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PHRM 845 > 5.7 non-malignant pain pt3 > Flashcards

5.7 non-malignant pain pt3 Flashcards

1
Q

What are SEs of opioids?

A
  • Antitussive
  • Constipation
  • N/V
  • Itching
  • Orthostatic hypotension
  • Urinary retention
  • Sedation
  • Respiratory depression
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2
Q

What other drug should be considered for pts taking opioids?

A

Consider starting stool softener and/or stimulant laxative

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3
Q

What are the available formulations of codeine?

A
  • Tablet
  • Cough syrup
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4
Q

What is codeine metabolized to and by what?

A

Metabolized to morphine via CYP2D6

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5
Q

Which pt group should not take codeine?

A

Not recommended in breastfeeding mothers or children <12

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6
Q

What are the available formulations for tramadol?

A
  • Capsule ER 24h (Conzip)
  • Tablet IR and ER 24h
  • Oral solution
  • Combo products w acetaminophen and celecoxib available
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7
Q

How is tramadol excreted?

A

Excreted renally

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8
Q

What is the boxed warning for tramadol?

A

Use of CYP 3A4 inducers and inhibitors, 2D6 inhibitors w tramadol requires careful consideration

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9
Q

What are the available formulations of morphine?

A
  • Capsule ER 24h
  • Tablet IR and 12h ER
  • Oral solution
  • Solution for injection
  • Suppository
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10
Q

What morphine dosage form was d/c?

A

Abuse-deterrent tablet

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11
Q

Which SE is more prominent w the use of morphine?

A

Itching

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12
Q

How is morphine excreted?

A

Renally excreted and accumulate in renal dysfxn

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13
Q

What is the boxed warning for morphine?

A

Avoid alcohol while taking ER capsules: leads to increased morphine plasma levels and potentially fatal

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14
Q

What are the available formulations of hydromorphone (dilaudid)?

A
  • IR and ER tablets
  • Oral solution
  • Solution for injection
  • Suppository
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15
Q

What is the boxed w hydromorphone (dilaudid)?

A

Boxed warning about dosing errors when prescribing, dispensing, and administering

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16
Q

What are the available formulations for hydrocodone +/- acetaminophen?

A
  • Oral solution
  • ER tablet (Hysingla)
  • Tablet (Norco)
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17
Q

What is the boxed warning for hydrocodone +/- acetaminophen?

A

Use w 3A4 inhibitors may increase hydrocodone plasma conc

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18
Q

What are the available formulations for oxycodone?

A
  • Tablet IR and ER 12h
  • Capsule IR and ER 12h
  • Oral solution
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19
Q

What is different about oxycodone ER capsule/tablets?

A

Abuse deterrent

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20
Q

What is the boxed warning for oxycodone ?

A

Use w 3A4 inhibitors may increase oxycodone plasma conc

21
Q

What are the available formulations of fentanyl?

A
  • Buccal tablet
  • SL tablet
  • Lozenge
  • Injectable solution
  • Patch
22
Q

What is the boxed warning for fentanyl?

A

Monitor pts receiving 3A4 inhibitors or inducers

23
Q

Can fentanyl be used in renal impairment?

A

Yes

24
Q

What is an advantage of fentanyl vs morphine or hydromorphone?

A

Less hypotension

25
Q

Non-injectable fentanyl is ONLY indicated for which pts?

A

Pts who are opioid tolerant

26
Q

How is opioid tolerant defined?

A

Taking morphine 60 mg per day or equivalent for at least 1 week w no effect

27
Q

How is fentanyl patch dosing converted from oral 24h morphine?

A

Half the 24h morphine dose to get fentanyl transdermal dose

28
Q

Can fentanyl patch dosing be converted w other opioid analgesics other than oral 24h morphine?

A

NO

29
Q

What are the uses of methadone (mathadose)?

A
  • Last line tx of chronic pain
  • Opioid detoxification
30
Q

What are the available formulations for methadone (methadose)?

A
  • Oral solution
  • Injectable solution
  • Tablet
31
Q

What are the boxed warnings for methadone (methadose)?

A
  • QTc prolongation
  • Monitor pts receiving inducers/inhibitors
32
Q

What are the available formulations for meperidine (demerol)?

A
  • Injectable solution
  • Oral solution
  • Tablet
33
Q

Which pt groups should avoid use of meperidine (demerol)?

A

Avoid in the elderly, avoid in renal impairment, caution use in hepatic impairment

34
Q

What are the boxed warnings for meperidone (demerol)?

A
  • Monitor pts receiving 3A4 inducers/inhibitors
  • Do not use within 14 days of MAOIs
35
Q

How is meperidone (demerol) metabolized?

A

Metabolized by liver into an active metabolite

36
Q

What is the dosing of codeine for opioid naive pts?

A

15-60 mg PO q4h PRN

37
Q

What is the dosing of tramadol for opioid naive pts?

A

25-50 mg PO q4-6h prn

38
Q

What is the dosing of morphine for opioid naive pts?

A
  • 5-10 mg PO q4h prn
  • 2.5-5 mg IV q3-4h prn
39
Q

What is the dosing of hydromorphone for opioid naive pts?

A
  • 2-4 mg PO q4-6h prn
  • 0.2-1 mg IV q2-3h prn
40
Q

What is the dosing of hydrocodone for opioid naive pts?

A

2.5-10 mg PO q4-6h prn

41
Q

What is the dosing of oxycodone for opioid naive pts?

A

5-15 mg PO q4-6h prn

42
Q

What is the dosing of fentanyl for opioid naive pts?

A

25-50 mcg q30-60min prn

43
Q

Which of the opioids are natural opiates?

A
  • Morphine
  • Codeine
44
Q

Do natural opiates have an allergic cross rxn?

A

Yes
- Avoid in pts w allergy to other natural opiates and semi-synthetic opioids

45
Q

Which of the opioids are semi-synthetic opioids?

A
  • Hydromorphone
  • Oxycodone
  • Oxymorphone
  • Hydrocodone
  • Buprenorphine
46
Q

Do semi-synthetic opioids have an allergic cross rxn?

A

Yes
- Avoid in pts w allergy to other semi-synthetic opioids and natural opiates

47
Q

Which of the opioids are synthetic opioids?

A
  • Fentanyl
  • Methadone
  • Meperidine
  • Tramadol
48
Q

Do synthetic opioids have an allergic cross rxn?

A

No
- Can be used if pt has an allergy to another synthetic opioid, semi-synthetic opioid, or natural opiate

49
Q
A

PHRM 845 (48 decks)

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