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TOP 300 drugs - NAPLEX > PAIN > Flashcards

PAIN Flashcards

1
Q

Tylenol + warfarin

A

Max 2gm/day

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2
Q

Aspirin vs other NSAID MoA

A

Aspirin irreversibly blocks COX-1 & COX-2

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3
Q

Non-aspirin NSAID Boxed warnings

A
  1. GI risk
  2. CV risk
  3. CABG surgery (C/I after)
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4
Q

All NSAID ADRs

A
  1. Dec. renal clearance by reducing blood flow to the glomerulus
  2. Inc. BP
  3. Premature closure of ductus arteriosus leading to HF in baby. Do not use in third trimester (≥ 30 weeks)
  4. Renal impairment, if used around 20 weeks gestation or later
  5. Photosensitivity
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5
Q

Ibuprofen max

A

Rx: 3.2 grams/day
OTC: 1.2 grams/day

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6
Q

Salicylate overdose can cause:

A

Tinnitus

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7
Q

NSAIDs + lithium

Which NSAID is preferred?

A

NSAIDs can inc. Li+ lvls
Sulindac is preferred

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8
Q

Codeine: contraindication

A

< 12 yrs (any indication)
< 18 yrs (following tonsillectomy/adenoidectomy)

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9
Q

When can people begin using fentanyl?

A

60 MME/day ≥ 7 days

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10
Q

Hydromorphone + MAOIs

A

2 week washout required

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11
Q

Methadone: warnings

A

QTc prolongation
CYP450 inhibitors
Serotenergic drugs/MAOIs
Caution in elderly/seizure hx

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12
Q

Which opioid can cause sexual dysfunction?

A

Methadone

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12
Q

Which opioid can cause hyperhidrosis?

A

Fentanyl
Methadone
Meperidine
Morphine
Oxycodone

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13
Q

Meperidine: warnings

A

Renal impairment/Elderly at risk for CNS toxicity
MAOIs (2 wk washout)
Serotonergic drugs

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14
Q

Which opioid can be used if a patient has difficulty swallowing?

A

Kadian (ER morphine capsules)
Xtampza (ER-Oxycodone-Capsules)

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15
Q

Morphine: IV to PO

A

10mg IV is 30 mg PO

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16
Q

Which opioid should be taken on a empty stomach?

A

Oxymorphone

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17
Q

Hydromorphone IV to PO

A

1.5mg IV is 7.5mg PO

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18
Q

Morphine-to-oxycodone conversion

A

30mg morphine (PO) is 20mg oxycodone

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19
Q

OIRD risks

A
  1. Hx of overdoses
  2. SUD
  3. Large doses (≥ 50 MME)
  4. Use with benzos, lyrica or gabapentin
  5. Comorbid illness (respiratory or psychiatric disease)
20
Q

All PAMORAs warnings

A

GI perforation
C/I in GI obstruction

21
Q

Tramadol + Tapentadol (Nucynta) MoA

A

Mu-opioid receptor agonists + NE reuptake inhibitors
Tramadol also inhibits reuptake of 5HT

22
Q

Tramadol: warnings

A
  1. CYP2D6 ultra-rapid metabolizers
  2. Seizure risk
  3. Serotonin syndrome
  4. Hypoglycemia
  5. C/I in < 12 or < 18 (tonsillectomy/abenoidectomy)
23
Q

Tapentadol vs tramadol

A

Tapentadol is a stronger analgesic, hence why its C-II instead of C-IV

24
Q

Lioresal: Boxed warning

A

Acute withdrawal of intrathecal baclofen = organ failure/death

25
Q

Cyclobenzaprine: D/I

A

serotonergic

26
Q

Common migraine triggers

A
  1. Hormonal changes
  2. Foods
  3. Stress
  4. Sensory stimuli (bright lights, scents, noises)
  5. Changes in sleep-wake pattern
  6. Changes in environment (weather, bariometric pressure)
27
Q

Migraine: diagnosis

A

5+ attacks fulfilling the following criteria:
1. lasting 4-72 hrs and recur sporadically
2. ≥ 2 characteristics: unilateral location, pulsating, moderate-severe pain, aggravated by (or causing avoidance of) routine physical activity
3. One of the following during the headache: N/V, photophobia, phonophobia

28
Q

Natural products used for headaches

A

Riboflavin
Magnesium
Butterbur
Feverfew
Peppermint (locally)
Co-Q-10

29
Q

MOH

A

Occur > 10-15 days/month

30
Q

Preventing MOH

A

limit acute treatment to 2-3 times/week

31
Q

Triptans C/I + warnings

A

CVD (stroke/TIA)
Uncontrolled HTN
IHD, PVD
Within 24 hrs of an ergogamine
Serotonin syndrome

32
Q

Formulations to use if nausea if present with migraine

A

Nasal, ODTs, Injections

33
Q

Longer lasting triptans

A

Frovatriptan (longest half-life with 26 hrs)
Naratriptan
Slower onset, use if HA recurs after dosing or can be anticipated

34
Q

ODT triptans

A

Rizatriptan (Maxalt-MLT)
Zolmitriptan (Zomig-MLT)

35
Q

Nasal spray/powder triptans

A

Imitrex
Zomig
Onzetra Xsail (powder)

36
Q

SC injection triptans

A

sumitriptan
Imitrex STATdose, Zembrace SymTouch (autoinjector)

37
Q

Ergotamine MoA

A

nonselective 5HT receptors agonist

38
Q

Migranal (Dihydroergotamine) warnings/CI

A
  1. Potent CYP3A4 inhibitors (d/t peripheral ischemia)
  2. Uncontrolled HTN
  3. IHD, MI, PVD
  4. Pregnancy
  5. Within 24 hrs of triptans
  6. Within 2 weeks of MAOIs
39
Q

Lasmiditan (Reyvow) MoA

A

Selective 5-HT1F receptor subtype agonist DOES NOT cause vasoconstriction

40
Q

When should you consider prophylactic treatment for migraines?

A

acute treatments ≥ 2 days/week or ≥ 3 times/month, migraines dec. QoL, ineffective acute treatments, pt requests it

41
Q

Atogepant (Qulipta): dosing

A

PO daily

42
Q

Epinezumab-jjmr (Vyepti)

A

IV every 3 months

43
Q

Erenumab-aooe (Aimovig)

A

SC monthly

44
Q

Fremanezumab-vfrm (Ajovy)

A

SC monthly or higher dose 675 mg every 3 months

45
Q

Galcancezumab-gnlm (Emgality)

A

SC monthly

46
Q

Rimegepant (Nurtec)

A

ODT every other day

47
Q

Triptans ADRs

A

somnolence (sleepiness, not activation), nausea, paresthesias (tingling/numbness), throat/neck pressure, dizziness, hot/cold sensations, chest pain/tightness

TOP 300 drugs - NAPLEX (11 decks)

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