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PHARM II > Pain Meds > Flashcards

Pain Meds Flashcards

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1
Q

what medication would you not want to take in with an OTC pain killer?

A

Tylenol (because it’s commonly combined w/ other meds for OTC painkillers & cold meds)

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2
Q

T/F, acetaminophen is an anti-inflammatory

A

False

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3
Q

MOA of acetaminophen

A

unknown: it’s an analgesic & antipyretic - raises pain threshold
(Centrally acting, may block cytokines in the dorsal horn, blocks PG release in CNS)

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4
Q

indications of acetaminophen

A
  • temporary relief of minor aches/pains

- fever reduction

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5
Q

what is acetaminophen first line for?

A

treatment of knee, hip osteoarthritis per ACR

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6
Q

Regular strength tylenol dose

A

325 – 650 mg q4 – 6h prn pain

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7
Q

Extra strength tylenol dose

A

1000 mg q6h prn pain

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8
Q

max daily dose of tylenol (adult)

A

4 g/day

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9
Q

max daily dose of tylenol (peds)

A

5 doses (50-75 mg/kg)/day (pts 12 & under)

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10
Q

why do you not want to exceed 3 alcoholic beverages per day when taking tylenol?

A

LIVER WARNING!!!

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11
Q

which tx is more effective in knee osteoarthritis, acetaminophen or hyaluronic acid inj?

A

Most effective: hyaluronic acid injections

Least effective: acetaminophen

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12
Q

what are nociceptors?

A

Primary sensory neurons that respond to noxious stimuli

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13
Q

at what age should parents talk to a PCP prior to administering tylenol to their child?

A

2 yrs/2 mos…can’t remember

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14
Q

what is the 2 step strategy for WHO Pain Treatment Peds 2012

A

Mild pain:
Acetaminophen or ibuprofen
< 3 mos of age, acetaminophen

Moderate to severe pain:
Opioids

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15
Q

which opiod is the DOC for peds w/ mod-sev pain?

A

Morphine is drug of choice (DOC)

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16
Q

why do we want to avoid giving codeine to peds?

A 
pharmacogenomic variability
(codeine is a prodrug of morphine, metabolized by 2D6)
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17
Q

why do we want to avoid tramadol in peds?

A

lack of evidence

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18
Q

what was the WHO Pain Ladder Adults 1986 originally created for?

A

CA pts

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19
Q

what’s another name for acetaminophen/tylenol?

A

paracetamol, APAP

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20
Q

what is APAP/acetaminophen metabolized by?

A

NAPQI (N-acetyl-p-benzo-quinone imine)

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21
Q

when does APAP/acetaminophen reach Cmax?

A

30 – 60 min

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22
Q

what med is the leading cause of acute liver failure in the US

A

acetaminophen

48% of acetaminophen-related cases (131 of 275) associated with accidental overdose

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23
Q

what were the majority of acetaminophen-associated OD cases from?

A

intentional overdose (70%)

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24
Q

FDA limits Rx combo meds to ___ mg acetaminophen

A

325 mg

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25
what is the boxed warning for acetaminophen?
severe liver injury | allergic rxn
26
alcoholics pts taking P450, 2E1 inducers pts fasting, malnourished, dehydrated pt's w/ a viral illness are at a higher risk of what, when taking APAP?
hepatoxicity
27
what doses of acetaminophen induce hepatoxicity?
10-15 g | >20 g can be fatal
28
what does TK stand for? | think PK
toxicity kinetics | vs pharmokinetics
29
how long after tylenol OD will serum concentrations peak?
4 hrs
30
what organs are affected by APAP toxicity? (5)
``` Liver (cell damage) Renal (ATN) Heart Pancreas CNS ```
31
list the early sx of APAP toxicity (5)
Nausea, Vomiting, AMS (maybe), metabolic acidosis, increased PT/INR
32
MOA of NSAIDs
Inhibit cyclooxygenase enzymes (COX)
33
what are COX?
Prostaglandin synthase enzymes
34
what is the difference between COX-1 & COX-2?
COX-1: Physiologic, Constitutive (found in nearly all cells at constant levels) COX-2: Pathologic, Inducible (released in response to cell mediators; pyretic, pain, inflammatory actions)
35
why is there a risk of renal ischemia w/ chronic NSAID use in pts w/ renal insufficiency, CHF or cirrhosis?
PGs help maintain renal blood flow in compromised kidneys & NSAIDs inhibit PG synthase enzymes
36
why should pts avoid NSAIDs in their 3rd trimester?
PGs induce uterine contractions during labor; may cause premature closure of PDA (Patent ductus arteriosus)
37
what med is used to help prevent premature labor?
Indomethacin
38
which is better to be selective for, COX-1 or COX-2?
COX-2
39
what pain relievers are best for runners (during/after)?
APAP (because NSAIDs can further damage kidneys)
40
name 3 indications for NSAIDs
- Acute/chronic pain (form any cause, caution w/ long-term use) - Cancer pain - Anti-inflammatory
41
name some common ADRs of NSAIDs
Nausea, dyspepsia, anorexia, abdominal pain, flatulence, diarrhea
42
how can you reduce GI SEs?
take w/ food/milk | enteric-coated products should not be taken with milk or antacids
43
what's the big risk w/ NSAIDs?
GI bleed: particulary w/ chronic use, elderly, CVD, h/o peptic ulcer or GI bleed (ulcer, GI perf & death more rare)
44
For chronic NSAID use, PPIs (-prazole) reduced risk of gastric & duodenal ulcers AND ___ & ___
GI bleed & dyspeptic sx
45
For chronic NSAID use, double-dose H2RAs (-tidine) reduced gastric & duodenal ulcers AND ___
abd pain
46
what is Yosprala (aspirin/omeprazole) used for?
patients who need ASA for CV risk, but are at risk for ulcers
47
what is another concern of NSAID use? (NOT GI/kidney)
HF
48
what is misoprostol?
Synthetic prostaglandin E1 analog
49
MOA for misoprostol
Inhibits gastric acid secretion | Protects GI mucosa, reduces incidence of gastric & duodenal ulcers
50
misoprostol ADRs
Nausea, DIARRHEA, Abdominal pain | worse w/ higher doses, ~25% pts experience SEs
51
warnings for misoprostol
abortifacient (induction of laobr/uterine rupture after 8th wk of pregnancy teratrogenic (preg cat X; deformities if used during 1st trimester)
52
what test to you need to run before prescribing misoprostol to a female pt?
``` pregnancy test (need to counsel on abortive effect, document!, pt cannot share med w/ others) ```
53
what risk is associated w/ COX-2 inhibitors?
CV (MI) | all NSAIDs can raise BP
54
which NSAID is safest for CVE?
naproxen
55
what is aspirin (acetylsalicylic acid)
Nonselective COX inhibitor | suicide inhibitor - irreversible
56
what is the max daily dose of ASA?
4 g/day
57
ASA MOA
Anti-platelet Analgesic, anti-inflammatory Anticancer?
58
daily max dose of ibuprofen?
3200 mg/day (Rx) | 2400 mg/day (OTC)
59
daily max dose of naproxen?
1500 mg/day
60
which NSAID would you especially not want to Rx if pt has an ASA allergy?
naproxen
61
what is first-line for gout flares?
indomethacin (take for up to a wk) can also use naproxen
62
3 indications for indomethacin
Gout flares Close PDA in neonates Can be used for premature labor (< 48 hrs)
63
Which med is a "true COX-2 inhibitor"?
celecoxib
64
Stage 1 APAP toxicity
``` No liver injury Asymptomatic or Early signs/symptoms Normal LFTs Nausea, vomiting, diaphoresis, pallor, malaise ```
65
Stage 2 APAP toxicity
``` Liver injury 24 - 36 hours AST elevated (may be > 1000) RUQ pain, hepatomegaly Possible nephrotoxicity Increased PT, bilirubin, sCr, BUN Proteinuria, hematuria, casts ```
66
Stage 3 APAP toxicity
``` Maximum liver injury 72 to 96 hours Hepatic failure Encephalopathy Coma Hemorrhage Nausea/vomiting may return High ammonia level AST/ALT elevated > 10,000 IU/L Abnormal: PT, creatinine, Glucose, pH, Bilirubin, lactate Fatality (Usually 3 – 5 days after OD, Multiorgan failure, Hemorrhage, ARDS, Sepsis, Cerebral edema) ```
67
Stage 4 APAP toxicity
Recovery Hepatic regeneration Several days to weeks
68
What is used to predict the likelihood of tylenol toxicity & determine the need for antidote?
Rumack-Matthew Nomogram
69
What is the antidote for tylenol toxicity?
NAC (N-acetylcysteine): admin w/in 8 hrs of OD, use w/ possible/probable risk of hepatotoxicity, preg cat B
70
MOA of NAC
Prevents hepatic injury by limiting formation of NAPQI
71
NAC dosage
IV/PO (fewer ADR PO) IV anaphylaxis possible: rash, urticaria, pruritus, flushing, N/V, bronchospasm, potentially fatal - antihistamines, steroids, beta agonist, epi

PHARM II (3 decks)

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