PAIN Flashcards
(191 cards)
1
Q
what is considered the fifth vital sign?
A
pain
2
Q
what is the right dose for pain?
A
the lowest dose that treats the pain is the right dose
3
Q
what are withdrawas symptoms of opioids?
A
Anxiety, tachycardia, shakiness,SOB
4
Q
what is addiction?
A
using the medication despite harm to oneself along with drug seeking behavior
5
Q
what is tolerance
A
needing a higher dose with time to achieve the same analgesi effect
6
Q
what is a typical pain regimen consist of in terms of agents ?
A
long acting pain agent,break through pain agent , constipation prophylaxis,sometimes may use an adjuvant
7
Q
How do you go about choosing a pain medication?
A
decide whehter the pain is mild, moderate or severe and where it is found (what is the quality)
8
Q
what type of agents to use for mild pain?
A
use APAP or an NSAID
9
Q
what agents to use for moderate pain
A
combination agents like apap/hydrocodone
10
Q
what agents to use for severe pain?
A
opioids
11
Q
how do you choose an adjuvant?
A
neuropathic pain: use an antidepressant like amitryptiline or duloxetine or anticonvulsant for shooting pain: pregabalin
12
Q
what is the name of the injectible APAP?
A
OFIRMEV
13
Q
Tylenol
A
APAP
14
Q
vicodin
A
apap+ hydrocodone
15
Q
norco
A
apap+hydrocodone
16
Q
lortab
A
apap+hydrocodone
17
Q
APAP+hydrocodone brands
A
vicodin, norco, lortab
18
Q
percocet apap+ oxycodone
A
apap+ oxycodone
19
Q
endocet
A
apap+oxycodone
20
Q
apap+ oxycodone brands
A
percocet , endocet
21
Q
apap + codeine
A
tyelone 2, 3, 4
22
Q
ultracet
A
apap+ tramadol
23
Q
apap+ tramadol
A
ultracet
24
Q
what is the maximum APAP dose?
A
4g max per day
25
typical apap dosing
325 mg 2 tabs q 4-6 hr,500mg 2tabs q 6h, 650mg ER 2 tabs q8h
26
children dosing for APAP
10-15mg/kg q 4-6 hours max 5 doses per day
27
can apap cause renal toxicity?
very rarely yes but generally safe in renal disease
28
main toxicity of apap?
liver toxicity
29
what is the DOC for pain in pregnancy?
APAP
30
maximum daily dose of APAP in heavy drinking?
3g per day
31
what is the antidote for APAP?
N-acetylcysteine PO or IV
32
what is the MOA of NAC?
resptores intracellular glutathione which basically helps the liver detoxify the toxic metabolite (NAPQI)
33
when to administer NAC
within 8 hours of acute injection
34
what is the PO dose fo NAC?
140mg/kg po loading dose then 70mg/kg q 4h x 17 doses
35
can you use APAP with warfarin?
yes its the doc but if used chronically can affect the INR
36
what is the MOA of NSAIDS?
they depelete prostaglandins by inhibitin COX-1/COX-2
37
which COX inhibition increases bleeding risk?
cox-1
38
what are the BBW for NSAIDS? "
CV risk: MI, stroke, thrombotic risk, GI bleed ulcer at high and chronic use
39
ASA brands
bayer, ascriptin, bufferin, ecotrin, excedrine
40
what is the MOA of ASA?
irreversible inhibition of COX
41
which NSIAD has the lowest risk of GI toxicity
celebrex, IBU and NAPROX have low risk but can be risky at high/chronic dosing"
42
what is the danger with chronic PPI use?
decreased bone density and increased infection risk
43
who should avoid aspirin?
pregnant women esp in 3rd trimester,children \<16yo with any viral infection due to risk of reyes syndrome
44
reye's sydrmoe symptoms
sleepiness, nausea, lethargy, confusion
45
what can you do if you are having nausea w/ NSAIDS?
take with food
46
effect of bP from nsaids?
increase
47
main side effects from ASA? "
dyspepsia, heartburn, gi bleed & irritaiton ,inc in bp
48
when should you stop NSAID before elective surgery?
1 week before
49
symptom of ASA overdose?
ringing of the ears
50
motrin
ibuprofen
51
advil
ibuprofen
52
vimovo
naproxen and esomprazole
53
otc vs rx dose fo ibuprofen
OTC up to 400 q q-6 h max 10 days use or less, max 1.2 g/day , RX up to 800 q 6-8 max 3.2 grams /day
54
what are the diff use of IBU depediong dose?
OTC: mild/mod pain , fever, dysmenrorrea, RX: moderate pain or inflammation
55
dosing frequency of naproxen
all twice daily
56
use of naproxen OTC?
typical pain
57
use of naproxen RX
mild-mod pain and ifnlamation
58
max naproxen dose otc
1250mg/day
59
max naproxen rx dose
1.5 /aday
60
otc vs rx dose of naproxen
otc 500mg dose then 250m g q6-8 h, rx: 250-bid to 500mg bid
61
diclofenac brands
voltaren, cataflam, arthrotec
62
arthrotec
diclofenac + misoprostol
63
what is the purpose of the misoprosotl in te arthortec?
to repace the gut-protective prostaglanding to reduce GI risk of the NSAID
64
what tis the pregancy category of misprostol?
X because can also be used as an abortifacent
65
indocin
indomethacin
66
indomethacin doses
IR 25-50mg CR 75 mg
67
main indication for indomethacin?
approved for gout
68
main side effect of indomethacin?
increased risk of cn Ses and GI toxiicty. CNS depresssant
69
feldene
piroxicam
70
typical dose of prioxicam
10-20mg daily
71
side effects with piroxicam
increased risk of gi toxicyt and sever skin reactions including sjs/TEN . Use only if the pt has ailed outher NSAIDs
72
toradol
ketorolac
73
sprix NS
ketorolac
74
typical ketorolac dose?
10-20mg
75
when should you not use ketorloac?
in any situation iwn which the pt has an increased risk of bleeding
76
what is the total max tx for ketorolac?
5 days PO max
77
how should you start ketorolac?
always start IV, IM or nasal sparay and then continue with orla if necessary
78
what are serious consecuenses dfron ketorloac?
severe bleeding, gi perforamtion, acute renal failure and liver failure, anaphylactic shoc. Use only in cmocerate to sever acute pain and MAX 5 days. Only for after the opeartion NEVER before the operation
79
what are the cox- 2 selective NSAIDS
celecoxib meloxicam etodolac nabumetone
80
whay use the cox-2 selective saisned over cox-1 ?
lower risk of GI complicaitons
81
which are the cox non selective NSAIDS?
all others
82
celebrex
celecoxib
83
mobic
meloxicam
84
lodine
etodolac
85
relafen
nabumetone
86
osteoarthryits dose of celbrex?
100mg po bid or 200 daily
87
Rheumatoid arthritis dose fore celebrex?
100-200 BID
88
what is a contraindiation of celcoxib?
SULFA ALLERGY
89
nsaid counseling?
take with food if this upsets your stomach, -can inc MI, stroke esp in pts w/ heart disease can cuase uslcers and bleeding in the stomach -do not use this medicaiton if pregnant -increases blood pressure
90
is there a ceiling for opioid doses?
no, u can go higher to achieve more pain relief but you should rotate them because it reduces tolerance
91
what are the main requirements by the FDA for opioids in the REMS program?
to education prescribrs and to counsel patients
92
MS contin
long-acting morphine
93
avinza
long acting morphine
94
kadian
long acting morphine
95
oramorph SR
long acting morphine
96
roxanol
long acting morphine
97
what is th dosing for AVINZA
once daily
98
what available PRN doses for IR morhpine exist?
10-30mg Q 4h as needed
99
what ER concentrations iexist for morphine?
15, 30, 60, 100, 200 q 8-12 hours
100
how often is kadian dosed
daily or twice daily
101
can you sprinke avinza and kadian on applesauce ?
yes
102
can you open kadian beads and put them down an NG tube?
yes
103
Embeda
morphone/naltrexone
104
what is the advantage of embeda
conatins naltrexone which is an apioid blocker that deters abuse since crussion the drug will lead to release of naltrexone
105
if allregic to morphine group, which agents can you use instead?
fentanyl, meperidine, mehtadone, tapentadol
106
if allergic to morphine group, which agents can you not used
morhphine, oxymorhpone, hydromophonem codeine, oxycodone, hydrodone
107
symptoms of an allergy to opoid?
Difficulty breaty, sever drop in bp, sever rash, swelling of face, lips , tongue,
108
main side effects of opioids?
constipation, nausea, vominting sedation, mood changes flushin prurritis, diaphoresis (can give antihistamine)
109
to which side effects does somoen not become tolerate of for opioids?
constipation
110
what strengths does fentanyl come in?
patch: 12, 25, 50, 75, 100 mcg/h
111
how often should you change fentanyl patch?
every 3 days
112
if using the fentanyl pathc and the pain relief does not last long enough, what do you do? i
shorten the dosing indterval, do not increase the dose (applies to all long acting opioids)
113
duragesic?
fentanyl
114
abstral
sublingual fentanly
115
fentora
SL fentanyl
116
when should you start fentanyl?
for chronic pain only . Patient on 60mg morphine equivalent x at least 7 days
117
how does heat affect the fentanyl patch?
can increase the dose that the patient gets. Avoid heating pads or if pt gets fever call the doctor.
118
how long after applying patch should pt see effect?
8-16 hours after
119
can fentanyl patch be flushed down the toilet/
YES, which is typically not what should be done with most patches
120
which fentanyl type is a REMS drug?
the Sublingual forms
121
if fentanyl transdermal gel touches skin, what to do?
wash with large amounts of water ONLY
122
dilaudid
hydromorphone
123
exalgo
hydromorphone extended release products
124
CI exalgo?
opioid NAÏVE patients
125
what dose to start for opioiod haive patients for hydromophone?
2-4mg po or 1-2 mg by injection q 4-6 h
126
oxycontin
CR oxycodone
127
coxycontin OP
controled release oxycodone
128
entocet, percoet, roxicet
oxycodone with apapa
129
what DDI is important with oxycodone?
cyp 3A4 inhibitors
130
opana
oxymorphone
131
whats the diff between opana ER and IPAN IR?
ER you take twice daily while the IR is used PRN
132
how should you take opana?
on ana empty stomach, most other analgesic should be take with food to avoid stoamch upset
133
what to avoid wit opan ER?
alcohole
134
contraidiation of ER Opana?
mod to sever liver impairment
135
dolophine
methdone
136
methadose
methadone liquid
137
methadone dependeance tx tdose?
40mg daily
138
methadone pain tx dose?
2.5mg to 10mg q 8-12 hours
139
demerol
meperidine
140
can you use meperidine for chronic pain?
no only for acut pain
141
biggest concertn for meperidine use in certain poulations
renal impairment/ elderly because of increased risk of toxicity. Has a metabolite that is renally cleared and can accumulate and cuase renal toxicity
142
Opoid DDIs
CNS depressants , aclochol etc
143
which agent should you be cuathious of for QT prolognation?
methadone
144
ultram
tramadol
145
ryzolt
trmaalod ER tabs
146
ultracet
tramadol + apap
147
concerns with tramadol?
increases seizure risk, risk of serotonin syndrome, SAME side effects as opioids
148
nycynta
tapentadol
149
why use nuycnta?
less gi side effect that opioikds
150
MOA of tramadol and tapentadol?
mu opioid agonists and Norepinephrie reuptake inhibtors
151
countsilin for opioids
don’t chew or crush controlled release forms all opioids NO ALCOHOL will cause drwosineess and fatigue take with full galss water & food if upset stomach will cause consipation
152
memorize the dose conversion table
OK will do
153
when dose converting fentanyl and morphine equivlants what must you always remember?
fentanyl is in MCG while morphine is in MG
154
equivalent fentanyl patch / morhine equivlanet
60mg morphine equals 25mcg/hr fentanyl
155
if an opioid dose does not last long enough what should you do?
increase to more frequent dosing interval rather than increasing the dose
156
know ho to calculate equivalent doses between opiods
see paper
157
what agents available to antagonize opioids from overdose?
naloxone
158
what are opoid antagonists used for?
when a patient has overdose and is undergoing respiratory depression, they give this so the patient can wake up
159
dosin of noloxone
0.4 to 2mg every 2-3 minuts or IV infusion at 100ml/hr= 0.4mg/hr
160
what are signs and symptoms of an acute opoid overdose/
somonlonece, dec RR, cold clammy skin, constricted pupils
161
suboxone
buprenorpine and naoloxone
162
moa of buprenorpine
opioid agonist
163
moa of naloxone
opiod antagonist
164
bbw for buprenorphine patch?
do not exceed a dose of one 20mcg/hour butrans patch systme because of risk of qt prolongation
165
two main side effects of buprenorphine?
causes CNS depression and possible qt prolongation
166
butrans patch counseling
don’t place any heat on patch wear one patch for 7 days continuously place on upper arm, upper chest, side of chest or upper back , don’t use same site in 21 days don’t drink alcohol , will make us sleepy an could kill you can flush or coffee grounds
167
soma
carisoprodol
168
lioresal
baclofen
169
flexeril
cyclobenzaprine
170
skelaxin
metalaxone
171
muscle relaxants generic names
carisoprodol, baclofen, cyclobenzaprine, metalaxone
172
SE for muscle relaxants?
excessive sedation, dizziness, confusion
173
dosing for carisoprodol
250-350m QID prn
174
dosing baclofen
5-20mg tid-qid prn
175
flexeril dosing
5-10 mg tid prn , er 15-30 prn
176
zanaflex
tizandine
177
what is the moa of tizanidine?
it is a skeletal muscle relaxant
178
muscle relaxant counseling?
causes sedation, avoid alcohol or other sedatives
179
four adjuvants used for pain relief?
pregabalin and gabapentin, duloxetine and amytryptiline
180
lyrica
pregabalin
181
cymbalta
duloxetine
182
neurontin
gabapentin
183
elavil
amitriptyline
184
main SE's of pregabalin?
dizziness, somonolence, PERipheral edema
185
topical pain agent for local pain
lidocaine, capsaicin, diclofenac topical
186
zostrix
capsaicin
187
lidoderm
liocain
188
can you cut lidocaine patches
surprisingly YES
189
maximum patches can put at one time?
3 patches
190
for what type of pain is lidocaine FDA approved/
shingles
191
lidocaine time duration of application
12 hours on, 12 hours off
