naloxone called as a nasal spray?
Narcan (a dose is in ONE nostril, may need to repeat in other) naloxone - injection, repeat every 2-3 minutes
68
Buprenorphine control?
CIII
69
Brand: Butrans
generic: buprenorphine patch
70
How often does the patient change Butrans?
weekly
71
To prescribe for opioid dependence, a prescriber needs what waiver
DATA 2000 waiver
72
What are common adjutants for pain management?
muscle relaxants AEDs (pregabalin, gabapentin) antidepressants topical anesthetics
73
Brand: Horizant
generic: gabapentin ER used for PHN and restless leg syndrome
74
What are common side effects of gabapentin?
dizziness somnolence peripheral edema
75
What control is Lyrica?
CV
76
what are the side effects of Lyrica?
dizziness somnolence peripheral edema/weight gain mild anxiolytic *actually approved for indications
77
What is the only FDA approved medication for the treatment of trigeminal neuralgia?
carbamazepine (Tegretol)
78
Brand: Elavil
generic: amitriptyline
79
What are some SNRI and TCAs used as adjuvants
elavil cymbalta
80
What are the oral adjuvants for musculoskeletal pain/spasms
baclofen cyclobenzaprine tizanidine
81
Brand: Zanaflex
generic: tizanidine | * dry mouth, hypotension
82
Brand: Amrix, Fexmid, Flexeril
generic: cyclobenzaprine | * dry mouth
83
Brand: Lioresal
generic: baclofen
84
antispasmodics that exert their effects by sedation
carisoprodol (Soma) | methocarbamol (Robaxin)
85
How long are lidocaine patches worn for?
up to 12 hours/day -- 1-3 patches/day
86
Can you cut lidocaine patches?
yes!
87
How do you apply diclofenac gel?
use the reusable dosing card inside the package to correctly measure each dose
88
The dose for hands, wrists or elbows of diclofenac gel is ____ applied four times daily
2 grams do not exceed 8g each day *do not shower for at least one hour
89
The dose for feet, ankles or knees of diclofenac gel is ____ applied four times daily
4 grams do not exceed 16g/day *do not shower for at least one hour
90
Which opioid can be opened and the contents sprinkled on applesauce immediately before ingestion?
Kadian
91
Unless treating hand pain, wash hands thoroughly with soap and water immediately after use of this drug
capsaicin tropical - if treating hands, wash after 30 mins

NAPLEX 21 (60 decks)

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