Adjuvant Tx for Opioids/Pain

Question 1

Relistor

Answer 1

• Methylnaltrexone

- PAMORA - block opioid receptors in gut to reduce constipation

Question 2

Methylnaltrexone Information

Answer 2

• Warning: GI perforation
• SE: Abdominal pain, flatulence
• Only for patients who failed OTC laxatives

Question 3

Movantik

Answer 3

• Naloxegol

- PAMORA - block opioid receptors in gut to reduce constipation

Question 4

Naloxegol Information

Answer 4

• Warning: GI perforation

- SE: Abdominal pain, flatulence

Question 5

Amitiza

Answer 5

• Lubiprostone
• Chloride channel activator
• Approved for OIC and other indications

Question 6

Ultram

Answer 6

• Tramadol, CIV
• Metabolizes to codeine so similar metabolizer risks
• Warning: Seizure risk, 5HT syndrome especially with inhibitors CYP2D6 or 3A4, hypoglycemia
• CI: Codeine CI and use with MAOI w/in 14 days
• SE: Dizziness, constipation, nausea, somnolence
• Use with CYP2D6 inhibitors has variable effects

Question 7

Nucynta

Answer 7

• Tapentadol, CII
• Warning: seizure and 5HT syndrome risk
• SE: Dizziness, constipation, nausea, somnolence

Question 8

Narcan

Answer 8

• Naloxone
• Abuse-deterrent/opioid reversal
• Repeat dosing can be required
• SE: acute withdrawal sxs (pain)

Question 9

Butrans

Answer 9

• Buprenorphine, patch
• Belbuca - buccal film for buprenorphine
• Change watch weekly, fold over itself and flush

Question 10

Suboxone

Answer 10

• Buprenorphine + Naloxone, film

- Zubsolv: sublingual tablets

Question 11

Buprenorphine Information

Answer 11

• Patch: dizziness, HA, application site rxn, nausea
• Need a DATA 2000 waiver to prescribe (DEA will start with X)
• Can only be covered with permitted adhesives including Bioclusive or Tegaderm

Question 12

Neurontin

Answer 12

• Gabapentin
• AED used for neuropathic pain
• PHN and restless leg syndrome can also be treated with Horizant formulation
• SE: Dizziness, somnolence, peripheral edema/weight gain

Question 13

Lyrica

Answer 13

• Pregabalin
• AED used for neuropathic pain, CV
• SE: Dizziness, somnolence, peripheral edema/weight gain, mild anxiolytic
• Approved for fibromyalgia, PHN, and neuropathic pain

Question 14

Tegretol

Answer 14

• Carbamazepine
• AED used for neuropathic pain
• Only FDA-approved medication for trigeminal neuralgia

Question 15

Lioresal

Answer 15

• Baclofen
• Antispasmodic, muscle relaxant, analgesic effects
• SE: All muscles relax causing excessive sedation, dizziness, confusion, asthenia

Question 16

Amrix

Answer 16

• Cyclobenzaprine
• Antispasmodic, muscle relaxant, analgesic effects
• Also Fexmid and Flexeril
• SE: Dry mouth
• Serotonergic agent

Question 17

Zanaflex

Answer 17

• Tizanidine
• Antispasmodic, muscle relaxant, analgesic effects
• SE: Hypotension, dry mouth

Question 18

Soma

Answer 18

• Carisoprodol
• Antispasmodic, sedation effects
• CIV
• Poor CYP2C19 metabolizers will increase [carisoprodol]

Question 19

Robaxin

Answer 19

• Methocarbamol

- Antispasmodic, sedation effects

Question 20

Dantrium

Answer 20

• Dantrolene

- Rarely used muscle relaxant due to malignant hyperthermia risk

Question 21

Lidoderm

Answer 21

• 5% lidocaine patch
• Comes in viscous gel and lower concentration patches (LidoPatch)
• Apply patch to painful area (up to 3 patches/d) and can be worn for up to 12h/d
• Approved for PHN (shingles) pain

Question 22

Lidocaine Patch Information

Answer 22

• Can cut into smaller pieces
• Lidoderm shouldn’t have more than 3 patches applied at one time
• Harm children and pets

Question 23

Zostrix

Answer 23

• Capsaicin topical (cream, patch, stick, lotion)
• Apply to affected area TID to QID
• Decreases substance P for analgesia
• Do not touch genitals, nasal area, mouth, or eyes after applying
• Wash hands after application