Pain mgmt non opioid focused pharm lecture

Question 1

acetaminophen MOA

Answer 1

not well understood

• blocks prostaglandin release
• raises pain threshold
• not anti-inflammatory
• analgesic, antipyretic

Question 2

regular strength APAP dose

Answer 2

325-650 mg

q4-6 hours prn pain

Question 3

extra strength APAP dose

Answer 3

1000 mg

q6 hr prn pain

Question 4

Max daily dose APAP

Answer 4

4g otherwise OD! (adults)

kids 5 doses of 50-75 mg/kg max

Question 5

3 main things to education pts about with tylenol

Answer 5

• liver warning
• alcoholic bev not recommended (esp. 3+ drinks)
• watch out combo products

Question 6

alcoholics and APAP

Answer 6

dose lower assume already have some liver damage

Question 7

APAP is metabolixed to

Answer 7

NAPQI (n-acetyle etc..)

Question 8

how does viral illness impact APAP metablosims

Answer 8

increased risk toxicity if dehydrated

Question 9

early sx APAP OD

Answer 9

N/V
AMS
metabolic acidosis
increased PT/INR (liver damage)

Question 10

stage 1 APAP toxicity

Answer 10

asymptomatic
LFT normal
N/V, diaphoretic, pallor, malaise etc

Question 11

stage 2 APAP tox

Answer 11

AST over 1000
RUQ pain
increased PT, bilirubin, sCr, BUN
proteinuria, hematuria, casts

Question 12

stage 3 APAP tox

Answer 12

-max liver injury 72-96 hr post ingestion
-coma
-high ammonia level
-fatal 3-5 days post APAP OD
multiorgan failure

Question 13

stage 4 APAP OD

Answer 13

recovery hepatic regeneration days to wks

Question 14

APAP OD suspect first step?

Answer 14

• rumack matthew nomogram
• for acute OD in pt over 12
• estimate level of toxicity
• use w/in 4-24 hrs
• above line need NAC

Question 15

NAC must be given w/in ___hrs of APAP OD

Answer 15

8

Question 16

NAC adminstered

Answer 16

IV or oral

less ADR with oral

Question 17

NSAIDS block __ enzymes

Answer 17

COX enzymes

Question 18

COX enzymes do what

Answer 18

create prostaglandins

Question 19

what do prostaglandins do

Answer 19

• released creating pain, inflammation, and pyretic properties
• induce uterine contractions with labor
• maintain renal blood flow (chronic NSAID use RF for renal ischemia AKI)

Question 20

why no NSAID third trimester of pregnancy?

Answer 20

• can cause premature closure PDA

- impact placenta detachment

Question 21

what is best pain reliever for post marathon pain?

Answer 21

APAP
- NSAID will block inflammatory response of muscle repair process, and will compromise blood flow to kidneys risk of renal ischemia

Question 22

t/f enteric coated NSIADS should not be taken with milk or antacids

Answer 22

true

Question 23

T/F nsaids take with food

Answer 23

yes decrease GI ADR

Question 24

those that are on chronic NSAID what think about?

Answer 24

• GI Risk ulcers, dyspepsia, bleeds

- rx: PPIs to reduce risk

Question 25

ASA/omeprazole | brand and indication?

Answer 25

brand: Yosprala | indicated for ppl who need ASA for CV risk but at risk for ulcers

Question 26

G6PD what drugs avoid?

Answer 26

``` APAP NSAIDS FQ Sulfas dimenhydramine ``` can lead to hemolysis in pt who RBC already shorter lifespan

Question 27

misoprostol brand

Answer 27

cytotec

Question 28

misoprostol is a ___

Answer 28

synthetic prostaglandin E1 analog

Question 29

misoprostol functions

Answer 29

- inhibits gastric acid secretion - protects GI mucosa - reduce incidence gastric and duodenal ulcers - abortifacient - teratogenic

Question 30

how does misoprostol lead to abortion ?

Answer 30

induces labor or uterine rupture after 8 wk pregnant

Question 31

if rx misoprostol what needs to be documented?

Answer 31

- advised pt risk abortion if pregnant - do not share with others - negative pregnancy test 2 wks prior to start - pt capable comply with contraceptive measures - pt got oral and written warnings of hazards - pt will start misoprostol only on second or third day of next period

Question 32

t/f celecoxib (celebrex) found to increase risk of CV events

Answer 32

yes

Question 33

t/f diclofenac increase risk CV events

Answer 33

true 36%!!!

Question 34

if have pt with high bp ask..?

Answer 34

are you taking NSAIDS? | all NSAIDS can increase BP

Question 35

NSAID renal risk

Answer 35

AKI hyperkalemia Need to dose adjust for renal insufficiency

Question 36

NSAIDS and ASA interaction

Answer 36

ibuprofen blocks antiplatelet effects of ASA - take 30 min after ASA or 8 hrs before

Question 37

List 5 classes of NSAIDS

Answer 37

- salicylate - propionic acids - carboxylic acids - enolic acids - cox 2 inhibitors

Question 38

ex salicylates

Answer 38

ASA (acetylsalicylic acid)

Question 39

max daily dose of ASA

Answer 39

4 g

Question 40

tx ASA overdose

Answer 40

sodium bicarbonate

Question 41

regular ASA dose

Answer 41

81 mg tab | 4-8 tabs q 4 hrs max

Question 42

3 propionic acids NSAIDS

Answer 42

- ibuprofen (advil, motrin) - ketoprofen (orudis) - naproxen (aleve, naprosyn, naprelan, anaprox)

Question 43

advil

Answer 43

ibuprofen

Question 44

motrin

Answer 44

ibuprofen

Question 45

asprin

Answer 45

ASA

Question 46

orudis

Answer 46

ketoprofen

Question 47

aleve

Answer 47

naproxen

Question 48

naprosyn

Answer 48

naproxen

Question 49

anaprox

Answer 49

naproxen

Question 50

naprelan

Answer 50

naproxen

Question 51

max does naproxen

Answer 51

1500 mg daily

Question 52

ibuprofen max dose

Answer 52

3200 mg daily | OTC max 2400mg daily

Question 53

naproxen gout regimen

Answer 53

750 mg naproxen first then 250 mg q8hrs until attack subsides

Question 54

t/f naproxen sodium has cross reactivtivity with ASA allergy

Answer 54

true! ! !

Question 55

6 carboxylic acids

Answer 55

- ketorolac - etodolac - diclofenac - sulindac - indomethacin - nabumetone

Question 56

toradol

Answer 56

ketorolac

Question 57

acular

Answer 57

ketorolac

Question 58

acuvail

Answer 58

ketorolac

Question 59

sprix

Answer 59

ketorolac

Question 60

lodine

Answer 60

etodolac

Question 61

voltaren

Answer 61

diclofenac

Question 62

flector

Answer 62

diclofenac

Question 63

zipsor

Answer 63

diclofenac

Question 64

pennsaid

Answer 64

diclofenac

Question 65

clinoril

Answer 65

sulindac

Question 66

indocin

Answer 66

indomethacin

Question 67

relafen

Answer 67

nabumetone

Question 68

why diclofenac should not be your first NSAID pick?

Answer 68

- increase cardiac risk - more liver tox than most other nsaids - more GI tox

Question 69

indocin commonly used for

Answer 69

first line gout acute flares close PDA in neonates used to be used premature labor

Question 70

indomethacin acute gout regimen

Answer 70

50 mg TID daily unitl pain improves then taper off

Question 71

enolic acid NSAIDS

Answer 71

meloxicam (mobic) | piroxicam (feldene)

Question 72

mobic

Answer 72

meloxicam

Question 73

feldene

Answer 73

piroxicam

Question 74

t/f meloxicam renal dose adjust?

Answer 74

yes

Question 75

maximum daily dose of meloxicam

Answer 75

15 mg

Question 76

indications meloxicam

Answer 76

- OA or RA pain relief

Question 77

indications of feldene (generic?)

Answer 77

generic piroxicam | tx for acute and chronic RA and OA

Question 78

t/f piroxicam dose adjust in hepatic impairment

Answer 78

true

Question 79

piroxicam monitoring

Answer 79

- occult blood loss - Hgb Hct - periodic renal and hepatic function ptests - periodic eye exams with chronic use

Question 80

piroxicam max daily dose

Answer 80

20 mg

Question 81

cox 2 inhibitors

Answer 81

celecoxib (celebrex)

Question 82

celebrex is brand for

Answer 82

celecoxib

Question 83

indications celecoxib

Answer 83

- prevention of familial adenomatous polyposis

Question 84

celecoxib dosing primary dysmenorrhea or acute pain

Answer 84

- 400 mg initial - additional 200mg if needed on day 1 maintanence dose 200mg BID prn

Question 85

osteoarthritis celecoxib dose

Answer 85

100 mg / day or divided into 50 mg BID

Question 86

RA celebrex dose

Answer 86

100-200 mg BID

Question 87

t/f celebrex not recommended in pts with advanced renal disease

Answer 87

true

Question 88

how dose adjust celebrex for hepatic impairment

Answer 88

decrease dose by 50% in pts with moderate hepatic impairment child pugh class II