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Quarter 4 finals > Pharm- Antihistamines and Pain > Flashcards

Pharm- Antihistamines and Pain Flashcards

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1
Q

1st generation ORAL Antihistamines

A

Benadryl (diphenhydramine)

Dramamine (dimehydrinate)

Phenergan (Promethazine)

Antivert (Meclizine)

Hydroxyzine (Atarax, Vistaril)

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2
Q

1st generation that is VERY sedating, good to use if pt’s sx are keeping them up at night (like so itchy)

A

Hydroxyzine

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3
Q

2nd generation ORAL Anthistamine (less SE overall, not as sedating)

A

Claritin (Loratadine)

Zyrtec (Cetirizine)

Allegra (Fexofenadine)

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4
Q

out of the 2nd generation, which one is the most sedating?

A

Zyrtec (Cetirizine)

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5
Q

Nasal and Ocular Antihistamines

A

Azelastine

Azelastine + Fluticasone

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6
Q

Antihistamine SE

A

just like Anticholinergic

Red as beet
Dry as bone
Blind as bat
Mad as hatter
Hot as hare
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7
Q

1st line for Allergic Rhinitis:

Inhaled Nasal Steroid

A

Flonase (Fluticasone) nasal spray

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8
Q

Approved Antihistamines for jobs where worker CANNOT be sleepy

A

Claritin (Loratadine)

Allegra (Fexofenadine)

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9
Q

If pilot takes a non-approved Anti-histamine, how long until they can fly?

A

5 times the drugs 1/2 life

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10
Q

Flomax (Tamsulosin) is

A

a-blocker

Used to tx BPH

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11
Q

What meds should NOT be used along with Flomax (Tamsulosin), an a-blocker

A

Sudafed
Benadryl (Diphenhydramine)

Bc ALL OF THESE can cause Urinary Retention

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12
Q

What are the classes you should avoid due to BPH

A

Decongestants
1st Gen Antihistamines

reason: can trigger urinary retention

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13
Q

What about a person with GLAUCOMA that has seasonal allergies?

A

Decongestant
Antihistamine
Steroids

ALL can increase IOP, so
Speak with pt’s eye doctor

Can follow IOP closely, consider immunotherapy

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14
Q

Scabies treatment

A

Permethrin cream

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15
Q

If someone has itchy sx, what can help them sleep?

A

Hydroxyzine (atarax)

Benadryl (diphenhydramine)

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16
Q

Chronic urticaria, sometimes linked to Auto-Immune condition

A

Tx with Non-sedating Antihistamine (2nd gen)

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17
Q

Poison Ivy tx

A

Steroid cream

Non-sedating Antihistamine (2nd gen)

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18
Q

Steroid cream for poison ivy

A

Triamcinolone (Kenalog) cream

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19
Q

What is Augmentin?

A

Amoxicillin/Clavulanic acid

has Penicillin in it, cannot give Augmentin to someone with PCN allergy

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20
Q

If person has hives,

Has tried Steroid and Anti-histamine and STILL NOT IMPROVING

A

can add H-2 blocker as adjunct

not 1st line

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21
Q

3 meds to immediately get on hand to treat Anaphylaxis

A

Benadryl
Epi
Steroid

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22
Q

Definition of Anaphylaxis

A

Affects >1 body part at same time

Skin/mucosa: 90%
Respiratory: 70%
GI: 45%
Cardiac: 45%

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23
Q

An example of what to give someone experiencing Anaphylaxis

A

Benadryl
EPI
Steroid: Dexamethasone aka “Decadron”
H-2 blocker as adjunct: Famotidine (pepcid)

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24
Q

Consider these ppl HIGH RISK when Rxing ANTIHISTAMINES and be very careful

A

BPH
Glaucoma
Very young/very old
High risk jobs

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25
Short acting Opioids
``` Ultram (tramadol) Nucynta Norco Percocet Opana Diluadid ```
26
Short acting Opioids used in CA pain only
Actiq, Subsys, Abstral AKA FENTANYL much shorter half life
27
Norco is
Hydrocodone + Tylenol
28
Percocet is
Oxycodone + Tylenol
29
Long acting opioids will have "ER at the end; extended release" in Generic name, Or Brand name is:
Oxycontin | Dilaudid
30
Methadone
Not as common Very potent, cheap Good for: Neuropathic pain
31
Generic name examples of Long acting pain med
``` Oxycodone ER Oxymorphone ER Morphine Sulfate ER Hydromorphone ER Fentanyl patch ```
32
Pseudo- addiction
Undertreated pain resulting in red flag behaviors but pt is really in pain
33
Nociceptive pain | "typical pain"
Injury to tissues peripheral pain receptors ``` Laceration Fracture Post op surgery Tumor/CA Internal organ injury ```
34
Options to tx Nociceptive pain
``` NSAIDs Tylenol Steroids Opioids PCA-pt controlled analgesics Physical Therapy TENs unit Muscle relaxant ```
35
Neuropathic pain
Dysfx of Nerves, Spinal cord, or Brain
36
Examples of Etiology of Neuropathic pain
``` Post herpes Radiculopathy Trigeminal neuralgia Diabetic neuropathy Phantom lib CVA, Traumatic spinal cord injury ```
37
Meds that help with Neuropathic pain
``` Neurontin (gabapentin) Lyrica (pregabalin) TCA Duloxetine (cymbalta) Tramadol Nucynta Lidoderm patch ``` ESI (epidural steroid injeciton)
38
Firefighter with back pain
``` NSAIDs Muscle relax Trigger point injection in office Medrol dose pack Ice/heat Consider short course of Opioids ``` F/u in 1-2 weeks
39
If no improvement of back pain
Consider PT, imaging, repeat Trigger point injection if it helped TENs unit
40
Older gardener lady with RA, on Percocet 10/325 every 6 hours but the 1/2 life of this is only 3-4 hours... she is a compliant pt... what can we do?
Consider switching to Long Acting Opioid: Oxycontin ER q12 hrs
41
If switching from Short to Long acting Opioid, what do we need to consider?
Reduce daily dose by 50-75% when converting Consider low dose opioid for breakthrough pain while converting Breakthrough med no more than 25% of daily acting long dose
42
What can we add topical for joint pain?
Topical compound cream, i.e.: Lidocaine Ibuprofen Diclofenac
43
Meds for Diabetic Neuropathy and | Fibromyalgia
Gabapentin (neurontin) Pregabalin (lyrica) Cymbalta (duloxetine)
44
Pt Controlled Analgesia a good option for
intractable CA pain
45
Considerations when using PCA (patient controlled analgesia)
Order continuous Pulse ox Narcan orders Monitor Mental status, Respiratory status Doc/PA see pt again within 12 hours Once dose stable, see every 12-24 hrs
46
PO to IV morphine conversion is typically 3:1 soo if pt is on IV and wants to go to Oral
have to multiple dose x 3 20mg IV qd x3 = 60 mg Morphine qd
47
Fentanyl patch
NOT GREAT for acute pain Better for long term, takes 12 hours to reach therap levels
48
Fentanyl additional considerations
less effective in super skinny pts (cachectic) exposure to heat increases potency- increased absorption- can be fatal!
49
Methadone Cheap, potent, good for NEUROPATHIC pain
CAUTION: ``` QT prolongation (tDP risk) many drug interactions ```
50
Tramadol/Nucynta good for NEUROPATHIC pain
CAUTION: pts on Antidepressants--> Seretonin syndrome
51
Drug of choice in ESRD (end stage Renal dz) person has bad Kidney
Fentanyl | Methadone
52
If pt has Hepatic dz (bad liver)
Avoid Opioids
53
Increased Intracranial pressure
NO opioids
54
Considerations for Rx of Opioids
Write out in LONG hand the # of pills
55
Wong-Baker FACES pain rating scale
3YO and older look at faces and match pain scale
56
Behavioral observation Pain scale
Scores: - facial expression - able to be consoled - level of interaction - limb/trunk motor responses - verbal responses
57
FLACC pain score
``` Face Legs Activity Cry Consolability ```
58
Opioid analgesics commonly used in kids
``` Morphine Hydromorphone Oxycodone Hydrocodone Fentanyl Methadone ```
59
When to refer
Current interventions not working Chronic pain PCA-pt controlled analgesia Life-limiting condition
60
If parent gave something at home that was working, and pt hasn't had the most recent dose
give that SAME med in office if it was working, use it again
61
Testicular torsion
No cremasteric reflex-testicle does not rise when thigh is stroked
62
Steps to tx testicular torsion
Manual detorsion Surgical detorsion Pain med Nausea med
63
Appendicitis
Opioids are indicated as pre-op need to be IV bc this pt is now NPO
64
12 YO w burn to hand, abdomen, and left leg 15% total
need to refer her bc >10% AND involving her HAND | following ABA referral criteria
65
What do we want to avoid in peds opioids
NO Codeine or Tramadol in 12 or younger
66
<12 yo
NO Codeine or Tramadol
67
Ginkgo biloba should not be used with ____ in elderly
Warfarin | *inc risk of bleeding
68
St. John's Wort should not be used with _____
SSRI | *inc risk of Serotonin Syndrome
69
Age related changes to consider with aging
Inc body fat relative to muscle Natural decline in Kidney fx Declining Liver fx (rapid weight loss can lead to increased absorption of med)
70
BEERS criteria
Avoid using Opioids with BENZOS or GABApentinoinds
71
Opioids with Benzos can lead to
severe ADE- adverse drug events like Respiratory depression, death
72
Avoid use of SNRI
pt with hx of Falls or Fractures
73
STOPP criteria (Screening Tool of Older Person's Prescriptions)
Consider drug intxns | Duplications of drugs within a class
74
Older pt with joint pain, already on Diazepam "pam" is a Benzo!!
DON'T want to add Opioid bc Opioid + Benzo is a no-no
75
Opioid naive 70 YO pt with compression fracture, severe low back pain
Can give short acting opioid, 3 day follow up

Quarter 4 finals (11 decks)

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