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Pharm Exam 5 > Unit VI Pain (Chapter 24 & 25) > Flashcards

Unit VI Pain (Chapter 24 & 25) Flashcards

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1
Q

Give examples of opioid agonists (5)?

A 
Morphine
Fentanyl (transdermal)
Methadone
Codeine
Hydrocodone
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2
Q

Indication for use of transdermal Fentanyl?

A

Persistent severe pain w/opoid tolerance

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3
Q

What is the risk that comes with taking Methadone?

A

QT prolongation

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4
Q

Monitoring parameters with Methadone?

A

EKG at initiation of therapy

Repeat in 30 Days then annually

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5
Q

Indication for use of Codeine?

A

Mild to moderate pain

Cough

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6
Q

Codeine has the same effect as what other meds?

A

325 mg ASA

Tylenol

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7
Q

What is the risk associated with the use of Hydrocodone?

A

Vicodin is associated with hepatotoxicity r/t acetaminophen

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8
Q

What is the benefit of using an opioid agonist-antagonist over an opioid agonist?

A

Lower potential for abuse

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9
Q

What is a risk of using an opioid agonist-antagonist?

A

Can precipitate withdrawal

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10
Q

Give an example of an Opioid Agonist-Antagonist?

A

Pentazocine

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11
Q

What side effect of Morphine and other Opioid Agonists is lessened with the use Pentazocine?

A

Pentazocine has a limited risk of respiratory depression

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12
Q

Indication for use of Pentazocine?

A

Mild to Moderate Pain

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13
Q

Contraindication for Pentazocine?

A

Opioid dependence (NEVER use or will precipitate withdrawal symptoms)

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14
Q

Give an example of Opioid Antagonist

A

Naloxone

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15
Q

Indication of use for Naloxone

A

Reversal of Opioid OD

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16
Q

Give an example of a Nonopioid Central Acting Analgesic?

A

Tramadol (Ultram)

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17
Q

Indication for use of Tramadol (Ultram)

A

Moderate to moderately severe pain

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18
Q

ABSOLUTE contraindication for use of Tramadol (Ultram)?

A

MAOI use

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19
Q

6 Considerations of opioid use with chronic, non-cancer pain:

A

1) Only use when nonopioid or more conservative methods have failed
2) Discuss risk vs. benefit
3) Use one prescribed and one pharmacy
4) Comprehensive follow-up required
5) Stopping opioids after attempting opioid rotation was unsuccessful
6) Document this entire process

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20
Q

How long does it take for opioid dependence to develop?

A

After 20 or more days of use

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21
Q

How should opioids be tapered to discontinue use?

A

Slowly taper over 3 days

If dependence is high, taper over 7-10 days

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22
Q

Name triggering factors for headaches (4)

A

Stress
Fatigue
Acute illness
Sensitivity to alcohol

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23
Q

Name possible underlying causes for headaches (5)

A 
HTN
Hyperthyroidism
Tumors
Infection
Disorders of the ENT
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24
Q

What are the defining characteristics (signs and symptoms) of migraine headaches (2)?

A

Throbbing pain, unilateral or bilateral pain

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25
Is it more common to have a migraine with or without aura?
Without is more common
26
What class of drugs are used for ABORTIVE treatment of mild to moderate migraines?
NDAIDS
27
What class of drugs are used for ABORTIVE treatment of moderate to severe migraines(2)?
Serotonin Agonist or | Ergot Alkaloid
28
What two specific drugs are used as ADJUNCT therapy for the treatment of migraine headaches?
Metoclopramide (Reglan) | Prochlorperazine (Compazine)
29
How does Metoclopramide (Reglan) help treat migraines when given with NSAIDs?
``` increases absorption (especially when given with ASA) Can be as effective as Sumatriptan and costs less ```
30
What is important to know about the use of Acetaminophen for the treatment of migraines?
Acetaminophen should only be used in combo with drugs, not alone (ie Excedrine migraine)
31
When can opioids be considered for the treatment of migraines?
Only use opioids for SEVERE migraines that do not respond to first-line treatments
32
Example of Serotonin Receptor Agonists (Triptans)
Sumatriptan (Imitrex)
33
MOA of Sumatriptan (Imitrex)?
Vasoconstriction and decreased perivascular inflammation
34
Adverse Effects of Sumatriptan (Imitrex)?
Coronary Vasospasm (biggest concern)
35
Contraindication of Sumatriptan (Imitrex) (5)?
``` CAD Hx of ischemic heart disease MI Uncontrolled HTN Heart disease of any kind ```
36
Patient Education regarding side effects for Sumatriptan (Imitrex)?
Chest symptoms such as heavy arms or chest pressure is not dangerous and should subside with use
37
Is Sumatriptan (Imitrex) safe for use in pregnancy?
NO
38
Sumatriptan (Imitrex) Drug Interactions?
``` Ergot Alkaloids (excessive vasoconstriction) Other Triptans (excessive vasoconstriction) ``` MAOI (sumatriptan toxicity) SSRI/SNRI (serotonin syndrome)
39
What are the second-line drugs used for the abortive treatment of migraines after Sumatriptan (Imitrex)?
Ergot Alkaloids (Ergotamine)
40
Why is Sumatriptan (Imitrex) preferred over Ergotamine for the treatment of migraine headaches?
Ergotamine has a greater risk of dependence than Sumatriptan (Imitrex)
41
Indication for use of Ergot Alkalines/Ergotamine?
Migraine headache that has not responded to Triptans
42
Adverse effects of Ergot Alkalines (6)?
``` NV Weakness in legs Myalgia Numbness and tingling in the fingers and toes Angina-like pain Tachycardia or bradycardia ```
43
What is the term used for Ergot Alkaloid OD?
Ergotism
44
s/s of Ergotism (4)?
Cold Pale Numb extremities Development of muscle pain followed by gangrene--especially high in those with sepsis, PVD, or renal/hepatic impairment
45
Ergot Alkaloid Drug Interactions?
Triptans (prolonged vasospastic response) | (should be dosed separately by at least 24 hours)
46
Ergot Alkaloid Contraindications (8)?
``` hepatic/renal impairment sepsis CAD PVD Uncontrolled HTN Pregnancy Drug dependency CYP ```
47
When should preventative drug therapy for migraines begin?
When a patient has 3 or more headaches a month
48
How long does it take for preventative drug therapy for migraines to take effect?
4-6 weeks
49
What drug classes are used for preventative therapy for migraines?
Beta Blockers Antiepiletptics TCAs Estrogens & Triptans
50
What beta blockers are used as a preventative therapy for migraines (3)?
Propranolol Timolol Atenolol
51
Use caution giving beta-blockers for preventative therapy for migraines in patients with what underlying condition?
Asthma
52
What Antiepileptics are used as preventative therapy for migraines?
Divalproex-Depakote ER | Topiramate (Topamax)
53
Black Box warning for Divalproex-Depakote ER?
Fatal pancreatitis/hepatitis
54
Contraindication for Divalproex-Depakote ER for preventative therapy for migraines?
Pregnancy
55
What TCAs are used for preventative therapy for migraines?
Amitriptyline (Elavil)
56
Adverse Reactions for use of amitriptyline (Elavil) for preventative treatment of migraines(2)?
Hypotension | Anticholinergic Effects
57
Indication for use of Estrogens and Triptans for preventative treatment of migraines?
Menstrual headaches
58
Cluster headaches are characterized by what duration of symptoms?
Last 15min-2 hours | 1-2 attacks every day for 2-3 months
59
s/s & defining characterisitcs of Custer headaches(7)?
``` No aura No N&V More debilitating Less common than typical migraines Mostly occurs in males No family history association Management is different than typical migraines ```
60
Fist line prophylactic treatment for cluster headaches?
Verapamil
61
Second-line prophylactic treatment for cluster headache?
Lithium
62
How are cluster headaches treated once they begin?
Sumatriptan (Imitrix) or oxygen

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