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PHRM 845 > Acute Pain > Flashcards

Acute Pain Flashcards

1
Q

APAP

A
  • Tylenol, Ofirmev
  • Max Dose: 4g from all sources
  • Boxed Warnings: Severe hepatotoxicity (>4g)
  • SE: severe skin rash (Rare)
  • Ethanol use: consuming >= 3 drinks per day can increase liver damage risk
  • Hepatic impairment: use with caution if patient has impairment of acute liver disease
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2
Q

APAP + Geriatrics

A

-Some recommend a max dose of 3g per day

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3
Q

Mild Pain Options

A
  • APAP
  • COXIBs
  • NSAIDs
  • Local/regional anesthesia
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4
Q

Moderate Pain Options

A 
-Low dose opioids
\+
-APAP
-COXIBs
-NSAIDs
-Local or regional anesthesia
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5
Q

Severe Pain Options

A 
-Higher dose of opioids
\+
-Low doses of opioids
\+
-APAP
-COXIBs
-NSAIDs
-Local or regional anesthesia
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6
Q

Chronic Liver Disease/Cirrhosis + APAP

A
  • Use with caution and consider dose adjustment
  • Limited data exists, but =<2 or 3g/day is usually well tolerated in these patients
  • Patients not actively drinking alcohol
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7
Q

NSAIDs + Kidneys

A
  • Coadministration with certain drugs increase kidney injury risk
  • Includes ACE-I, ARBs, antirheumatics (Methotrexate), Diuretics, and Lithium
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8
Q

NSAIDs + CV Risk

A
  • Risk of adverse CV effects
  • Consider baseline ASCVD risk
  • High NSAID doses are associated with higher CV risk
  • COX-2 selective agents don’t seem to have a significant CV risk factor
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9
Q

COX-2 Selective NSAIDs

A
  • Lower risk for complications
  • Increased risk of MI/stroke
  • Same risk for renal complications
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10
Q

Bleed Risk + NSAIDs

A
  • Coadministration of certain drugs increase bleed risk

- Includes anticoagulants, antiplatelets, corticosteroids, SSRI, SNRI, TCA, and herbals

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11
Q

Ketorlac

A
  • Toradol

- Pain management (acute, moderately severe) in patients >= 50 kg

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12
Q

Multimodal Analgesia

A
  • APAP
  • Gabapentin/pregabalin
  • Ketamine
  • NSAIDs
  • Skeletal muscle relaxants
  • Steroids
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13
Q

Methocarbamol Warnings/SE

A
  • Considerations: half-life is prolonged in older adults and has increased risk of drowsiness/dizziness (Beers List)
  • Warning: caution with other CNS depressants (increased CNS depression)
  • SE: dizziness, drowsiness, HA, insomnia, metallic taste, N/V
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14
Q

Antispasmodic Agents

A
  • Cyclobenzaprine
  • Metaxalone
  • Methocarbamol
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15
Q

Antispasticity Agents

A
  • Baclofen

- Dantrolene

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16
Q

Antispasmodic/Antispasticity Agents

A
  • Diazepam

- Tizanidine

17
Q

Beers List + Antispasmodics

A
  • Atropine
  • Belladonna
  • Dicyclomine Hometropine
  • Hyocyamine
  • Scopolamine
18
Q

Beers List + Skeletal Muscle Relaxants

A
  • Carisoprodol
  • Cyclobenzaprine
  • Metaxalone
  • Methocarbamol
19
Q

OIC Management Options

A

-Traditional Laxatives: Osmotic, Stimulant, Detergent/surfactant, lubricant
PAMORAs

20
Q

Traditional Laxatives

A
  • Strong recommendation for OIC
  • Moderate leveled evidence
  • First-line Agent
21
Q

PAMORAs

A
  • Peripherally acting mu opioid receptor antagonists
  • Generally recommended for laxative refractory OIC over no treatment
  • Depending on medication, recommendation is strong or conditional
  • Level of evidence ranges from high to low depending on the situation
22
Q

Type A ADR

A
  • Predictable, dose-dependent effect

- From known pharmacologic properties

23
Q

Type B ADR

A
  • Not dose-dependent and are unrelated to pharmacologic action of drug
  • Can be patient-specific factors
  • EX: allergies, pseudoallergic reactions, drug intolerances
24
Q

Morphine Induced Itching

A
  • From histamine release by mast cells

- Fentanyl and oxymorphone are less likely to product histamine release (still associated with pruritis)

25
Q

Fentanyl Warnings/SE

A
  • Note: Don’t use in opioid naive
  • Warning: potential for dosing error when converting between dosage forms, CYP3A4 inhibitors can increase its SE
  • SE: Bradycardia, confusion, dizziness, diaphoresis, dehydration, dry mouth, N/V

PHRM 845 (5 decks)

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