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HPM Boards > Pharmacology & Medical Pain Management > Flashcards

Pharmacology & Medical Pain Management Flashcards

1
Q

What is an INCORRECT strategy in treating incident pain?

A

Increasing the dose of long acting pain medications (can worsen side effects)

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2
Q

What are the most common side effects of NSAIDs? Who should NOT get them?

A

1) RENAL DYSFUNCTION RENAL DYSFUNCTION- do not use in patients with renal disease, CHF, elderly, cirrhosis, on diuretics, dehydrated
2) GIB- ulceration, bleeding (as common as renal)
3) Cognitive changes in elderly- confusion, memory changes, irritability (less common than renal issues)
4) Reduced control over HTN (less common)

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3
Q

What drugs should be AVOIDED in patients on tamoxifen therapy? Why?

A

Antidepressants (Paxil, Fluoxetine, Duloxetine, Buproprion) (all inhibit CYP2D6)

Tamoxifen is (a prodrug) converted to its active metabolites via CYP2D6

No difference in mortality BUT may have more adverse cancer outcomes (response rate, symptom prevalence)

SAFEST are venlafaxine, sertraline, citalopram

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4
Q

Who should receive a baseline EKG when starting methadone? (7) When should this be repeated?

A

Patients with
1) electrolyte abnormalities
2) impaired liver function
3) structural heart disease
4) genetic predisposition
5) use of other drugs that may prolong the QTc
6) any prior EKG with a QTc greater than 450 ms
7) history suggestive of ventricular arrhythmia

Baseline is when STARTING drug or done in 3 months prior

Must REPEAT when total daily dose of methadone is 30-40 mg/day

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5
Q

What are the constellation of symptoms associated with opioid induced bowel dysfunction? (6)

A

1) constipation
2) abdominal pain
3) nausea/vomiting
4) anorexia
5) dry mouth/xerostomia
6) GERD.

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6
Q

Two major enzymes responsible for opioid metabolism??

A

CYP3A4 (fentanyl, methadone, oxycodone, tramadol) and CYP2D6 (hydrocodone, methadone, morphine, oxycodone, tramadol)

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7
Q

Inhibitors of CYP3A4? Fentanyl, methadone, oxycodone, tramadol, codeine (3 main classes)

A

1) Amiodarone, diltiazem, verapamil
2) Ciprofloxacin, Clarithromycin, Erythromycin
3) ketoconazole, voriconazole, FLUCONAZOLE, itraconazole,

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8
Q

Inducers of CYP3A4? As in what makes Fentanyl, methadone, oxycodone, tramadol, codeine LESS effective

A

1) Carbamazepine, oxcarbazepine
2) Phenobarbital, phenytoin
3) Rifampin
4) Dexamethasone
5) St. John’s wort

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9
Q

Inhibitors of CYP2D6? (4 drug ‘types’). Codeine, hydrocodone, methadone, MORPHINE, oxycodone, tramadol

A

1) Amiodarone
2) Buproprion, duloxetine
3) Citalopram, Lexapro, Fluoxetine, Sertraline, Paxil
4) Haldol, Chlorpromazine
5) Reglan
6) Hydroxyzine, Benadryl, Doxepin

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10
Q

Active metabolite of codeine? Or hydrocodone?

A

Codeine–> Morphine
Hydrocodone–> Hydromorphone by CYP2D6

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11
Q

What is mechanism of memantine? Side effects?

A

NMDA antagonist

Side effects
- Dizziness
- Agitation
- Hallucinations
- Confusion
- Constipation
- Headache
- Elevated BP

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12
Q

What is the mechanism for donepezil? Rivastigmine? Galantamine?

A

Anticholinesterase inhibitors

Donepezil: Can cause INSOMNIA

All can cause BRADYCARDIA

SLUDGE symptoms (Cholinergic Crisis)

Salivation
Lacrimation
Urination
Diarrhea/diaphoresis
GI upset (nausea)
Emesis

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13
Q

2 random cardiac drugs that also have anticholinergic side effects and can lead to anticholinergic toxicity?

A

1) Digoxin
2) Furosemide

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14
Q

Opioids that can cause serotonin syndrome?

Other common HPM drugs that can cause serotonin syndrome?

A

Tramadol, fentanyl, methadone, tapentadol, meperidine

Ondansteron, metoclopramide, trazodone

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15
Q

SSRI with anticholinergic properties?

A

Paxil

Avoid in elderly!

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16
Q

What are signs and symptoms of androgen insufficiency? Workup? TX?

A

Fatigue, depression, anxiety, sexual side effects

Can occur WEEKS after starting chronic opioids but reverses within DAYS if opioids are stopped

FSH, LH, total T

Treat with T replacement

17
Q

What metabolite is responsible for OIH?

A

Morphine 3-glucuronide is a neurostimulant
that can lead to agitated delirium, myoclonus, hyperalgesia, and even seizures. Morphine and hydromorphone are
the most common culprits. Morphine 6-glucuronide is a metabolite that is active on the mu-opioid receptor, and
thus is not a major player in terms of inducing agitated neurotoxicity.

18
Q

Only 2 indications for Dronabinol?

A

AIDS cachexia

Chemo induced nausea/vomiting

19
Q

Treatment for oral thrush?

A

Clotrimazole Troches (if can tolerate 5 times per day dosing)

Otherwise–> fluconazole

20
Q

Treatment for esophageal candidiasis?

A

Systemic fluconazole

21
Q

3 ways opioids cause nausea?

A

1) Direct stimulation of CTZ
2) Reduces GI motility (early satiety, bloating)
3) Triggers vestibular apparatus

22
Q

Common side effects of cisplatin?(8)

A

nausea
vomiting
anorexia
myelosuppression
renal failure
paresthesias
rash
elevated LFTs.

23
Q

Common side effects of docetaxel?(7)

A

myelosuppression
alopecia
elevated LFTs
anorexia,
dyspnea
cough
myalgias

24
Q

Common side effects of doxorubicin? (6)

A

alopecia
congestive heart failure
facial flushing,
nausea/vomiting
anorexia
mucositis

25
Q

Dexamethasone causes WHAT palliative care symptom? What other two classes of meds also cause this same symptom?

A

Hiccups!!

Opioids and benzos can also cause hiccups!

26
Q

Patient stem has patient with Lewy Body Dementia or Parkinson’s…. what drug choice do you NOT choose?

A

ANYTHING that is anti-dopaminergic

  • Haldol or other typical AP
  • Reglan
  • Chlorpromazine, Prochlorperazine etc
27
Q

What are the 4A’s of Pain?

A

The Four A’s include: analgesia (pain relief); activities of daily living (functional status); adverse effects; aberrant drug-taking behaviors.

28
Q

4 specific concerns for tramadol? What is it LESS likely to do compared to morphine?

A

1) Seizures
2) Serotonin syndrome
3) Hypoglycemia
4) Suicide risk (especially if on SSRI, hx of addiction or MH issues)

LESS likely to lead to addiction or respiratory depression compared to morphine

29
Q

Never give trazodone for patient if stem has hx of WHAT issues?

A

Severe MDD/suicide
EtOH abuse

30
Q

What are the 3 types of pain fibers?

A

C fibers: SLOW conducting
- Small, unmyelinated fibers
-Transmit dull, poorly localized, diffuse, burning, aching pain
- Sensitive to: mechanical, thermal, CHEMICAL stimuli

A delta fibers: FAST conducting
-Large, MYELINATED fibers
-Transmit well-localized, SHARP pain
-Sensitive only to mechanical and thermal stimuli

A beta fibers: Rapidly conducting, transmit TOUCH sensation
-Mainly concerned with NON NOXIOUS input
-Involved in ALLODYNIA–> touch perceived as pain

31
Q

5 phases of pain transmission? Which is NOT responsive to drugs?

A

1) Transduction
2) Conduction
3) Transmission
4) Perception
5) Modulation

PERCEPTION! Only thing that helps is CBT, relaxation, music therapy etc

HPM Boards (13 decks)

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