U2: Pain Management

Question 1

How do NSAIDs function?

Answer 1

By blocking COX 1 and COX 2 enzymes responsible for making prostaglandins.

Question 2

What are side effects of NSAIDs?

Answer 2

Bleeding risk, kidney / liver problems, hypertension, stomach upset / ulcers.

Question 3

Why are NSAIDs contraindicated for patients who have had bariatric surgery?

Answer 3

Bariatric surgery decreases the surface area of the stomach lining, meaning an ulcer would potentially lead to malnutrition

Question 4

What is the first generation NSAID?

Answer 4

Aspirin

Question 5

Why is aspirin contraindicated for children?

Answer 5

High risk of Reye’s syndrome

Question 6

Is acetaminophen (Tylenol) an NSAID?

Answer 6

No. It is a non-opioid anti-pyretic

Question 7

What is a sign of aspirin toxicity?

Answer 7

Ringing in the ears / hearing loss.

Question 8

What chemicals are released during an inflammation reaction?

Answer 8

Histamines, kinins, prostaglandins

Question 9

What is an NSAID used long-term for inflammation?

Answer 9

Meloxicam

Question 10

What is the first injectable NSAID?

Answer 10

Ketorolac tromethamine (Toradol)

Question 11

What is the longest recommended use for Ketorolac tromethamine?

Answer 11

5 days or less.

Question 12

What increases the risk of toxicity when taken with ibuprofen or naproxen?

Answer 12

Calcium channel blockers

Question 13

What are some education points for ibuprofen and naproxen?

Answer 13

Take with food, do not take if pregnant, many drug interactions and highly protein bound.

Question 14

What are side effects of acetaminophen?

Answer 14

N/V, constipation, insomnia, headache, anorexia, fatigue, peripheral edema

Question 15

What are adverse reactions of acetaminophen?

Answer 15

Oliguria, hearing loss, elevated hepatic enzymes, renal / hepatic failure, hypokalemia, hemolytic anemia, agranulocytosis, low platelets

Question 16

Patients with which conditions should use caution when taking acetaminophen?

Answer 16

Renal / hepatic disease, hypertension, Type 2 diabetes (DM), alcohol abuse, hypovolemia, malnutrition, older adults

Question 17

What is the antidote for acetaminophen?

Answer 17

N Acetylcysteine

Question 18

What is the brand name for Indomethacin?

Answer 18

Indocin - a strong prostaglandin inhibitor

Question 19

Give three examples of corticosteroids.

Answer 19

Prednisone, prednisolone, Dexamethasone

Question 20

What are side effects of corticosteroids?

Answer 20

Bone loss (osteoporosis), fluid retention, mood changes, peptic ulcer disease, moon-shaped face

Question 21

Why are corticosteroids typically prescribed?

Answer 21

To fight inflammation.

Question 22

Should corticosteroids be taken with or without food?

Answer 22

With food.

Question 23

What should you educate the patient on about corticosteroids regarding compiance?

Answer 23

Do not stop taking corticosteroids abruptly.

Question 24

Do corticosteroids have a long or short half life?

Answer 24

Long, which is why they’re typically given once a day.

Question 25

How do steroids affect blood sugar?

Answer 25

Steroids raise blood sugar.

Question 26

DMARDs stands for

Answer 26

Disease-modifying anti-rheumatic drugs

Question 27

Three types of DMARDs:

Answer 27

Immunosuppressives, immunomodulators, and antimalarials

Question 28

In which situations would immunosuppressives be prescribed?

Answer 28

When disease process does not react to NSAIDs. Treats RA and arthritis and can also be used to suppress cancer growth.

Question 29

How do immunomodulators work and what is one example?

Answer 29

Treats RA by disrupting inflammatory process and delaying disease progression. Example: Infliximab (Remicade)

Question 30

Which DMARD is a last line of defense to treat RA if other methods fail? How long does it take to become effective.

Answer 30

Antimalarials. 4-12 weeks.

Question 31

What are side effects of DMARDs?

Answer 31

Decreases effectiveness of vaccines, increased risk of infection, hypo / hypertension, chest pain, dyspnea

Question 32

What causes gout?

Answer 32

Ineffective clearance of uric acid by the kidneys

Question 33

What should be checked before gout meds are prescribed?

Answer 33

Patient’s history of renal function

Question 34

What are two anti-gout medications?

Answer 34

Colchicine and allopurinol

Question 35

Which anti-gout medication is contraindicated for patients with renal disease?

Answer 35

Colchicine

Question 36

What are the side effects of colchicine?

Answer 36

GI bleed, gastric irritation, headache

Question 37

What are the side effects of allopurinol?

Answer 37

Bleeding, GI obstruction, N/V, depletion of uric acid

Question 38

What should you educate a patient about regarding allopurinol?

Answer 38

Increase fluids to promote diuresis (increased production of urine.)

Question 39

What should patients avoid while taking anti-gout medication?

Answer 39

Vitamin C, caffeine (diuretic) and purine in their diet (red meat, salmon, anchovies, legumes, organ meat and alcohol - especially beer.)

Question 40

What should you educate a patient about regarding anti-gout medications?

Answer 40

Attend all scheduled appointments and lab draws, and report side effects immediately

Question 41

What are six examples of opioid analgesics?

Answer 41

Morphine, codeine, hydrocodone, hydromorphone (Dilaudid), oxycodone (Roxicodone), and fentanyl

Question 42

What is the antidote to an opioid overdose?

Answer 42

Naloxone (Narcan)

Question 43

What are side effects of opioids?

Answer 43

N/V/D, dizziness, sleepiness, respiratory depression

Question 44

When should you not medicate for pain?

Answer 44

When pt has increased intracranial pressure

Question 45

What analgesic is used to treat migraines and cluster headaches?

Answer 45

Sumatriptan