Pain

Question 1

Chronic pain

Answer 1

Pain that last more than 3 months.

Question 2

Pain scales

Answer 2

Assess severity of pain.
A Joint committee standard.
Pain is the “5th Vital sign”

Question 3

Analgesic Regimen for pain

Answer 3

Start low and stop at the lowest dose needed to control pain. Using meds with multiple MOA is ideal

Pain scale of 1-3: Non-opioid. +/- 2 agents

Pain scale of 4-6: Opioid for mild pain. +/- non-opioid or opioid.

Pain scale of 7-10: Opioid for severe pain. +/- non opioid or opioid.

Question 4

Apap

Brand, BBW, Peds dosing, antidote (4)

Answer 4

Brand: INJ; ofirmev, Supp; FeverAll

BBW: do not exceed 4g/day

Peds: 10-15mg/kg q 4 to 6 h

antidote: NAC, Mucomyst, Acetadote, Cetylev (Use Rumack-Matthew Nomogram)

Question 5

NSAIDS

BBW (3), SE (3), C/I, Med guides?

Answer 5

Med guide is required for all RX NSAIDs

BBW: GI Bleeding Risk, Cardiovascular risk (MI or Stoke), and CABG (only aspirin is recommended)

SE: reduce renal clearance, increase BP, nausea (take with food)

Contraindication: third trimester

Question 6

ASA

Brand, Avoid, EC, Notes

Answer 6

Brand: Bufferin, Ecotrin

Avoid ASA in children and teens with viral infections due to reyes syndrome

EC: is used to decrease nausea.

Durlaza and yosprala are not used when immediate effect is needed (MI) due to low aspirin

Question 7

Non-ASA salicylates

Answer 7

Salsalate, Mag salicylate, Difunisal,

Question 8

Ibuprofen
brand (3), peds dose

Answer 8

Brand: Motrin, Advil, caldolor

peds dose: 5-10mg/kg q 6 - 8 h max 40mg/kg/day

Question 9

Indomethicin

Brand, SE

Answer 9

Indocin

High risk for CNS SE

Question 10

Naproxen
Branded Combo (2), dosing

Answer 10

Treximet (+sumatriptan), Vimovo (+Esomeprazole)

Can be dosed bid

Question 11

NSAIDs (Rare counseling point)

Answer 11

Photosensitivity

Question 12

*Ketorolac

Brand (2), BBW, Warnigs

Answer 12

Brand: Sprix, Toradol
BBW: Use no more than 5 days regardless of dosage forms*

Warnings: Renal (Volume depletion)* and Liver failure

decrease dose in 65 yo or more or less than 50kg or increase SCr.*

Question 13

Piroxicam; Brand?

Answer 13

Feldene

Question 14

Sulindac

Answer 14

CLinoril

Question 15

Celecoxib

brand, C/I, selectivity?

Answer 15

Celebrex
C/I: Sulfonamide allergy
HIGH COX 2 Inhibition

Question 16

Diclofenac

Brand((3), BB,

Answer 16

Volaren, Dyloject, Antrotec(+Misoprostol)

BBW: Avoid in women childbearing potential

Misoprostol is used to replace gut-protective prostaglanins and can terminate pregnancy

Do not use more than 32 grams and use dosing card. 2g for hands wrist elbows

4g for feet ankles or knees

Question 17

Meloxicam

Answer 17

Mobic

Question 18

Nabumetone

Answer 18

Relefan

MOA: NSAID

Question 19

Etodolac

Answer 19

Lodine

Question 20

Opioid Hyperanalgesia

Answer 20

When an increase dose occurs and makes the pain worse. Try different opioid.

Question 21

Centrally acting opioid antagonist

Answer 21

Naloxone is used to reverse respiratory depressin

Naltrexone is used in combo to prevent rhe use of another opioid inapporiately.

Question 22

Opioids concerns

Answer 22

REMS for all ER and LA meds including methadone

Question 23

Opiod BBW

Answer 23

BBW: Addiction leading to death
Respiratory depression
avoid use with BZD and alcohol

Question 24

Codeine

Brand, BBW, CS categorization

Answer 24

Brand: Tylenol #2,3,4

BBW: 2D6 Ultra metabolizers avoid due to respiratory depression

CII: Codeine (itself)
CIII: capsule/tablet combination products
CIV: Oral solutions

Question 25

Fentanyl | BBW, Brand, Notes, disposal, Similar

Answer 25

Duragesic, Sublimaze, Onsolis (buccual) BBW: avoid 3A4 inhibitors Start on pt using more than 60 morphine equiv per day for 7 days Disposal: in toilet Alfentanil (Alfenta) , Remifentanil (Ultiva) Sufentanil (Sufenta)

Question 26

Hydrocodone IR | Brand (4), warning

Answer 26

Brand: Norco, Lorcet, Lortab, vicodin Warning: poor 2d6 metabolizers

Question 27

Hydrocodone ER

Answer 27

Vantrela ER | BBW: 3a4 inhibitors

Question 28

Hydromorphone

Answer 28

Dilaudid | BBW: use in opiod tolerant pt (High risk for OD)

Question 29

Methadone | Brand, BBW, Notes (3)

Answer 29

Dolophine, Methadose BBW: QT prolong Notes: Variable half-life, serotonergic agents and major 3A4 substrate

Question 30

Morphine

Answer 30

MS Contin, Kadian, Roxanol, Arymo ER If renally impaired start at lower dose. SE: Dizziness CNS Effects, N/V pruritis

Question 31

Oxycodone | IR, ER, BBW,

Answer 31

IR: Roxicodone, RoxyBOnd ER: Xtampza, Endocet, percocet, Roxicet, (all 3 with apap) BBW: 3A4 inhibitor or stoping inducer can cause fetal OD

Question 32

Oxymorphone

Answer 32

Opana | Take on empty stomach

Question 33

Tramadol | Brand, MOA

Answer 33

Ultram, Conzip (Ultracet +apap) | MOA: Centrally acting analgesic

Question 34

Tapentadol | Brand, MOA, C/I

Answer 34

Nuncyta C/I avoid MAOi MOA: Centrally acting analgesia

Question 35

Fentanyl Counseling points

Answer 35

Do not heat patch apply to hairness skin or short hair and press for 30 secs dispose in toilet keep away from animals or children

Question 36

Opioid management

Answer 36

If medications is effective but runs out to fast increase frequenct and NOT strength If ineffectivie increase dose

Question 37

Opiod conversion

Answer 37

Calc 24 hr dose, use ration, | then reduce dose by 25% (if the exam dose not specifiy to reduce then do not reduce)

Question 38

Fentanyl

Answer 38

Convert to mcg then divide by 24 to get the mcg/her dosing

Question 39

OIC

Answer 39

Methylnaltrexone (Relistor), Naloxegel (Movantik), Lupiprostone (Amitzia), Naldemedine (Symproic)

Question 40

Opioid allergy

Answer 40

Drugs in the same chemical class has COD or MORPH in the name. Buprenorphine is still apart of the MORPH class. + heroin

Question 41

Patient needs Naloxone if:

Answer 41

``` Hx of previous OD, more than 50mg morphine equiv substanse abuse concurrent use of BZD respiratory illness or psych ```

Question 42

Naloxone | Brand (2) notes

Answer 42

Narcan, Evzio may repeat dosing, will cause acute pain, tachy

Question 43

Buprenorphine

Answer 43

Brand: Butrans, Belbucca, suboxone, Zubsolv (+naloxone) Prescribers need an X in their DEA to prescribe it

Question 44

Neurological pain

Answer 44

Diabetes, spinal chord injury, fibromyalgia, Postherpatic pain.

Question 45

Gabapentin

Answer 45

Neurontin, Fanatrex, Gralise (PHN), Horizant (PHN + RLS)

Question 46

Pregabalin

Answer 46

Lyrica

Question 47

Baclofen

Answer 47

Lioresal | MOA: Antispasmodic with anagesic effects

Question 48

Cyclobenzaprine

Answer 48

Fexmid, Amrix, Flexeril | MOA: Antispasmodic with anagesic effects

Question 49

Tizanidine

Answer 49

Zanaflex MOA: Alpha 2 agonist for muscle spasm SE: Hypotension, dry mouthm weakness

Question 50

Carisoprodol

Answer 50

Soma poor 2c19 will have higher conc MOA: Antispasmodic effect with sedation

Question 51

MEthocarbomal

Answer 51

Robaxin-750 | MOA: Antispasmodic effect with sedation

Question 52

Metexalone

Answer 52

Skelaxin | MOA: Antispasmodic effect with sedation

Question 53

Milnacipran | Brand, MOA, BBW

Answer 53

Savella MOA: SNRI BBW psychatric events

Question 54

Amitriptyline

Answer 54

Elavil

Question 55

Duloxetine

Answer 55

Cymbalta

Question 56

lidocaine 5% patch

Answer 56

Lidoderm Can cut patch. Do not use more than 3 at one time

Question 57

Casaicin 0.025% and 0.075%

Answer 57

Zostrix and Qutenza 8% (given in health care office due to burning. pretreat with lidocaine)