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Flashcards in Pain Deck (42):
1

WHO recommendations for mild oain

acetaminophin, ibuprofen

2

Who rec for moderate pain

morphine

3

Acetaminophine MOA

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

4

Acetaminophen indications

temp relief of minor aches and pains, fever reducer.

5

ACR First line for treatment of knee, hip, osteoarthritis

Acetaminophen

6

acetaminophen max daily doses

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

7

Acetaminophen warning

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

8

Things to think about with acetametophine

liver, alcohol and combo drugs

9

Acetaminophen toxic metabolite

NAPQI

10

early Signs and symptoms of Acetaminophen toxicity

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

11

Stage 1 toxicity

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

12

Stage 2 toxicity

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

13

Stage 3 toxicity

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

14

Stage 4 toxicity

recovery

15

acetominophen OD antidoteq

N-acetylcysteine.

16

N-acetylcysteine MOA

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

17

NAC IV ADR

anaphylaxis, rash, flush, NV, brochospasm

18

NSAIDs MOA

inhibit cycloxygenase enzymes Cox-1 and COX-2

19

NSAID uses

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

20

NSAID common ADR

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

21

Naproxen/esomeprazole

Vimovo. decreases GI ADR

22

Duexis

ibuprofen + Famotidine. decreases GI ADR

23

Misoprostol MOA

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

24

Misoprostol ADR

Nausea, Diarrhea, abdominal pain,

25

Misoprostal warnings

Abortifacient and teratogenic

26

NSAIDs renal risk

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

27

NSAID warnings

avoid in 3rd trimester, liver impairment, SJS

28

NSAID drug interactions

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

29

Salicylates

Aspirin

30

Aspirin MOA

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

31

Treatment for Aspirin OD

Bicarb sodium

32

Aspirin max dose

4 g daily

33

proprionic acids

ibuprofen, Ketoprofen, naproxen

34

Ibuprofen dosing

Rx: 3200mg, OTC: 2400mg

35

Naproxen dosing

1500mg

36

Carboxylic acids

ketorolac, etodolac, diclofenac, sulindac, indometheacin, nabumetone

37

Diclofenac warnings

increases cardiac events, causes liver toxicity, GI toxicity

38

Indomethacin indications

first line in gout, PDA in neonates

39

Enolic acids

meloxican, piroxicam, semi-selective COX 2 inhibitors

40

Meloxicam indications

oseoarthritis and rheumatoid arthritis. adjust for kidney impairment

41

Piroxicam indications

OA and RA, adjust for liver impairment

42

Celecoxib

COX2 inhibitor for familial adenomatous polyposis