Pain Flashcards
(124 cards)
1
Q
What is the difference between nociceptive and neuropathic pain?
A
Nociceptive: Tissue damage causes stimulation of sensory nerves
Neuropathic: damage or malfunction of the nervous system
2
Q
What is the difference between acute and chronic pain?
A
Acute: sharp and sudden pain
Chronic: pain that persists for 3 months → dull pain
3
Q
Mild pain
A
Non-opioid +/- adjuvant
4
Q
Moderate pain
A
Opioid for mild-mod
+/- non-opioid
+/- adjunct
5
Q
Severe pain
A
Opioid for mod-severe
+/- non-opioid
+/- adjunct
6
Q
Max dose of APAP
A
4 g/day
7
Q
Pediatric dose of APAP
A
10-15 mg/kg Q4-6H
8
Q
Strength of children APAP suspension
A
160 mg/5 mL
9
Q
Antidote for APAP
A
NAC
10
Q
Which NSAID have least GI risk? CV risk?
A
COX2
Nonselective
11
Q
ADRs of NSAIDs
A
- Increased BP
- Premature closure of ductus arteriosus (Avoid in 3rd trimester)
- Nausea (take with food or use enteric coated)
- Photosensitivity
- Dyspepsia, ab pain, nausea
12
Q
What medication is used to intensionally close the patent ductus arteriosus
A
Used within 14 days:
IV indomethacin or ibuprofen
13
Q
Max dose of ibuprofen
A
3.2 g/d
14
Q
Pediatric dose of ibuprofen
A
5-10 mg/kg/dose Q6-8H
15
Q
OTC limit of Ibuprofen
A
10 days
16
Q
NSAID that has the highest risk for CNS ADRs
A
indomethacin
17
Q
OTC of Naproxen
A
220 mg Q8-12H
18
Q
Max dose of naproxen
A
1000 mg/d
19
Q
BBW of ketorolac
A
Max duration 5 days
20
Q
ADR of ketorolac
A
↑ bleeding, acute renal failure, liver failure
21
Q
Non-selective NSAIDs
A
Ibuprofen
Naproxen
Ketorolac
Indomethacin
22
Q
Selective CoX2 inhibitors
A
Celecoxib
Diclofenac
Meloxicam
23
Q
Highest COX2 selectivity
A
Celecoxib
24
Q
CI of Celebrex
A
Sulfonamide allergy
25
Dosing of topical voltaren gel
2-4 g to affected joint QID (total body max: 32 g/d)
26
BBW of Diclofenac
Athrotec: avoid in pregnancy due to misoprostol
27
Cardioprotective dosing of ASA
81-162 mg QD
28
ADR of ASA
Reye's syndrome
Dyspepsia, heartburn, bleeding
29
Used for GI protection while on chronic NSAIDs
PPI
30
Counseling when taking ASA and another NSAID
ASA on 1 hr before or 8 hr after ibuprfen
31
Physical dependence
Physiologically adapted to a drug and experience physical sx of withdraw with discontinued
32
Addiction
Strong desire or compulsion to take the drug despite harm → drug seeking behavior
33
OUD
Problematic pattern of opioid use that causes significant impairment or distress
34
Tolerance
A higher opioid dose is needed to produce the same level of analgesia that a lower dose previously provided
35
Opioid hyperalgesia
When the opioid dose is increased that pain becomes worse rater than better
36
What is break-through pain
Sharp spikes of severe pain that occur despite the use of an ER opioid
37
Opioid BBW
1. Addiction, abuse, and misuse
2. Respiratory depression
3. Fatal overdose
38
What schedule are opioids
C-II
39
ADRs of all opioids
Constipation, NV, somnolence, DZ, seizures, respiratory depression, pruritus
40
BBW of codeine
Avoid in <18 yo if having had a tonseilectomy or adenectomy
CI in all <12YO
Ultra CYP2D6 metabolizer → ↑ morphine
41
Schedule of codeine
CIII with APAP
CV with cough products
42
Opioid that comes in lozenges
Fentanyl
43
Indications of Fentanyl patch
Non-opioid naive; Patient who receive 60MME/day for at least 7 days
44
Counseling on fentanyl patches
1 patch Q72H
1. Apply on hairless
2. Can apply Bioclusive or Tegaderm
3. Don't cover with heat
4. Dispose in toilet
45
Schedule of Bupernorphine
CIII
46
Counseling on Belbuca
Insert between gum and cheek tissue
47
Counseling on Betrans
Can be covered with Bioclusive or Tegaderm
Flush in toilet or but in disposable unit
48
BBW of Butrans
QTc prolongation
49
Hydrocodone/APAP
Norco, Vicodin
50
Hydromorphone
Dilaudid
51
Dosing for opioid naive for DIlaudid
PO: 2-4 mg Q4-6H PRN
IV: 0.2-1 mg Q2-3H PRN
52
BBW of dilaudid
Medication error with high potency drug injection (use in opioid tolerant only)
Risk for OD
53
BBW of methadone
QTc prolongation
54
PK of methadone
Variable half-life
Can ↓ testosterone
Major CYP3A4 substrate
55
Meperidine
Demerol
56
Warning and ADR of meperidine
Renal impairment → CNS toxicity → no longer recommended as an analgesic
Normeperidine (metabolite): is renally cleared
Serotenergic
57
Tx for opioid-induced pruritis
Benadryl
58
Morphine
MS COntin, Duramorph, Infumorph
59
ADR of morphine
Purirtis
60
Oxycodone
Roxicodone, Oxycontin
+APAP (Endocet, Percocet)
61
ADR of Oxycodone
Puritits
62
Opioid that should be taken on an empty stomach
Oxymorphone
63
Opioids that cause puritis
Oxycodone, Hydrocodone, Morphine
64
Opioid that cause QTc prolongation
Methadone
65
Opioids that are metabolized by CYP3A4
Hydrocondone, fentanyl, methadone, oxycodone
66
Steps to convert opioids
1. Calculate 24 hr dose
2. Use ration
3. Calculate 24 hr of new drug → reduce the dose ≥25% for cross tolerance (only if exam specifiy)
4. Divide by appropraiate interval and dose
5. Calculate breakthrough dose (10-15%) Q1-2H PRN
- Elderly 5% Q4H PRN
67
Indication for methadone
Opioid addiction for chronic pain
68
Safety recommendations when dispensing opioids
Not first-line for chronic pain:
1. Better to reach low pain instead of no pain
2. Start with IR
3. Evaluate risk facotrs
4. Check PDMP
5. Use adjunctive to lower opioid dose
6. Avoid BZDs
69
Opioids that have cross reactivity
Codeine
Hydrocodone
Morphine
Hydromoprhone
Oxycodone
Oxymorphone
Buprenorphine
Heroin
70
Opioid that don't have cross-reactivity with other opioids
Methadone, fentanyl
71
OIRD risk factors
Hx of previous OD
SUD
Large doses ≥50MME
Use with BZD, pregabalin, Gabapentin
Respiratory or psychiatric disease
72
Why do opioids cause constipation
Reduce GI peristalsis
73
First line for opioid induced constipation
Stimulants (Senna, bisacodyl)
Osmotic (PEG)
2nd line: Pamoras
74
MOA of PAMORAs
Block opioid receptors in the gut to reduce constipation without affect analgesia → only effective if constipation is secondary to opioids
75
PAMORAs
Methylnaltrexone
Naloxegol
76
Chloride channel activator
Lubiprostone
77
Methylnaltrexone
Relistor
78
Naloxegol
Movantik
79
Lubiprostone
Amitiza
80
ADR of PAMORAs
GI perforation risk
Abdominal pain
Indications: failed OTC laxative
81
MOA of Tramadol
Mu-opioid receptor agonist and inhibitors or NE uptake, and serotonin
82
BBW of Tramadol
Repiratory depression
Avoid in children with tonsillectomy and adenoidectomy
Avoid pt what are CYP2D6 ultra metabolizers
Serotonin syndrome and MOAI
83
ADR of Tramadol
DZ, Constipation, nausea, somnolence
Seizure risk, hypoglycemia
84
Schedule of tramadol
CIV
85
Schedule of tapentadol
CII
86
Administration of Naloxone nasal spray
Administer in 1 nostril and repeat in 2-3 min PRN (alternate nostril) → until emergency arrives
87
Administration of Naloxone inj
Dose Q2-3min until emergency arrives
88
Opioids formulated to deter OD
Suboxone
OxyContin and Hysingla ER (deter crushing and dissolving)
89
Opioid reversal agents
Naloxone
Nalmefene
90
Naloxone
Narcan, RiVive (Nasal spray)
Zimhi (inj)
91
ADR of opioid reversals
Acute withdrawal sx (pain, anxiety, tachypnea)
92
Drugs for opioid use disorder
Buprenorphine
Methadone
Naltrexone
93
Buprenorphine for OUD
+ Naloxone (Suboxone, Zubsolv)
94
Naltrexone
Vivitrol
95
ADR of Subsolv
QTc prolongation, DZ
96
When to initiate Naltrexone for OUD
Patient must have 7-10 opioid-free days
97
Drugs for neuropathic pain
Antiseizure: Gabapentin, Pregabalin, Carbamazepine
SNRI: Duloxetine
TCA: Amitryptiline
98
Antidepressant indicated for neuropathic and musculoskeletal pain
Duloxetine
99
Gabapentin
NeurontinP
100
Pregabaline
Lyrica
101
Schedule of Lyrica
CV
102
Indication of pregabalin
Fibromyalgia, PHN, neuropathic pain
103
ADR of gabapentin and pregabalin
DZ, somnolence, peripheral edema, weight gain, mild anxiolytic (Pregabalin)
104
Carbamazepine indication for pain
Trigeminal neuralgia
105
Antispasmodics with analgesic effect
Baclofen
Cyclobenzaprine
Tizanidine
106
Baclofen
Lioresal
107
Cyclobenzaprine
Flexeril, Amrix, Flexmid
108
Tizanidine
Zanaflex
109
ADR of all muscle relaxanrs
Sedation, DZ, confusion, asthenia (weakness)
110
ADR of Flexeril
Dry mouth
Serotenergic
111
ADR of tizanidine
Dry mouth, hypotension
112
Antispasmodics that exert their effects by sedation
Carisoprodol
Methocarbamol
Metaxalone
113
Carisoprodol
Soma
114
Metaxalone
Skelaxin
115
Methocarbamol
Robaxin
116
Warning of Carisoprodol
Poor CYP2C19 metabolizers → ↑ concentration
117
Drugs used for malignant hyperthermia
Dantrolene (Dantrium)
118
Lidocaine
LidoDerm, Salonpas
119
Capsaicin
Zostrix
120
Methyl salicylate
BenGay, IcyHot, Salonpas
121
Trolamine
Aspercreme
122
Counseling on lidocaine patches
Can cut
Apply to painful area → up to 12 hrs
Approved for PHN (shingles) pain
Don't apply more than 3 patches at one time → Harm children and pets
123
Counseling on capsaicin
Reduces substance P
Don't touch genitals, nasal area, mouth, or eyes, after application → wash hands
124
Max diclofenac
Don't exceed 8 g each area QD → 2 g QID hands, wrists, or elbows
Don't exceed 16 g each area QD → 4 grams QID feet, ankles, knees
TBM should not exceed 32g/day
