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Flashcards in Pain Management Deck (81):
1

What is the pain algorithm for acute mild/moderate pain?

1. NSAIDs or APAP
2. Opiods

2

What is the pain algorithm for acute severe pain?

1. Opiods
2. Add NSAIDs or APAP

3

Pain algorithm chronic visceral

1. Opiods for severe
2. Add adjuvants (TCA or AED)

4

Pain algorithm chronic inflammatory

1. APAP or NSAIDs
2. Long acting opiod

5

Pain algorithm chronic neuropathic, central acting

Clonidine or Baclofen

6

Plain algotrithm chronic neuropathic, peripheral acting

-TCA or AED
-Lidocaine
-SSRI or SNRI
-Long acting opiod

7

Pain algorithm chronic functional

1. TCA or Tramadol
2. SSRI or SNRI

8

NSAIDs inhibit what enzyme

cyclooxygenase

9

Three major clinical actions of NSAIDs

analgesia
anti-inflammatory
antipyretic

10

PGE analog used to treat NSAID induced GI damage

Misoprostol

11

Adverse effects include GI bleeds, tinnitus, edema, hyperkalemia

NSAIDs

12

Contraindications include GI bleeds, hypersensitivity, surgery 1 week prior. Caution in patients with asthma, renal impairment, and thrombocytopenia

NSAIDs

13

Aspirin gets its anti-coagulant effect how?

it inhibits thromboxane A2 production in platelets leading to ineffective platelets for clotting

14

Used prophylactically to decrease incidence of TIAs, MI, unstable angina

Aspirin

15

With chronic use, can prevent colon cancer

Aspirin

16

Adverse effects include salicylism and hypersensitivity (urticaria, bronchoconstriction, angioedema)

Aspirin

17

Respiratory effect of aspirin at high dose

hyperventilation->respiratory alkalosis

18

Respiratory effect of aspirin at toxic dose

central respiratory paralysis->respiratory acidosis

19

Adverse effects include Reye's syndrome (given with viral infections can lead to cerebral edema and hepatitis)

Aspirin

20

Dont give this drug if:
someone is on heparin or warfarin
someone has gout (probenecid & sulfinpyrazone)

Aspirin

21

What drug could decrease rate of Aspirin absorption?

antacids

22

What drug inhibits the anti platelet effect of Aspirin?

Ibuprofen

23

This drug is a derivative of salicylic acid, does not cause salicylate intoxication, is more potent than Aspirin, does not have antipyretic activity, and does not cross the BBB

Diflunisal

24

This class has less GI side effects than Aspirin. Side effects include dyspepsia (bleeding), HA, tinnitus, and dizziness

Propionic acids

25

Theraputic use includes gouty arthritis and osteoarthritis of the hip

Indomethacin

26

This drug is rapidly and almost completely absorbed, metabolized by the liver, and cleared in bile and urine

Indomethacin

27

Side effects of this NSAID are "worse" than others... Dizziness, N/V/D, anorexia, HA, dizziness, vertigo, mental confusion, hepatic & pancreatic effects

Indomethacin

28

This drug decreases the effects of ACEI, furosemide, thiazides, and beta blockers

Indomethacin

29

Interacts with digoxin, lithium, MTX, and enhances the nephrotoxicity of cyclosporines

Etodolac

30

This drug is approved for RA, OA, and ankylosing spondilitis. An opthalmic preparation is available

Diclofenac

31

Prodrug used for treatment of RA and OA

Nabumatone

32

This drug is COX-2 selective at low-moderate doses and nonselective at high doses

Meloxicam

33

2 drugs: have a high incidence of GI ADRs, once daily dosing, and interfere with renal excretion of lithium

Meloxicam and Piroxicam

34

This NSAID has limited use due to serious side effects of agranulocytosis and aplastic anemia

Phenylbutazone

35

This NSAID has GI side effects along with fluid retention, insomnia, blurred vision, euphoria, and nervousness

Phenylbutazone

36

This NSAID displaces warfarin, oral hypoglycemics, and sulfonamides from their protein binding sites

Phenylbutazone

37

This drug is a pyrrolizine carboxylic acid derivative

Ketorolac

38

This NSAID is the only available injectable (IM, IV). It is also available PO, and opthalmic solution

Ketorolac

39

You should only administer this drug for a max of 5 days (3 is better) due to potential GI bleeding

Ketorolac

40

These 3 drugs inhibit COX 2 only. Use cautiously in patients with CHF or renal disease. May need to add Aspirin as these lack antiplatelet effects

Celecoxib (BB WARNING)
Rolecoxib (not on market)
Valdecoxib (not on market)

41

This drug has analgesic and antipyretic effects, but has weak anti-inflammatory and no anti-platelet effects

Acetaminophen

42

This drug is rapidly absorbed from the GI, undergoes 1st pass metabolism, and is excreted in the urine

Acetaminophen

43

This drug gets hydroxylated to N-acetyl-benzoquinoneimine, which reacts with glutathione to form non-toxic substances (UNLESS its an OD)

Acetaminophen

44

When left without glutathione, NAB binds sulfhydryl groups elsewhere causing what?

Hepatic necrosis and renal tubular necrosis

45

Use this drug to counteract acetaminophen OD (creates sulfhydryl groups to bind)

N-acetylcysteine

46

Name 3 endogenous peptide neurotransmitters

endorphins, enkephalins, dynorphins (opiates mimic these)

47

Name three types of pure agonist opiods

Phenanthrenes (morphine like)
Phenylpiperidine (meperidine like)
Diphenylheptane (methadone like)

48

This opiod agonist has high affinity for u receptors. Actions include analgesia, euphoria, respiratory depression, cough suppression, miosis

Morphine

49

This opiod agonist effects include: emesis, relief of diarrhea and dysentery, decrease motility of smooth muscle, increases GI and anal sphincter tone. Causes constipation

Morphine

50

HIgh doses of this drug can cause bradycardia and/or hypotension and can increase CSF pressure (contraindicated in pts with severe brain injury)

Morphine

51

This drug triggers histamine release causing urticaria, sweating and vasodilation, and bronchoconstriction

Morphine

52

This drug
-inhibits the release of GNRH and CRH.
-decreases LH, FSH, ACH, b-endorphin, testosterone, and cortisol
-increases prolactin, GH, and ADH

Morphine

53

Name three theraputic uses for morphine

analgesia
diarrhea
cough

54

This drug demonstrates an extensive first pass effect

Morphine

55

BE CAREFUL if giving to a pt with a head injury, asthma, COPD, BPH or urethral stricture, olds, neonates, BP maintenance problems

Morphine

56

This drug interacts with ETOH, antipsychotics, benzos, and Cimetidine

Morphine

57

This drug binds primarily to kappa receptors

Meperidine

58

This drug demonstrates antimuscarinic activity and causes mydriasis

Meperidine

59

This drug is hydrolyzed and metabolized in the liver. Its active metabolite is then hydrolyzed further

Meperidine (active metabolite- normeperidine)

60

ADR for this drug is SEIZURES (esp in pts with renal failure, hx seizures, long term use)

Meperidine

61

YOU CAN NOT TAKE THIS DRUG if you have taken an MAOI within the last 14-21 days

Meperidine

62

This drug should be cautiously given to olds or pts with renal/hepatic failure. Drug interactions with MAOIs, barbs, Chlorpromazine, and Phenytoin

Meperidine

63

Monitor signs and symptoms of jerking and twitching AND pain scores

Meperidine

64

DO NOT USE THIS MED FOR CHRONIC PAIN MANAGEMENT

Meperidine

65

This drug is a synthetic opiod with greatest action at u receptors. It can be used as a substitute for morphine and heroine for controlled withdrawal.

Methadone

66

You can use this for long acting chronic pain control

Methadone

67

This drug dose needs to be slowly escalated. It has a long DOA and VARIABLE KINETICS

Methadone

68

This drug is highly protein bound, has urinary elimination, and has a wide range of dose equivalents

Methadone

69

Monitor signs of withdrawal on pts with this drug (lacrimation, rhinorrhea, diaphoresis, yawning, restlessness, insomnia, dilated pupils

Methadone

70

This drug is more potent than morphine and is available IV or transdermal

Fentanyl

71

This drug does not cause release of histamine, so it may be preferred when CV stability is an issue

Fentanyl

72

P450 inhibitors increase the effects of these 2 drugs. Inducers decrease effects of them.

Methadone and Fentanyl

73

This is a mild-moderate opiate agonist that is a prodrug. It gets metabolized to morphine

Codeine

74

Two mild-moderate opiate agonists used for management of diarrhea

Diphenoxylate, Loperamide

75

This partial opiod agonist/antagonist is 20x more potent than morphine in producing analgesia. It is a partial u agonist that has slower developing effects

Buprenorphine

76

This drug has similar ADRs to morphine but can antagonize the respiratory depression caused by morphine.

Buprenorphine

77

This opiod partial agonist/antagonist is an agonist of the kappa receptor

Butorphanol

78

This opiod partial agonist/antagonist is a mild u and kappa agonist and has effects at sigma receptor causing dysphoria

Pentazocine

79

This is an opiod antagonist. Has high binding affinity for u receptor and is a competitive antagonist of kappa and delta

Naloxone

80

This opiod antagonist has a long DOA (48 hours) used for opiod dependent maintenance programs

Naltrexone

81

This opioid is a weak u agonist. Works by norepi/serotonin CNS reuptake inhibition. Useful if a pt is allergic to other opiates

Tramadol