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Analgesics Flashcards

1
Q

How were we supposed to supply pain meds prior to the opioid crisis?

A

Scheduled

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2
Q

What were we supposed to check 1 hour after giving the pain med?

A

Effectiveness

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3
Q

What were two practices used for severe pain pre-opioid crisis?

A

Provide long acting analgesics ACT

Provide short-acting analgesics PRN for breakthrough pain

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4
Q

How were we supposed to address varying levels of pain?

A

Dose titration

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5
Q

What are the current analgesic categories?

A

Non-opioids
Adjuvants
Opiates
Opioids

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6
Q

What is the MOA of NSAIDs?

A

Inhibition of cyclooxygenase

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7
Q

Are NSAIDs mostly selective or non-selective for COX1 and COX2

A

Non-selective

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8
Q

Is COX-1 cyto-protective or inflammatory?

A

Cyto-protective

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9
Q

Is COX-2 cyto-protective or inflammatory?

A

Inflammatory

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10
Q

What kind of pain do NSAIDs treat?

A

Mild-moderate

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11
Q

What is an issue with continued use of NSAIDs?

A

Ceiling effect (no additional help, just more SEs)

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12
Q

What are some standard SEs of NSAIDs?

A

GI upset
GI irritation/ulceration
Edema
Renal impairment

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13
Q

Give two examples of salicylic acid derivative NSAIDs

A

Aspirin

Salsalate

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14
Q

Give 3 examples of propionic acid NSAIDs

A

Ibuprofen
Ketoprofen
Naproxen

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15
Q

Give 4 examples of acetic acid NSAIDs

A

Ketorolac
Diclofenac
Etodolac
Indomethacin

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16
Q

Give 1 example of oxicam NSAIDs

A

Meolxicam

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17
Q

Give 1 example of COX2 inhbitors

A

Celecoxib

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18
Q

What do we do if 1 class of NSAIDs fails

A

We try another

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19
Q

Why do we use dual MOA NSAIDs in synergy?

A

The efficacy is > than the sum of individual components

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20
Q

What is combo therapy usually limited by?

A

The non-opioid

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21
Q

What other effects does the non-opioid have on combo therapy?

A

Cause of unintended overdose

Most hepatic failure from excessive opiate/APAP use

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22
Q

What is the max dose of acetaminophen?

A

4 g/day (maybe will be 3 soon)

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23
Q

What is the max dose of aspirin?

A

4 g/day (higher for anti-inflammatory)

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24
Q

What is the max dose for ibuprofen?

A

3.2 g/d

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25
What kind of anti-inflammatory is aspirin?
A weak anti-inflammatory
26
When is aspirin contraindicated? Why?
< 16 years | Risk of Reye's syndrome
27
What dose form do we give of ASA generally?
Low dose ASA | Not kid's ASA
28
What is the standard dose of ASA for anti-inflammatory purposes?
3.6-5.4 g/day
29
What actions does ibuprofen have?
Anti-inflammatory Antipyretic Analgesic
30
What is the max of ibuprofen for inflammatory issues?
3.2 g/day
31
What is the max of ibuprofen for pain/fever/dysmenorreha?
1.2 g/day
32
What kind of drug is ketorolac?
Injectable NSAID
33
What kind of pain does ketorolac treat?
Mod-severe
34
When is ketorolac very useful?
Post-op pain
35
How long can we use ketorolac? Why?
5 days | Risk of GI bleed
36
What is the usual dose of ketorolac? | What is the max?
30 mg IVP q 6 | 120 mg/d
37
When do you reduce the ketorolac dose?
Pt > 65 years Body weight < 50 kg Moderately elevated serum creatinine
38
What kind of pain do we use mefenamic acid for?
Mild-moderate
39
What must we avoid while on mefenamic acid?
Alcohol
40
How frequently is mefenamic acid used?
Little
41
What do we use piroxicam for?
Acute and chronic RA and OA
42
Is the half-life of piroxicam long or short? What does this allow?
Long | Once daily dosing
43
When do you reduce the dosing of piroxicam?
Hepatic dysfunction
44
What is celecoxib?
The only remaining selective COX2 inhibitor
45
Why was a different COX2 inhibitor removed from use in 2004?
Increased # of cardiac events (AMIs)
46
When is celecoxib very useful?
Non-cardiac pts (ortho pts)
47
What kind of action do acetaminophen and APAP have?
Analgesia | Antypyretic
48
Does acetaminophen have significant anti-inflammatory activity?
No -> little
49
What kind of failure comes post acetaminophen overdose?
Hepatic failure
50
When do you avoid acetaminophen?
In pts w/ alcoholic liver disease
51
What is the MOA of acetaminophen at 1000 mg?
Inhibits both COX isozymes
52
Where is COX inhibition more pronounced with acetaminophen?
In the brain
53
What center does acetaminophen inhibit? What does this explain?
Hypothalamic heat-regulating center | It's anti-pyretic activity
54
What do we do with acetaminophen when there is renal impairment and why?
Adjust the doses | Metabolites accumulate
55
What is the adjustment of acetaminophen if CrCl is 10-50
Administer q6 hours
56
What is the adjustment of acetaminophen if CrCl < 10
administer q8 hours
57
What is the ratio of injection of acetaminophen?
1000 mg/100 mL (post op x 4 doses)
58
What is an issue w/ injection acetaminophen?
Very expensive
59
What is the dosing of acetaminophen injection for pts > 50 kg? What is the max
1000 mg q 6 | Max: 4 g/day
60
What is the dosing of acetaminophen injection for pts < 50 kg? What is the max?
15 mg/kg q6 hours or 12.5 mg/kg q4 hours Max: 75 mg/kg
61
Review slide 27
acetaminophen dosing
62
Review slide 28
Toxicity of acetaminophen
63
What is the oral therapy for acetaminophen toxicity?
Mucomyst
64
What is the IV therapy for acetaminophen toxicity?
Acetadote
65
How many kids were studied from 1999-2009
114744
66
What was found in this study with long term acetaminophen use during pregnancy?
2 fold increase of ADHD in offspring
67
What was shown with acetaminophen use for < 8 days during pregnancy?
Decrease in ADHD risk
68
What drugs showed a serious decrease in pain when combined with acetaminophen?
Oxycodone Hydrocodone Codeine

Pharm (32 decks)

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