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Pharm > Analgesics > Flashcards

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
Q

What kind of anti-inflammatory is aspirin?

A

A weak anti-inflammatory

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26
Q

When is aspirin contraindicated? Why?

A

< 16 years

Risk of Reye’s syndrome

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27
Q

What dose form do we give of ASA generally?

A

Low dose ASA

Not kid’s ASA

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28
Q

What is the standard dose of ASA for anti-inflammatory purposes?

A

3.6-5.4 g/day

29
Q

What actions does ibuprofen have?

A

Anti-inflammatory
Antipyretic
Analgesic

30
Q

What is the max of ibuprofen for inflammatory issues?

31
Q

What is the max of ibuprofen for pain/fever/dysmenorreha?

32
Q

What kind of drug is ketorolac?

A

Injectable NSAID

33
Q

What kind of pain does ketorolac treat?

A

Mod-severe

34
Q

When is ketorolac very useful?

A

Post-op pain

35
Q

How long can we use ketorolac? Why?

A

5 days

Risk of GI bleed

36
Q

What is the usual dose of ketorolac?

What is the max?

A

30 mg IVP q 6

120 mg/d

37
Q

When do you reduce the ketorolac dose?

A

Pt > 65 years
Body weight < 50 kg
Moderately elevated serum creatinine

38
Q

What kind of pain do we use mefenamic acid for?

A

Mild-moderate

39
Q

What must we avoid while on mefenamic acid?

40
Q

How frequently is mefenamic acid used?

41
Q

What do we use piroxicam for?

A

Acute and chronic RA and OA

42
Q

Is the half-life of piroxicam long or short? What does this allow?

A

Long

Once daily dosing

43
Q

When do you reduce the dosing of piroxicam?

A

Hepatic dysfunction

44
Q

What is celecoxib?

A

The only remaining selective COX2 inhibitor

45
Q

Why was a different COX2 inhibitor removed from use in 2004?

A

Increased # of cardiac events (AMIs)

46
Q

When is celecoxib very useful?

A

Non-cardiac pts (ortho pts)

47
Q

What kind of action do acetaminophen and APAP have?

A

Analgesia

Antypyretic

48
Q

Does acetaminophen have significant anti-inflammatory activity?

A

No -> little

49
Q

What kind of failure comes post acetaminophen overdose?

A

Hepatic failure

50
Q

When do you avoid acetaminophen?

A

In pts w/ alcoholic liver disease

51
Q

What is the MOA of acetaminophen at 1000 mg?

A

Inhibits both COX isozymes

52
Q

Where is COX inhibition more pronounced with acetaminophen?

A

In the brain

53
Q

What center does acetaminophen inhibit? What does this explain?

A

Hypothalamic heat-regulating center

It’s anti-pyretic activity

54
Q

What do we do with acetaminophen when there is renal impairment and why?

A

Adjust the doses

Metabolites accumulate

55
Q

What is the adjustment of acetaminophen if CrCl is 10-50

A

Administer q6 hours

56
Q

What is the adjustment of acetaminophen if CrCl < 10

A

administer q8 hours

57
Q

What is the ratio of injection of acetaminophen?

A

1000 mg/100 mL (post op x 4 doses)

58
Q

What is an issue w/ injection acetaminophen?

A

Very expensive

59
Q

What is the dosing of acetaminophen injection for pts > 50 kg? What is the max

A

1000 mg q 6

Max: 4 g/day

60
Q

What is the dosing of acetaminophen injection for pts < 50 kg? What is the max?

A

15 mg/kg q6 hours
or 12.5 mg/kg q4 hours
Max: 75 mg/kg

61
Q

Review slide 27

A

acetaminophen dosing

62
Q

Review slide 28

A

Toxicity of acetaminophen

63
Q

What is the oral therapy for acetaminophen toxicity?

64
Q

What is the IV therapy for acetaminophen toxicity?

65
Q

How many kids were studied from 1999-2009

66
Q

What was found in this study with long term acetaminophen use during pregnancy?

A

2 fold increase of ADHD in offspring

67
Q

What was shown with acetaminophen use for < 8 days during pregnancy?

A

Decrease in ADHD risk

68
Q

What drugs showed a serious decrease in pain when combined with acetaminophen?

A

Oxycodone
Hydrocodone
Codeine

Pharm (32 decks)

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