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Pharmacology 2 Connor > Analgesics & Muscle Relaxants > Flashcards

Analgesics & Muscle Relaxants Flashcards

1
Q

What is used as the standard by which all other medications are measured

A

Morphine

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2
Q

What is morphine derived from

A

Poppy plant

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3
Q

T/F opioids are morphine like substances

A

True

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4
Q

What are narcotics

A

Opioids + those that induce narcosis

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5
Q

When does pain become chronic and why

A

12 weeks, due to changes in the pain pathway making it difficult to correct.

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6
Q

T/F in pain management we cure/fix pain

A

False, we treat/manage

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7
Q

T/F all opiates have a side effect of constipation

A

True

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8
Q

T/F opiates cause urethral contractions

A

True

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9
Q

What amount of morphine is used as the standard guide for opiates

A

10 mg

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10
Q

What does Darvon do to seizure threshold

A

Lowers it

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11
Q

When is meperidine used for

A

Perioperative pain (short term only)

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12
Q

What is hydromorphone (dilaudid, exalgo) partially metabolized to

A

Hydrocodone

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13
Q

When taking hydromorphone how many drugs will show up on the U tox

A

4

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14
Q

How much more potent is fentanyl than morphine

A

10X

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15
Q

What does fentanyl do to respiration

A

Suppresses it

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16
Q

T/F fentanyl can cause skeletal muscle rigidity and moderate bradycardia

A

Truth

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17
Q

Does fentanyl typically have more or less histamine release

A

Less

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18
Q

What does fentanyl not being absorbed from the GI tract mean

A

Less constipation

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19
Q

How much stronger is sufentanil (dsuvia) than fentanyl

A

10X

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20
Q

T/F sufentanil (dsuvia) should only be used in a medically observed setting

A

True

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21
Q

Where/when should sufentanil (dsuvia) be used

A

Setting where usual modes of administration are compromised (severe trauma or battlefield injuries)

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22
Q

How much stronger than fentanyl is carfentanil

A

100X

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23
Q

What are the synthetic forms of fentanyl (2)

A
  1. Sufentanil (dsuvia)
  2. Carfentanil
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24
Q

What is the most abused prescription drug in America

A

Hydrocodone

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25
Q

T/F Hydrocodone has a risk of ease of abuse and potential acetaminophen toxicity

A

True

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26
Q

What is codeine metabolized into

A

Morphine

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27
Q

When should levorphanol (levo-dromoran) be used

A

Opiate tolerant patients only

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28
Q

Where is the only place oliceridine (olinvyk) used

A

Hospital settings only

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29
Q

What is special about pentazocine (talacen, talwin, talwin NX) (3)

A
  1. No ADH effect
  2. Less GI effects
  3. Lowers seizure threshold
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30
Q

Where is nalbuphine (nubain) used

A

Obstetrics

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31
Q

What is butorphanol (stadholder) used for

A

Rescue medication for patients with headaches

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32
Q

What route of administration does butorphanol have that is unique

A

Nasal spray

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33
Q

What is the concern of butorphanol (stadol) nasal spray

A

We don’t know how much of a dose the pt is getting

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34
Q

T/F tramadol (ultram) is a 5-HT-agonist

A

True

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35
Q

What is buprenorphine used for (2)

A
  1. Chronic pain
  2. Opiate addiction
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36
Q

When should buprenophine NOT be used

A

Conditions that are expected to be short-lived

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37
Q

T/F buprenorphine has less respiratory depression

A

True

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38
Q

What patient does having less respiratory depression benefit

A

Elderly

39
Q

What is used in fetal abstinence programs

A

Buprenorphine

40
Q

T/F methadone (dolophine) has a Lon half-life

A

True

41
Q

What does the long half-life of methadone (dolophine) mean

A

Withdrawal can last for months

42
Q

How many days does it take the body to metabolize methadone (dolophine)

A

5 days

43
Q

What does pupillary constriction typically indicate

A

Opiate abuse

44
Q

What does naloxone (narcan) do

A

Reverses effect of opiate agonists

45
Q

T/F naloxone (narcan) is absorbed orally

A

False

46
Q

T/F naloxone (narcan) is used to investigate whether agonist is involved in toxic state

A

True

47
Q

T/F naloxone (narcan) can evoke acute, severe withdrawal syndrome

A

True

48
Q

T/F naloxone (narcan) is added to other drugs so if a person injects the drug they go into withdrawal

A

True

49
Q

T/F nalmefene (opvee) has a longer half-life than naloxone (narcan) (11 hours)

A

True

50
Q

What does the long half-life of nalmefene (opvee) mean

A

Withdrawal symptoms last longer

51
Q

Tommy typed his name

A

Tommy

52
Q

Is nalmefene (opvee) sold OTC

A

Nope, prescription only

53
Q

What is used for alcohol abuse and opiate dependence

A

Naltrexone (revia or vivitrol)

54
Q

What schedule is naltrexone (revia or vivitrol)

A

No class

55
Q

T/F naltrexone (revia or vivitrol) can precipitate withdrawal symptoms

A

True

56
Q

T/F tapentadol (nucynta) has dual action of pain inhibition

A

True

57
Q

What 2 pathways does tapentabol (nucynta) effect

A

Ascending: mu-opiate antagonist
Descending: inhibits norepinephrine reuptkae

58
Q

What patient do we use caution taking tapentadol (nucynta)

A

Respiratory distress and patients on other psychotropic drugs

59
Q

What are the mixed agonists/antagonists (6)

A
  1. Pentazocine
  2. Nalbuphine
  3. Butorphanol
  4. Tramadol
  5. Buprenorphine
  6. Methadone
60
Q

What are the pure agonists (4)

A
  1. Naloxone
  2. Nalmefene
  3. Naltrexone
  4. Tapentadol
61
Q

T/F In general, opiates should be prescribed as first line treatment for chronic pain

A

FALSE

62
Q

T/F for acute pain, consider the least amount of medication which is reasonable (3-7 days)

A

True

63
Q

T/F providers must ensure continuity of care if they are to prescribe opiates

A

True

64
Q

When you prescribe >50 MME of opiates for chronic pain what must you do

A

Increase follow-up frequency

65
Q

At what point should we consider referral to a pain specialist

A

> 90 MME of opiates being prescribed (so don’t prescribe it)

66
Q

What is the MME factor for Hydrocodone

A

1

67
Q

What is the MME factor for oxycodone

A

1.5

68
Q

What do we do if over-sedated or addiction risk

A

Taper medication using 10% decrease in original dose per week (tailor as needed)

69
Q

T/F 90% of patients in pain management have an undiagnosed psych disorder

A

True

70
Q

What is the treatment of choice for opiate addiction

A

Suboxone

71
Q

What is in suboxone (2)

A
  1. Buprenorphine
  2. Naloxone
72
Q

What do we expect in pain management

A

Tolerance, dependence, and withdrawal

73
Q

What do we not expect in pain management

A

Abuse and addiction

74
Q

A phenomenon whereby an organism chronically exposed to a substance becomes progressively less sensitive to it

A

Tolerance

75
Q

The condition of habituation defined by the occurrence of a withdrawal syndrome upon cessation of use of the substance

A

Dependence

76
Q

An illness-like syndrome that develops when an organism habituated to a substance is suddenly deprived of it

A

Withdrawal

77
Q

The intentional misuse of a substance despite the medical, socioeconomic harm it causes

A

Abuse

78
Q

What is dantrolene used to treat (3)

A
  1. CP
  2. MNS
  3. Malignant hyperthermia
79
Q

What are the risks of chronic use of dantrolene (2)

A
  1. Liver toxicity
  2. Pleural effusion
80
Q

T/F there is an issue with dependence, tolerance, withdrawal, and addiction with diazepam

A

True

81
Q

What do we need to be aware of with baclofen (lioresal)

A

Glycemic derangement

82
Q

Due to the glycemic derangement, who do we not use baclofen with

A

Diabetics

83
Q

What is cyclobenzaprine (flexeril, amri) a close derivative of

A

Amitriptyline (tramadol)

84
Q

Do we ever use cyclobenzaprine (flexeril, Amrit) and amitriptyline (tramadol) together

A

NEVER

85
Q

What are the side effects of cyclobenzaprine (flexeril, amrix) (5)

A
  1. Very sedating
  2. Dry mouth
  3. Fatigue
  4. Mental confusion
  5. Atropine-like effect
86
Q

What is the atropine effect (5)

A
  1. Hot as a hare
  2. Blind as a bat
  3. Dry as a bone
  4. Red as a beet
  5. Mad as a hatter
87
Q

Do we ever prescribe SOMA

A

NEVER, EVER, EVER (unless you want a broken stylus)

88
Q

What is the only muscle relaxant that requires us to monitor LFTs

A

Tizanidine (zanaflex)

89
Q

What is the side effect of orphenadrine

A

Anticholinergic action (dry out)

90
Q

Who do we use orphenadrine with caution for

A

Elderly

91
Q

T/F metaxalone (skelaxin) is less sedating than other muscle relaxants

A

True

92
Q

According to Beers criteria which 2 muscle relaxants are the only excluded, or safe, ones

A
  1. Tizanidine (zanaflex)
  2. Baclofen (lioresal)
93
Q

What are the muscle relaxants (8)

A
  1. Dantrolene (dantrium)
  2. Diazepam (Valium)
  3. Baclofen (lioresal)
  4. Cyclobenzaprine (flexeril, amrix)
  5. Carisoprodol (SOMA)
  6. Tizanidine (zanaflex)
  7. Orphenadrine (norflex)
  8. Metaxalone (skelaxin)
94
Q

What is our obligation if there is an aberrant tox screen

A

Weaning on opiates

Pharmacology 2 Connor (13 decks)

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