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Pharm 2 > Pain > Flashcards

Pain Flashcards

(58 cards)

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1
Q

ceiling dose for acetaminophen

A

4,000 mg/day if using for LESS than 7 days
• 3,000 mg optimal for long term use and may become our standard of care
• (Utilize ceiling of 2,000 mg in elderly, or those with organ (liver) dysfunction, or excessive alcohol use, cirrhosis)

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2
Q

ceiling dose for aspirin

A

4g/day

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3
Q

ceiling dose for ibuprofen

A

3200mg/day

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4
Q

ceiling dose for ketorolac

A

150 mg first day, 120mg/day thereafter – DO NOT USE longer than 5 days

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5
Q

NSAIDs contras

A

CABG, CHF, recent MI, renal dysfunction, aspirin allergy/ hypersensitivity

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6
Q

most common NSAID AE category

A

GI: Dyspepsia, gastritis, ulcers, bleeding. Protective mucus production is disrupted, increase in gastric acid production.

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7
Q

BBW for NSAIDs

A

increased risk of MI and stroke in all pts

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8
Q

NSAID interactions

A

ACE-I (risk of renal impairment), FQ (lowers seizure threshold), corticosteroids (risk of ulcers), anti-hypertensives (increases BP slightly), aspirin (can reduce antiplatelet effect), other NSAIDs (never combine)

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9
Q

GI AE from NSAIDs can be serious/fatal in whom?

A

GI can be serious/fatal in elderly, hx of PUD or GI bleeding, H pylori infx, heavy alcohol use, steroid use

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10
Q

pt counseling for NSAIDs

A

Onset will be in 20-30 min; take w/ food and full glass of water so it doesn’t irritate your stomach or cause an ulcer

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11
Q

NSAIDs need routine monitoring for what things

A

renal failure, hepatic dysfunction, and GI ulceration (gastric > duodenal)

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12
Q

age contra for ibuprofen

A

<6 mo

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13
Q

age contra for naproxen

A

<12 y/o

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14
Q

ibuprofen analgesic, etc dosing

A

Analgesic Dose = 1200 - 1800mg / day
Anti-Inflammatory Dose = 1800-2400mg/d
Anti-Rheumatic Dose = 2400-3200mg/day

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15
Q

ceiling max of ibuprofen is ok for how many days

A

3-5

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16
Q

ceiling dose for naproxen

A

ceiling = 500mg Q12 hr

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17
Q

go-to IV or IM NSAID

A

ketorolac

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18
Q

contras for Indomethacin (Indocin)

A

Caution: elderly, epilepsy, psych disorders, Parkinsons

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19
Q

pt counseling for voltaren gel

A

Voltaren: wash hands well after application; do not cover w/ dressings or apply heat; do not use w/ other topical lotions/meds; don’t wash off/shower for 1 hr

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20
Q

longest half life NSAID

A

Piroxicam (Feldene)

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21
Q

contras for Celecoxib (Celebrex)

A

post-CABG, aspirin or sulfa allergy

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22
Q

BBW for Celecoxib (Celebrex)

A

MI

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23
Q

indications: mild-mod pain and inflammation at high doses only, prevention of MI/stroke, ACS, Dressler’s syndrome, fever, prophylactic for colon cancer

A

aspirin

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24
Q

contra for aspirin

Study These Flashcards
A

kids (Reye’s syndrome)

25
aspirin toxicity signs
Toxicity: n/v, diaphoresis, tinnitus, hyperventilation
26
treatment for aspirin toxcitiy
dialysis
27
interactions: Anticoagulants, Lithium, Certain Antihypertensives
aspirin
28
early symptoms of tylenol overdose
N/V/D, abdominal pain
29
treatmetn for tylenol overdose
Acetylcysteine (Acetadote®, NAC, Mucomyst) or activated charcoal (if w/in 4 hrs)
30
tylenol and NSAID combo that beats opioids
1g acet + 400mg ibuprofen > opioids
31
AEs: "CNS depression (drowsiness/confusion) Headache Hypotonia (weakness/low muscle tone)"
baclofen
32
baclofen withdrawal symptoms
PO: Seizures, hallucinations, etc. Intrathecal: severe sequelae (hyperpyrexia, obtundation, rebound/exaggerated spasticity, muscle rigidity, and rhabdomyolysis), leading to organ failure and some fatalities Slow taper over 2 weeks is needed
33
interactions for diazepam (Valium)
Metabolised by CYP34A to active. Avoid opioids: respiratory depression. Avoid alcohol: Increased effect of alcohol. Excess grapefruit will increase effect of diazepam
34
contra / interaction for •tizanidine (Zanaflex)
cipro
35
AEs: "Drowsiness. Hypotension )Especially when combined with other antihypertensives) Dizziness. Dry mouth. Hepatotoxicity: Monitor LFTs regularly with long-term use"
•tizanidine (Zanaflex)
36
withdrawal symptoms of •tizanidine (Zanaflex)
Abrupt withdrawal may result in rebound hypertension, tachycardia, and hypertonia (if pt was receiving high doses for prolonged periods ≥9 weeks)
37
indications for dantrolene | *dantrolene (Dantrium) PO for spasticity, IV
Chronic muscle spasms. Primarily to treat malignant hyperthermia- complication of general anesthesia
38
AEs: respiratory tract infections, muscle weakness, urinary incontinence, falls, fever, pain
botox
39
which spasmolytic is Structurally related to tricyclic antidepressants (TCAs)
cyclobenzaprine (Flexeril)
40
is flexeril rec for low back pain
no
41
cyclobenzaprine (Flexeril) CI | contras
Caution in elderly. Avoid use if history of arrhythmias, CHF, hyperthyroidism, glaucoma or MAOI use in the past 14 days
42
SE of all antispasmodics
CNS depression / sedation
43
cyclobenzaprine (Flexeril) interactions | interactions
serotoninergic drugs, alcohol, opioids
44
Pt cousenling for flexeril
Counsel against operating heavy machinery or driving.
45
how long to describe flexeril / antispasmodics
max 3 wks
46
contras: metaxalone (Skelaxin)
"Caution in elderly. | Absolute: severe renal or hepatic dysfunction "
47
``` AEs: "Sedation, esp when combined w/ alcohol or opioids. CNS depression, Hallucinations, Anticholinergic effects (Dry mouth, blurred vision, urinary retention, dizziness, hypotension, constipation, increased intraocular pressure) Serotonin syndrome (Monitor if on other serotoninergic drugs)" ```
flexeril
48
AEs: Sedation, esp when combined w/ alcohol or opioids. CNS depression. Bradycardia, hypotension, syncope, flushing. Pruritus, rash, urticaria. Dyspepsia, N/V
methocarbamol (Robaxin) PO, IV, IM
49
AEs: Sedation, esp when combined w/ alcohol or opioids. Fairly benign adverse effect profile…although fatalities attributed to its use have been reported. Hemolytic anemia. Leukopenia. Impaired liver function. CNS depression
metaxalone (Skelaxin)
50
contras: carisoprodol (Soma)
Caution in elderly. patients with past substance abuse/addiction
51
AEs: Sedation, esp when combined w/ alcohol or opioids. CNS depression (Very sedating), Seizures. Physical and psychological dependence (Schedule IV)
carisoprodol (Soma)
52
AEs: "Sedation, esp when combined w/ alcohol or opioids. CNS depression. Urine discoloration (red or orange). Rash, petechiae, angioedema. Hepatotoxicity: Rare, serious (including fatal) idiosyncratic and unpredictable hepatocellular reaction (discontinue)"
chlorzoxazone (Lorzone, Parafon Forte)
53
2 categories that are first line for neuropathic pain
anticonvulsants, SNRI
54
AEs: Significant dizziness and sedation. Serious and possibly fatal respiratory depression may occur (Risk increased when combined with opioids or other sedatives; Elderly/underlying respiratory disease at higher risk). Euphoria (abuse potential)
Gabapentin (Neurontin), Pregabalin (Lyrica)
55
couseling for Duloxetine(Cymbalta)
Take on a full stomach to reduce nausea
56
AEs: nausea, Drowsiness, fatigue, headache also common
Duloxetine(Cymbalta)
57
AEs: Drowsiness, dizziness, diaphoresis, nausea, anorexia (all actually fairly common)
Venlafaxine(Effexor)
58
AEs: Anticholinergic effects: dry mouth, urinary retention, constipation, delirium, sedation, orthostatic hypotension
TCAs: "Nortiptyline (Pamelor) | Amitriptlyine (Elavil)"

Pharm 2 (29 decks)

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