Pain Flashcards
(197 cards)
0
Q
Acetaminophen ceiling effect at what dose
A
1000 mg
1
Q
Acetaminophen routes of administration
A
Po pr iv
2
Q
Acetaminophen drug interactions
A
Increase inr with warfarin if over 2 g per day
3
Q
Acetaminophen toxicities
A
Hepatotoxicity
4
Q
Nsaids toxicities
A
Peptic ulcer Renal dysfunction Cv effects Cns effects Htn Skin rash Mild hepatotoxicity
5
Q
Nsaids drug interactions
A
Anticoags- increase bleeding risk
Ace or arb- worsens renal impairment
6
Q
Adverse effects of opioids common
A
Euphoria drowsinesS N/v Decreased respiratory rate Constipation Pruritus
7
Q
Less common aes of opioids
A
Myoclonus Seizures Hallucinations Confusion Sexual dysfunction Sleep disturbances Dyspepsia
8
Q
Cis and precautions to opioids
A
Respiratory diseases Renal impairment Hepatic impairment Paralytic ileus Other meds with cns suppressant effects (avoid with maois)
9
Q
What drugs are morphine like
A
Morphine (roxanol, msir, avinza, kadian, ms contin)
Hydromorphone (dilaudid, exalgo)
Oxycodone (oxy ir, eth-oxydose, roxicodone, oxycontin, percocet, tylox)
Oxymorphone (opana)
Codiene
Hydrocodone (vicodin, vicoprophen, lortab, norco, rezira, zutripro)
10
Q
Which opioids have active metabolites
A
Morphine codeine and meperidine
11
Q
Morphine dose adjustments
A
Renal
12
Q
Morphine dose range
A
10-200. No ceiling.
13
Q
Morphine dosage forms
A
Ir and er po Oral solution Iv Im Pr
14
Q
Dosage forms of hydromorphone
A
Ir po Oral solution Iv Im Subq Intrathecal Pr
15
Q
Dose range of hydromorphone
A
1-16 mg
16
Q
Hydromorphone potentcy related to morphine
A
More potent but shorter acting
17
Q
Oxycodone potency compared to morphine
A
Slighty more potent but longer acting
18
Q
Available forms of oxycodone
A
Ir and er po. Oral solution and combo products
19
Q
Dose range of oxycodone
A
1.5-80 mg
20
Q
Oxycodone metabolized y which cyps
A
3a4 and 2d6
21
Q
Oxymorphone available dosage forms
A
Ir and er po
Injectable
22
Q
Pr counselig for oxymorphone
A
Take one hour before or two hours after meals. Enhanced absoption with food
23
Q
Codeine potentcy compared to morphine
A
Much less potent
24
Codeine cyp enzyme
2d6
25
Codeines antitussive moa
Supresses reflex at cough center on medulla
26
Hydrocodone potentcy compared to morphine
Similar
27
Hydrocodone cyps
3a4 ad 2d6
28
Hydrocodone availability
Er po
| Combo products
29
Drugs categorized as meperidine like
Meperidine
| Fentanyl
30
Meperidine dosage forms
Im
Po
Subq
31
Dose adjustment for meperidine
In renal failure
32
Toxicitiea of meperidine
Lower seizure threshold
| Cns toxicities
33
American pain society recommendation for meperidine
Less than 48 hours at doses less than 600 mg in 24 hours
34
Meperidine used for what not pain
Rigors and shivering
35
Fentanyl dosage forms
Transmucosal
Transdermal
Im
Iv
36
Fentanyl cyp interactions
3a4 inhibitors
37
Fentanyl dose range
100 to 1600 mcg
38
Transmucosal ir fentanyl indication
Acite breakthrough cancer pain
39
Fentanyl patch indication
Chronic pain in opioid tolerant
40
Cautions with fentanyl patch
Morbidly obese or cachectic
| Exposure to heat
41
Opioids with rems
Er formulations and fentanyl ir transmucosal products
42
Methadone available formulations
Injectable and oral (long acting oral)
43
Blackbox of methadone
Qtc prolongation
45
Methadone drug interactions
```
Serontinin and norepinephrine inhibition
3a4
2b6
2c9
2c19
2d6
```
46
Pain definition
An unpleasant sensory and emotional experience associated with actual of potential tissue damage, or described in terms of such damage
47
Allodynia definition
Pain due to a stimulus that does not normally provoke pain
48
analgesia definition
absence of pain in response to stimulation which would normally be painful
49
Anesthesia dolorsa definition
pain in an area or region which is anesthetic
50
Causalgia definition
a syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes
51
Dysesthesia definition
an unpleasant abnormal sensation, whether spontaneous or evoked
52
Hyperalgesia definition
increased pain from a stimulus that normally provokes pain
53
Hyperesthesia definition
increased sensitivity to stimulation, excluding the special senses
54
Hyperpathia
A painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold
55
hypoalgesia
diminished pain in response to a normally painful stimulus
56
hypoesthesia
decreased sensitivity to stimulation, excluding the special senses
57
Neuralgia
pain in the distribution of a nerve or nerves
58
neuritis
inflammation of a nerve or nerves
59
Neuropathic pain
pain caused by a lesion or disease of the somatosensory nervous system
60
central neuropathic pain
pain caused by a lesion or disease of the central somatosensory nervous system
61
Peripheral neuropathic pain
pain caused by a lesion or disease of the peripheral somatosensory nervous system
62
neuropathy
a disturbance of function or pathological change in a nerve;
63
nociception
the neural process of encoding noxious stimuli
64
nociceptive neuron
a central or peripheral neuron of the somatosensory nervous system that is capable of encoding noxious stimuli
65
nociceptive pain
pain that arises from actual or threatened damage to non-neural tissue and is due to activation of nociceptors
66
Noxious stimulus
a stimulus that is damaging or threatens damage to normal tissues
67
pain threshold
the minimum pain intensity of a stimulus that is perceived as painful
68
Pain tolerance level
the maximum intensity of a pain-producing stimulus that a subject is willing to accept in a given situation
69
Paresthesia
an abnormal sensation, whether spontaneous or evoked
70
sensitization
increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally subthreshold inputs
71
Central sensitization
increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input
72
peripheral sensitization
increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields
73
non pharm for pain
```
TENS
psychological intervention
cold/heat
massage
prayer/meditation
distraction
exercise
music
```
74
treatment goals of chronic pain
keep patient functional
improve mental health
decrease pain preception and dependence on drug therapy
decrease rate of physical deterioration
reduce pain as much as possible without undue aes
75
acute pain treatment goals
reduction of pain to acceptable levels
| facilitate recovery from underlying disease
76
Who step 1 treatment option
non-opiod +/- adjuvant
77
WHO step 2 treatment options
opiod for mild to moderate pain ATC
+/- non-opioid
+/- adjuvent
78
WHO step 3 treatment options
Opioid for moderate to severe pain
+/- non-opioid
+/- adjuvent
79
Mixed opioid receptor agonists/antagonists MOA
stimulate kappa and sigma receptors, partially stimulate mu receptors
80
Pentazocine brand name
talwin
81
Pentazocine available forms
injectable solution
82
Pentazocine/naloxone brand name
talwin NX
83
Pentazocine/naloxone available forms
tablets
84
Pentazocine/APAP brand name
talacen
85
Pentazocine/APAP available forms
tablets
86
Butorphanol brand name
stadol
87
butorphanol available forms
injectable solution, nasal spray
88
Nalbuphine brand name
nubain
89
nalbuphine available forms
injectable solution
90
buprenorphine brand names
buprenex, butrans, subutex
91
buprenorphine available forms
injectable solution, transdermal patch, sublingual tablets
92
buprenorphine/naloxone brand name
suboxone
93
buprenorphine/naloxone available forms
sublingual tablets/film
94
buprenophine cyp
3a4
95
centrally acting analgesics
tapentadol, tramadol
96
centrally acting analgesics MOA
mu receptors, inhibit norepinephrine reuptake (tramadol serotonin reuptake too)
97
risks with centrally acting analgesics
seizures, serontonin syndrome (with SSRIs and TCAs)
98
Tramadol Cyps
2d6
| 3a4
99
tapentadol brand name
nucynta, Nucynta ER
100
tapentadol available forms
tablets
101
tramadol brand names
ultram, ryzolt, rybix ODT
102
tramdol available forms
tablets
103
tramadol/APAP brand name
ultracet
104
Topical agents for pain
capsaicin cream
lidocaine patch
oral viscous lidocaine
105
capsaicin cream MOA
depletes substance P
106
AEs with capsaicin cream
burning/tingling; do not get in eyes
107
Lidocaine patch brand
lidoderm
108
lidocaine patch cyps
3a4, 1a2, 2a6, 2b6, 2c9
109
oral viscous lidocaine brand
xylocaine
110
tricyclic antidepressant used for pain
amitriptyline
111
amitriptyline brand name
elavil
112
FDA approved indication for lidocaine patches
post herpetic neuralgia
113
dose of amitriptyline
start 25 mg target 25-150mg
114
anticonvulsants used for pain
```
gabapentin
pregabalin
carbamazepine
valproic acid
lamotrigine
tiagabine
topiramate
```
115
gabapentin brand name
neurontin
116
gabapentin FDA indication of pain
post herpetic neuralgia
117
starting dose of gabapentin
300 mg/day divided doses
118
pregabalin brand name
lyrica
119
pregabalin fda indication of pain
diabetic peripheral neuropathy
post herpetic neuralgia
fibromyalgia
120
pregabalin starting dose
50 mg TID (DPN) 75 mg BID (PHN)
121
SNRI used for pain
duloxetine
122
duloxetine brand name
cymbalta
123
duloxetine fda indication
diabetic peripheral neuropathy
| fibromyalgia
124
duloxetine starting dose
60 mg QD
125
NMDA antagonists used for pain
dextromethorphan
amantadine
ketamine
126
Cautions using TCAs for pain
in elderly and cardiac patients
127
Medications used for bone pain
corticosteroids
| bisphosphonates/bone resorption modifiers
128
bisphophonates used for pain
pamidronate
| zoledronic acid
129
pamidronate brand name
aredia
130
pamidronate dose
30-90 mg IV q3-4 weeks
131
zoledronic acid brand name
zometa
132
zoledronic acid dose
4 mg IV q3-4 weeks
133
AEs of bisphosphonates/bone resoption modifiers
osteonecrosis of the jaw
134
bone resorption modifiers used for pain
calcitonin
| denosumab
135
calcitonin brand name
miacalcin
136
calcitonin dose
100-200 IU.day IV/subQ
137
denosumab brand name
Xgeva
138
denosumab dose
120 mg SubQ q3-4weeks
139
Ziconotide brand name
prialt
140
ziconotide indication
pain with intolerance or refractory to other therapies
141
ziconotide MOA
binds to N type calcium channels or nociceptive neurons in dorsal horn
142
ziconotide available forms
intrathecal
143
ziconotide black box
psychotic symptoms, neurological impairment
144
regional analgesics used for pain
```
procaine
tetracaine
buprivacaine
lidocaine
ropicacine
```
145
use of opioid antagonists
narcotic overdose, reverse respiratory depression caused by opioids
146
opioid antagonists
naloxone
| naltrexone
147
naloxone brand
narcan
148
naloxone dose
0.4-2mg IV Q20-60 minutes
149
naltrexone brands
depade, revia
150
First line for prevention/treatment of opioid induced constipation
senokot S
151
methylnaltrexone brand
relistor
152
methylnaltrexone use
opioid induced constipation in advanced illness with inadequate response to traditional laxatives
153
methylnaltrexone MOA
mu receptor antagonist that does not cross BBB and works in GI tract
154
methylnaltrexone dosage form
subQ
155
which opioids carry highest risk of respiratory depression
morphine
| oxymorphone
156
pruritis is most common with which opioid
morphine
157
tolerance definition
physiologic response; patient required inreasing doses to achieve the same analagesic response
158
dependence definition
phyiologic response; patient requires continuous dosing to prevent withdrawal symptoms
159
addiction definition
psychological response; misusing a substance for other purposes, despite negative consequences to health, employment, legal, and social situations
160
psuedoaddiction definition
some behaviors of addiction are displayed; behaviors cease when pain is controlled
161
Schedule I definition
high potential for abuse; no currently accepted medical use
162
schedule II definition
high potential for abuse, currently accepted medical use; abuse can lead to severe psychological/physiological dependence
163
schedule II examples
```
morphine
hydromorphone
oxycodone
oxymorphone
hydrocodone
meperidine
fentanyl
methadone
pentazocine
tapentadol
```
164
schedule III definition
potential for abuse but less than drugs in Schedule I or II; currently accepted medical use; abuse may lead to moderate-low physiological or high psychological dependence
165
Schedule III examples
buprenorphine
ketamine
166
Schedule IV definition
low potential for abuse relative to drugs in Schedule III; currently accepted medical use; abuse may lead to limited physiological/psychological dependence relative to drugs in schedule III
167
Schedule IV examples
tramadol, buorphanol
168
schedule V definition
low potential for abuse relative to schedule IV; currently accepted medical use; abuse may lead to limited physiological/psychological dependence relative to schedule IV
169
schedule V examples
pregabalin
170
breakthrough pain definition
acute pain that occurs despite current long-acting/controlled release treatment
171
breakthrough pain dose is what percent of total daily
5-15% q3-6 hours
172
Reduce dose by what percent when switching opioids to account for cross tolerance
25%
173
components of a PCA order
basal rate
patient controlled bolus dose
lockout period
174
morphine IR tablets brand name
MSIR
175
morphine IR oral solution brand name
roxanol
176
morphine ER brand name
avinza, kadian, MS contin
177
hydromorphone IR brand name
dilaudid
178
hydromorphone ER brand name
exalgo
179
Oxycodone IR brand name tablets
oxyIR, roxicodone
180
Oxycodone ER brand name
Oxycontin
181
oxycodone IR solution brand name
eth-oxydose
182
oxycodone/APAP brand names
percocet, tylox
183
oxymorphone brand name
opana
184
hydrocodone ER brand name
zohydro ER
185
hydrocodone/APAP brand name
vicodin, norco, lortab
186
hydrocodone/ibuprophen brand name
vicoprophen
187
hydrocodone/psuedophedrine brand name
rezira
188
hydrocodone/chlorpheniramine/pseudophedrine brand name
zutripro
189
meperidine brand name
demerol
190
fentanyl oral lozenge brand name
actiq
191
fentanyl buccal tablet brand name
fentora
192
fentanyl buccal soluble film brand name
onsolis
193
fentanyl sublingual spray brand name
subsys
194
fentanyl sublingual tablets brand name
abstral
195
fentanyl nasal spray brand name
lazanda
196
fentanyl transdermal patch brand name
duragesic
197
methadone brand names
dolophine, methadose
