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Flashcards in Pharm2 7 Pain pt1 Deck (24)

the complaint of Pain is split into 2 categories:

Acute Pain
Chronic Pain


What kind of pain?
Short duration
Identifiable pathology
Predictable prognosis
Treatment of underlying pathology eliminates or mediates pain

And how it is treated?

Acute pain
Tx with analgesics


What kind of pain?
Long duration (usu > 3 mos)
Pathology may be unclear
Potential lack of physical findings
Unpredictable prognosis

And how is it treated?

Chronic pain

Treatment often requires multidisciplinary approach (or a multimodal approach – multiple medications to to control he pain)


Ankle fracture is an example of ___ pain. How is it managed?

Acute pain
Reduced, casted, use an analgesic, elevate and ice the area.


What type of pain does not qualify as 'acute' or 'chronic'?

Pain from cancer


6 categories of drug treatments for pain

NSAIDS (ASA, Ibuprofen, etc.)
Tricyclic antidepressants (amitriptyline)
Centrally-acting agents (that are non-narcotic)
Muscle relaxants


Describe the WHO 3-Step Ladder for Pain

(A patient rarely explicitly falls into one of these categories, nor do the drugs work consistently in each patient)

1: Mild - nonopiod +/- adjuvant
2: Moderate - Opiod for mild to moderate pain +/- nonopiod +/- adjuvant
3: Severe - Opiod for moderate to severe pain +/- nonopiod +/-adjuvant


COX-2 vs COX-1

COX-2 is selective, lower incidence of bleeding.


Why is aspirin not always just given at a higher dose such as 325 (instead of 81)?
Who is it used for?

325 deaggregates more platelets. Causes more bleeding. It’d kill ppl at risk for bleeding. So it’s only used for very serious cases unless they are aspirin insensitive.


3 types of drugs for Acute & Chronic pain

Acetaminophen, NSAIDs, Opioids


4 drugs used for Neuropathic pain, neuralgias. These drugs are ____ drugs, but they also work for neuralgias.

Carbamazepine, phenytoin, tricyclics, gabapentin, others
These are antiepileptic drugs, but work for neuralgias


Top 2 most common types of Neuropathic Pain

diabetic peripheral neuropathy
post-herpetic neuralgia.


What is it used for?
What property does it not have?
What 2 things must you keep in mind about this drug?

Low effect on peripheral COX
Few drug-drug interactions
*Not antiinflammatory - not for inflamm'n, used specifically for the pain.
Analgesic ceiling (if you give a higher dose it won’t do anything)
Liver toxicity (really horrible way to die! Acetylcysteine only helps so much)


__ is why FDA limited the daily dosing for acetaminophen.

What's the max dose of Acetaminophen per day?

Liver toxicity

Max dose: FDA has lowered it so you can only take 4g in one day ONCE, the subsequent days must be <4g.


What's a concern about Acetominophen-containing products?

Patients may take products other than Tylenol, not knowing it contains Acetominophen and may become acetominophen toxicitiy. Must warn them that it contains Acetominophen.


Vicodin (Hydrocodone/Acetaminophen) is about to be reclassified from sched _ to a sched _ drug. Why?

From schedule 3 to schedule 2. this reclassifying of schedules will make no difference in NY. But there are 10 states where PA’s cannot prescribe Schedule II drugs in the outpatient setting.

B/c it is most commonly the drug ppl are prescribed that gets them addicted to narcotics”


NY state requirement for prescribing Sched 2 drug:

requires you to log online in outpatient setting before prescribing controlled substance meds istop website: updates prescription in real time for patients.
Just started this year b/c of overdoses, deaths. So if a patient needs a Sched 2 pain med, you check istop before you write the prescription to see if they are addicted and seeing prescribers to get their fix. ISTOP Dramatically stops “doc-shopping”


Effects (3)
Additional benefits (2)

Analgesic, Antiinflammatory, Antipyretic

Inhibits COX
Irreversibly inhibits platelet aggregation
Irreversible inhibitor of COX


Side effects (3)

what's another important note about aspirin for pain?

Nonselective inhibitor of COX (adverse effects)
Drug-drug interactions (with anything else that may increase bleeding)
Reye’s syndrome ( this is why you don’t give Aspirin to kids with fevers)

Aspirin has an Analgesic ceiling


“there is an additional benefit of 22% reduction if you combine with ___”. Aspirin is cheap, but ___ ain’t cheap. Wouldn’t be used if not necessary.



Aspirin Dosing & Effects

80-160mg: Antiplatelet
325-1000 - Antipyretic, analgesic
325-6000 - Antiinflammatory, tinnitus
6-10g - Resp alkalosis
10-20g - Fever, dehydration, acidosis
>20g - Shock, coma


Any aspirin dose over ___ has antiplatelet effects
over __ adds on antipyretic & analgesic effect
over __ adds on inflammatory and tinnits (adverse)

>325 mg
>1 g


If aspirin follows by bleeding, it’s reversed how?

FFP (platelets)


*when should you stop aspirin?

5 days if applying pressure can get bleeding to stop.
Otherwise 7 days.

cardiologist would never want a patient to stop aspirin if they’re on stent thrombosis.
Also won't stop it for Orthopedics doing total knee replacement, a bloody surgery. Tourniquet can control bleeding in this patient