Analgesics & Muscle Relaxants Flashcards
1
Q
What is used as the standard by which all other medications are measured
A
Morphine
2
Q
What is morphine derived from
A
Poppy plant
3
Q
T/F opioids are morphine like substances
A
True
4
Q
What are narcotics
A
Opioids + those that induce narcosis
5
Q
When does pain become chronic and why
A
12 weeks, due to changes in the pain pathway making it difficult to correct.
6
Q
T/F in pain management we cure/fix pain
A
False, we treat/manage
7
Q
T/F all opiates have a side effect of constipation
A
True
8
Q
T/F opiates cause urethral contractions
A
True
9
Q
What amount of morphine is used as the standard guide for opiates
A
10 mg
10
Q
What does Darvon do to seizure threshold
A
Lowers it
11
Q
When is meperidine used for
A
Perioperative pain (short term only)
12
Q
What is hydromorphone (dilaudid, exalgo) partially metabolized to
A
Hydrocodone
13
Q
When taking hydromorphone how many drugs will show up on the U tox
A
4
14
Q
How much more potent is fentanyl than morphine
A
10X
15
Q
What does fentanyl do to respiration
A
Suppresses it
16
Q
T/F fentanyl can cause skeletal muscle rigidity and moderate bradycardia
A
Truth
17
Q
Does fentanyl typically have more or less histamine release
A
Less
18
Q
What does fentanyl not being absorbed from the GI tract mean
A
Less constipation
19
Q
How much stronger is sufentanil (dsuvia) than fentanyl
A
10X
20
Q
T/F sufentanil (dsuvia) should only be used in a medically observed setting
A
True
21
Q
Where/when should sufentanil (dsuvia) be used
A
Setting where usual modes of administration are compromised (severe trauma or battlefield injuries)
22
Q
How much stronger than fentanyl is carfentanil
A
100X
23
Q
What are the synthetic forms of fentanyl (2)
A
- Sufentanil (dsuvia)
- Carfentanil
24
Q
What is the most abused prescription drug in America
A
Hydrocodone
25
T/F Hydrocodone has a risk of ease of abuse and potential acetaminophen toxicity
True
26
What is codeine metabolized into
Morphine
27
When should levorphanol (levo-dromoran) be used
Opiate tolerant patients only
28
Where is the only place oliceridine (olinvyk) used
Hospital settings only
29
What is special about pentazocine (talacen, talwin, talwin NX) (3)
1. No ADH effect
2. Less GI effects
3. Lowers seizure threshold
30
Where is nalbuphine (nubain) used
Obstetrics
31
What is butorphanol (stadholder) used for
Rescue medication for patients with headaches
32
What route of administration does butorphanol have that is unique
Nasal spray
33
What is the concern of butorphanol (stadol) nasal spray
We don’t know how much of a dose the pt is getting
34
T/F tramadol (ultram) is a 5-HT-agonist
True
35
What is buprenorphine used for (2)
1. Chronic pain
2. Opiate addiction
36
When should buprenophine NOT be used
Conditions that are expected to be short-lived
37
T/F buprenorphine has less respiratory depression
True
38
What patient does having less respiratory depression benefit
Elderly
39
What is used in fetal abstinence programs
Buprenorphine
40
T/F methadone (dolophine) has a Lon half-life
True
41
What does the long half-life of methadone (dolophine) mean
Withdrawal can last for months
42
How many days does it take the body to metabolize methadone (dolophine)
5 days
43
What does pupillary constriction typically indicate
Opiate abuse
44
What does naloxone (narcan) do
Reverses effect of opiate agonists
45
T/F naloxone (narcan) is absorbed orally
False
46
T/F naloxone (narcan) is used to investigate whether agonist is involved in toxic state
True
47
T/F naloxone (narcan) can evoke acute, severe withdrawal syndrome
True
48
T/F naloxone (narcan) is added to other drugs so if a person injects the drug they go into withdrawal
True
49
T/F nalmefene (opvee) has a longer half-life than naloxone (narcan) (11 hours)
True
50
What does the long half-life of nalmefene (opvee) mean
Withdrawal symptoms last longer
51
Tommy typed his name
Tommy
52
Is nalmefene (opvee) sold OTC
Nope, prescription only
53
What is used for alcohol abuse and opiate dependence
Naltrexone (revia or vivitrol)
54
What schedule is naltrexone (revia or vivitrol)
No class
55
T/F naltrexone (revia or vivitrol) can precipitate withdrawal symptoms
True
56
T/F tapentadol (nucynta) has dual action of pain inhibition
True
57
What 2 pathways does tapentabol (nucynta) effect
Ascending: mu-opiate antagonist
Descending: inhibits norepinephrine reuptkae
58
What patient do we use caution taking tapentadol (nucynta)
Respiratory distress and patients on other psychotropic drugs
59
What are the mixed agonists/antagonists (6)
1. Pentazocine
2. Nalbuphine
3. Butorphanol
4. Tramadol
5. Buprenorphine
6. Methadone
60
What are the pure agonists (4)
1. Naloxone
2. Nalmefene
3. Naltrexone
4. Tapentadol
61
T/F In general, opiates should be prescribed as first line treatment for chronic pain
FALSE
62
T/F for acute pain, consider the least amount of medication which is reasonable (3-7 days)
True
63
T/F providers must ensure continuity of care if they are to prescribe opiates
True
64
When you prescribe >50 MME of opiates for chronic pain what must you do
Increase follow-up frequency
65
At what point should we consider referral to a pain specialist
>90 MME of opiates being prescribed (so don’t prescribe it)
66
What is the MME factor for Hydrocodone
1
67
What is the MME factor for oxycodone
1.5
68
What do we do if over-sedated or addiction risk
Taper medication using 10% decrease in original dose per week (tailor as needed)
69
T/F 90% of patients in pain management have an undiagnosed psych disorder
True
70
What is the treatment of choice for opiate addiction
Suboxone
71
What is in suboxone (2)
1. Buprenorphine
2. Naloxone
72
What do we expect in pain management
Tolerance, dependence, and withdrawal
73
What do we not expect in pain management
Abuse and addiction
74
A phenomenon whereby an organism chronically exposed to a substance becomes progressively less sensitive to it
Tolerance
75
The condition of habituation defined by the occurrence of a withdrawal syndrome upon cessation of use of the substance
Dependence
76
An illness-like syndrome that develops when an organism habituated to a substance is suddenly deprived of it
Withdrawal
77
The intentional misuse of a substance despite the medical, socioeconomic harm it causes
Abuse
78
What is dantrolene used to treat (3)
1. CP
2. MNS
3. Malignant hyperthermia
79
What are the risks of chronic use of dantrolene (2)
1. Liver toxicity
2. Pleural effusion
80
T/F there is an issue with dependence, tolerance, withdrawal, and addiction with diazepam
True
81
What do we need to be aware of with baclofen (lioresal)
Glycemic derangement
82
Due to the glycemic derangement, who do we not use baclofen with
Diabetics
83
What is cyclobenzaprine (flexeril, amri) a close derivative of
Amitriptyline (tramadol)
84
Do we ever use cyclobenzaprine (flexeril, Amrit) and amitriptyline (tramadol) together
NEVER
85
What are the side effects of cyclobenzaprine (flexeril, amrix) (5)
1. Very sedating
2. Dry mouth
3. Fatigue
4. Mental confusion
5. Atropine-like effect
86
What is the atropine effect (5)
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
Do we ever prescribe SOMA
NEVER, EVER, EVER (unless you want a broken stylus)
88
What is the only muscle relaxant that requires us to monitor LFTs
Tizanidine (zanaflex)
89
What is the side effect of orphenadrine
Anticholinergic action (dry out)
90
Who do we use orphenadrine with caution for
Elderly
91
T/F metaxalone (skelaxin) is less sedating than other muscle relaxants
True
92
According to Beers criteria which 2 muscle relaxants are the only excluded, or safe, ones
1. Tizanidine (zanaflex)
2. Baclofen (lioresal)
93
What are the muscle relaxants (8)
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
What is our obligation if there is an aberrant tox screen
Weaning on opiates
