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NAPLEx > Pain > Flashcards

Pain Flashcards

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1
Q

acetaminophen

A

Tylenol, FeverAll (rectal suppository), Ofirmev (injection)
max 4,000 mg
avoid APAP abbreviation

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2
Q

acetaminophen + hydrocodone

A

Lorcet, Lortab, Norco, Vicodin

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3
Q

acetaminophen
+ codeine

A

tylenol #2, 3, 4

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4
Q

acetaminophen
+ caffeine

A

Excedrin tension headache

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5
Q

acetaminophen
+ aspirin/caffeine

A

Excedrine Extra strngth, Excedrine Migraine

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6
Q

acetaminophen
+ caffeine/pyrilamine

A

Midol Complete

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7
Q

acetaminophen
+ Butalbital/Caffeine

A

Fioricet

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8
Q

cox-1 and cox-2 non-selective NSAIDs

A

all agents have GI risk, CV risk in post-operative CABG setting`
Ibuprofen
Indomethacin
Naproxen
Ketorolac

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9
Q

Ibuprofen

A

Advil, Caldolor, Motrin IB

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10
Q

Indomethacin

A

Indocin

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11
Q

OTC self- tx days? ibuprofen
also notes

A

less then 10
IV injection is indicated for closure of PDA in premature infants
severe skin reaction including SJS

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12
Q

notes high risk in indomethacin

A

CNS side effects especially in psych conditions… (think of the depression chapter)

IV injection is indicated for the closure of PDA in premature infants

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13
Q

NSAIDs and the Ductus Arteriosus (DA)

A

Do not use NSAIDs in the third trimester of prego can cause the premature closure of DA

IV NSAIDs (indomethacin, Ibuprofen) can be used within 14 days after birth to close a patent ductus arteriosus (PDA)

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14
Q

naproxen

A

aleve

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15
Q

naproxen
+ esomeprazole

A

Vimovo

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16
Q

Katerolac

A

Toradol, Acular (ophthalmic), Sprix (Nasal Spray)
usually used after surgery never before if that’s the case..

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17
Q

Sprix

A

katerolac nasal spray
prime five times before use and discard 24 hrs after opening

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18
Q

max duration of Katerolac

A

5 days

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19
Q

NSAIDS GI risk

A

increases the risk of serious GI adverse events, including bleeding and ulceration.
Elderly, and pt taking systemic steroids, SSRIs and SNRIs are at greatest risk

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20
Q

CV risk NSAIDs and renal

A

Risk of MI and stroke avoid use in pt w/ CV disease or risk factors. except aspirin

can decrease renal clearance by reducing blood flow

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21
Q

Aspirin is an

A

irreversible cox 1 cox 2 and is an effective antiplatelet agent that provides CV benefit

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22
Q

increased cox 2 selective

A

lower risk for GI complications (but still present). Increased risk MI/stroke (avoid w/ CV risk, avoid increased dose and longer duration in pt at risk for CV disease), the same risk for renal complications
celecoxib
diclofenac
meloxicam
Nabumetone

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23
Q

celecoxib

A

Celebrex

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24
Q

celecoxib
+ amlodipoine

+ tramadol

A

consensi

seglentis

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25
celecoxib notes and contra
contra: sulfa allergy highest cox-2 selectivity avoid prego: risk greatest at >= 30 weeks gestation severe skin reaction...
26
diclofenac
voltaren (gel) otc
27
diclofenac + misoprostol
arthrotec avoid in females of childbearing potential... can increase uterine contractions (abortifacient) but misoprostol is used to replace the gut-protective prostaglandins
28
meloxicam
mobic
29
aspirin/acetylsalicylic acid
ascriptin, Bufferin, Ecotrin: EC/buffered
30
aspirin + omeprazole
Yosprala Durlazo and Yosprala are slow releases, do not use if you need an immediate effect
31
Durlazo
ER capsule aspirin Durlazo and Yosprala are slow releases, do not use if you need an immediate effect
32
Warning w/ salicylates NSAIDs
- hypersensitivity reaction risk, including SJS - AVOID aspirin in children and teenagers w/ any viral infection due to the potential risk of Reye's syndrome! (symptoms: somnolence, N/V, lethargy, confusion) - avoid third trimester of prego - GI bleed and ulceration
33
Magnesium salicylate
non-acetylated salicylates Doan's extra strenght
34
salicylate overdose can cause
tinnitus! also: aspirin w/ other ototoxic agents (e.g. aminoglycosides, IV loop diuretics).. can increase tinnitus risk
35
codeine codeine + acetaminophen
codeine tablets- C-II combo products tablets/capsules- C-III Tylenol #2, 3, 4
36
key things about codeine
FDA avoid in <18 cold and cough products w/ codeine ultra-rapid metabolizers be careful or avoid especially lactating women
37
fentanyl
duragestic, sublimaze atiq: oral transmucosal lozenges on a stick "loollipop" lazanda: nasal spray subsys: spray, SL fentora: buccal tabs
38
use of fentanyl
if outpatient, chronic pain management only not used in opioid-naive pts pt who has been using equivalent to morphine 60 mg/day or more for 7 days! short t1/2 when given IV
39
atiqu disposal
cut off the stick and flush unused/unneeded doses
40
transmucosal IR fentalny requires
REMs program and documentation of patient's opioid tolerance w/ each prescription
41
fentanyl patch use
- effect seen up to 8-16 hrs. d/c all around the clock opioids drugs when the patch is applied - apply to hairless skin (cut hair if needed) - do not apply > 1 patch at a time - can only be covered w/ adhesive film dressing Bioclusive or tegaderm - removed before MRI - dispose of patch in toilet
42
hydrocodone IR (combo products only) warning and notes
+ acetaminophen (Vicodin, norco...) + chlorpheniramine (tussiCaps) warning: Cyp3A4 substrate!!!!!! notes: do not use <18
43
hydrocodone ER warning: Note:
Zohydro ER (capsule), Hysingla ER (tablet) Warning: Cyp3A4 substrate!!!!!! Note: preferably avoid use if breasting, abuse-deterrent formulations
44
Hysingla ER Note:
QT prolongation has occurred at doses >160mg/day
45
hydromorphone
Dilaudid: 1mg/ml high potency injections (HP)- risk for medication error, use ONLY in opioid-tolerant pt 10mg/ml
46
methadone
dolophine
47
methadone box warnings and notes
box warning: QT prolongations! Notes: variable half-life
48
Meperidine
Demerol
49
meperidine warnings and notes
warning: renal impairment/elderly at risk for CNS tox. avoid w/ or within 2 weeks of MOA Notes: NO LONGER recommended for analgesic metabolite normeperidine. renally cleared! accumulation leads to CNS tox and seizures
50
Morphine ER
MS Contin, Kadian
51
Morphine injection
Duramorph, Infumorph
52
Oxycodone IR
Roxicodone, Oxaydo warning: cyp3A4 substrate!!!
53
Oxycodone CR, ER
OxyContin (CR), Xtampza (ER) warning: cyp3A4 substrate!!!
54
Oxycodone + acetaminophen
Endocet, Percocet warning: cyp3A4 substrate!!!
55
oxycodone abuse-deterrent formulations
Oxaydo, OxyContin, Xtampza ER
56
Xtampza ER caps note
can be opened up and content can be administered w/ soft food or through a gastric tube
57
oxycodone notes:
avoid high fat meals w/ higher dose (except re-formulated OxyContin) if renally impaired start a lower dose or avoid oxycodone due to accumulation of parent and /or active metabolite
58
oxymorphone
Opana do not use w/ moderate-to-severe liver impairment! take on empty stomach!
59
conversion
drug IV/IM(mg) oral(mg) morphine 10 30 Hydromorphone 1.5 7.5 oxycodone _ 20 hydrocodone _ 30 codeine 130 200 fentanyl 0.1 _ Meperidine 75 300 Oxymorphone 1 10
60
genal opioid box warning
- addiction abuse and misuse can lead to overdose and death - respiratory depression can be fatal - use of any opioids w/ benzo, CNS depressants, including OH can increase the risk of death -** Kadian, Nucynta ER, Oxymorhone ER, and Zohydro ER: DO NOT consume with -OH! can increase drug plasma levels, which can lead to a potentially fatal overdose ** - accidental ingestion/exposure of even one dose can be fatal to children - crushing, dissolving or chewing of the long-acting products can cause delivery of potentially fatal dose - life-threatening neonatal opioid withdraw w/ prolong use during prego
61
acetaminophen overdose
- tx: N-acetylcysteine (NAC, acetadote) - it increases glutathione precursor - Rumac-Mathew nomogram for dosing
62
which opioids use w/ OH specifically avoid even though avoid with all
- Kadian, Nucynta ER, Oxymorhone ER, and Zohydro ER: DO NOT consume with -OH! can increase drug plasma levels, which can lead to a potentially fatal overdose
63
opioid allergy cross-react
cod or morph (except buprenorphine has norph) CODeine MORPHine HydroCODone HydroMORPHone OxyCODone OxyMORPHone bupreNORPHine Heroin (diacetyl-morphine)
64
opioid-induced constipation (OIC)
stimulant laxatives (including senna) first line bisacodyl tablet for prophylaxis or suppository for tx can use PAMORAs for only opioid-induced constipation peripherally-acting mu-opioids receptor antagonists (PAMORAs) can try lubiprostone
65
Methylnaltrexone
Relistor contra: GI obstruction warning: GI perforation stay close to toilet after injection lol d/c all laxatives prior to use... only use when otc laxative failed - PAMORAs
66
Naloxegol
Movantik contra: GI obstruction, strong cyp3A4 inhibitors warning: GI perforation d/c all laxatives prior to use, can reintroduce if suboptimal response after 3 days - PAMORAs
67
lubiprostone
amitiza
68
tramadol
ultram - seizure risk, serotonin syndrome risk (MOA avoid or 14 days..) - boxed warning: serious risk w/ ultrarapid metabolizers (risk in breastfeeding mothers) - do not use in <12 and <18 if tonsillectomy/adenoidectomy surgery
69
tapentadol
Nucynta - seizure risk, serotonin syndrome risk (MOA avoid or 14 days..) - stronger than tramadol
70
Narcan
onset of actin is slower than injection, 4mg one nostril and if needed to re-dose, use the other nostril
71
Naloxone
injection 2-3 min redose if needed
72
Buprenorphine
belbuca (bucal film), butrans (patch) subclade: once monthly injection- pt must be on a stable dose for 7 days
73
buprenorphine + naloxone
suboxone (sublingual film) zubsolv (sublingual tab)
74
buprenorphine warning: and what do prescribers need?
QT prolongation (>20mcg/hr, CNS depression, and severe dental AE with oral formulations... prescribers need the X number: drug addiction treatment act
75
gabapentin
Neurontin gralise tab: for PHN
76
gabapentin enacarbil
Harizant ER: for Postherpetic neuralgia (PHN) (think of shingles pain....) and restless legs syndrome take w/ food
77
gabapentin warnings and notes
warning: increase seizure frequency if rapidly stoped notes: off-label use fibromyalgia, pain (neuropathic), headache, drug abuse, alcohol withdrawal IR, ER, and gabapentin encarbil are not interchangeable
78
pregabalin
lyrica warning: increase seizure frequency if rapidly stoped notes: provided use in fibromyalgia, PHN and neuropathic pain associated w/ diabetes and spinal cord injury
79
carbamazepine
Tegretol only FDA-approved medications for the tx of trigeminal neuralgia
80
baclofen
Lioresal boxed warning: abrupt withdrawal of intrathecal baclofen has resulted in severe effects (high fever, lethargy, rebound/increased capacity, muscle rigidity and rhabdomyolysis) leading to organ failure and death
81
cyclobenzaprine
Amrix, Fexmid, Flexeril serotoninergic, do not combine w/ other serotonin agents can cause arrhythmias....
82
tizanidine
zanaflex centrally acting alpha-2 agonist

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