Pain

Question 1

WHO recommendations for mild oain

Answer 1

acetaminophin, ibuprofen

Question 2

Who rec for moderate pain

Answer 2

morphine

Question 3

Acetaminophine MOA

Answer 3

analgesic, antipyretic. Centrally acting, may block cytokines in the dorsal horns, blocks PG release in the CNS

Question 4

Acetaminophen indications

Answer 4

temp relief of minor aches and pains, fever reducer.

Question 5

ACR First line for treatment of knee, hip, osteoarthritis

Answer 5

Acetaminophen

Question 6

acetaminophen max daily doses

Answer 6

adults 4 g, peds 5 doses of 50-75mg/kg

Question 7

Acetaminophen warning

Answer 7

severe liver damage may occur with move than 4g in 24 hrs.

Question 8

Things to think about with acetametophine

Answer 8

liver, alcohol and combo drugs

Question 9

Acetaminophen toxic metabolite

Answer 9

NAPQI

Question 10

early Signs and symptoms of Acetaminophen toxicity

Answer 10

NV, altered mental status, metabolic acidosis, increased PT/INR

Question 11

Stage 1 toxicity

Answer 11

no liver injury, asymptomatic, early signs/symptoms, normal LFT, NV, diaphoresis, pallor, malaise

Question 12

Stage 2 toxicity

Answer 12

liver injury in 24-36 hrs, AST elevated, RUQ pain, possible nephrotoxicity, increased PT, Bilirubin, sCR, BUN, proteinuria, hematuria, red cell casts

Question 13

Stage 3 toxicity

Answer 13

maximum liver injury in 72-96 hrs, hepatic failure, encephalopathy, coma, hemorrhage, NV, high ammonia, AST/ALT elevated, abnormal PT, creatinine, glucose pH, bilirubin, lactate. fatal after 3-5 days of OD

Question 14

Stage 4 toxicity

Answer 14

recovery

Question 15

acetominophen OD antidoteq

Answer 15

N-acetylcysteine.

Question 16

N-acetylcysteine MOA

Answer 16

prevents liver injury by inhibiting formation of NAPQI when administered within 8 hrs of OD

Question 17

NAC IV ADR

Answer 17

anaphylaxis, rash, flush, NV, brochospasm

Question 18

NSAIDs MOA

Answer 18

inhibit cycloxygenase enzymes Cox-1 and COX-2

Question 19

NSAID uses

Answer 19

acute or chronic pain, cancer pain, anti-inflammatory, antipyretics

Question 20

NSAID common ADR

Answer 20

Nausea, dyspepsia, anorexia, abd pain, flatulence, diarrhea, GI bleed, ulcers.

Question 21

Naproxen/esomeprazole

Answer 21

Vimovo. decreases GI ADR

Question 22

Duexis

Answer 22

ibuprofen + Famotidine. decreases GI ADR

Question 23

Misoprostol MOA

Answer 23

synthetic prostaglandin E1 analog. inhibits gastric acid secretion and protects GI mucosa

Question 24

Misoprostol ADR

Answer 24

Nausea, Diarrhea, abdominal pain,

Question 25

Misoprostal warnings

Answer 25

Abortifacient and teratogenic

Question 26

NSAIDs renal risk

Answer 26

acute renal insufficiency, tubulointerstital nephropathy, hyperkalemia, renal papillary necrosis,

Question 27

NSAID warnings

Answer 27

avoid in 3rd trimester, liver impairment, SJS

Question 28

NSAID drug interactions

Answer 28

ASA (ibuprofen blocks antiplatelet effects, take 30mins after ASA) anticoags, antihypertensive, diuretics, hypoglycemics

Question 29

Salicylates

Answer 29

Aspirin

Question 30

Aspirin MOA

Answer 30

nonselective suicide COX inhibitor. antiplatelet, analgesic, anti-inflammatory, anticancer?

Question 31

Treatment for Aspirin OD

Answer 31

Bicarb sodium

Question 32

Aspirin max dose

Answer 32

4 g daily

Question 33

proprionic acids

Answer 33

ibuprofen, Ketoprofen, naproxen

Question 34

Ibuprofen dosing

Answer 34

Rx: 3200mg, OTC: 2400mg

Question 35

Naproxen dosing

Answer 35

1500mg

Question 36

Carboxylic acids

Answer 36

ketorolac, etodolac, diclofenac, sulindac, indometheacin, nabumetone

Question 37

Diclofenac warnings

Answer 37

increases cardiac events, causes liver toxicity, GI toxicity

Question 38

Indomethacin indications

Answer 38

first line in gout, PDA in neonates

Question 39

Enolic acids

Answer 39

meloxican, piroxicam, semi-selective COX 2 inhibitors

Question 40

Meloxicam indications

Answer 40

oseoarthritis and rheumatoid arthritis. adjust for kidney impairment

Question 41

Piroxicam indications

Answer 41

OA and RA, adjust for liver impairment

Question 42

Celecoxib

Answer 42

COX2 inhibitor for familial adenomatous polyposis