Chapter 58: Pain Flashcards
____ pain occurs when sensory nerves identify tissue namage
Nociceptive
Which drug classes can be given for mild pain (score 1-3)
Non-opioid +/- adjuvant
Which drug classes can be given for moderate pain (score 4-6)
Opioid for mild-moderate pain
+/- non-opioid
+/- adjuvant
Which drug classes can be given for severe pain (score 7-10)
Opioid for moderate-severe pain
+/- non-opioid
+/- adjuvant
Acetaminophen does not provide ____ effect
anti-inflammatory
Mechanism of APAP
inhibits PG synthesis in the CNS
APAP brand names
Tylenol, FeverAll, Ofirmev
FeverAll drug formulation
rectal suppository
APAP
Ofirmev drug formulation
Injection
APAP
APAP + hydrocodone brand names
Lorcet, Lortab, Norco, Vicodin
APAP + oxycodone brand names
Endocet, Percocet
APAP + codeine brand names
Tylenol #2, #3, #4
APAP + caffeine brand name
Excedrin Tension Headache
APAP + ASA + Caffeine brand names
Excedrin Extra Strength, Excedrin Migraine
APAP + caffeine + pyrilamine brand name
Midol Complete
Max APAP per day for adults
< 4000 mg/day
APAP dosing for children < 12 yrs
10-15 mg/kg Q4-6H
APAP infants and childrens suspension concentration
160 mg/5 ml
APAP BW
Severe hepatotoxicity with doses > 4 g/day or use of multiple APAP-containing products
Antidote for APAP overdose
NAC, Acetadote
How is NAC administered for APAP overdose
IV or PO (using the solution for inhalation or injectable formulation)
How does NAC help with APAP overdose
restores hepatic glutathione
Non-selective NSAIDs block the synthesis of
both COX enzymes
COX-2 selective NSAIDs block the synthesis of
COX-2 only, which decreases GI risk (b/c COX-1 protects the gastric mucosa)
Aspirin MOA
irreversible COX-1 & 2 inhibitor
makes it an effective antiplatelet
All Rx, non-aspirin NSAIDs require a MedGuide with the following info
- GI risk including bleeding and ulceration
- CV risk (MI and stroke)
- CABG surgery: NSAID use is CI after surgery. Antiplatelet therapy is recommended (commonly ASA)
NSAID side effects
- Caution in renal failure
- Can increase BP
- Can cause premature closure of the ductus arteriosus (do not use in 3rd trimester)
- Nausea (take with food)
- Photosensitivity
If the ductus arteriosus does not close after birth, which NSAIDs can be used
IV NSAIDs (indomethacin, ibuprofen) can be used within 14 days of birth
to close a patent ductus arteriosus
Ibuprofen brand name
Advil, Caldolor, Motrin
Which NSAIDs are COX-1 & COX-2 non-selective
Ibuprofen, indomethacin, Naproxen, Ketorolac
(NIKI)
Adult OTC dosing for Ibuprofen
200-400 mg Q4-6H
Max Rx dose of ibuprofen
3.2 g/day
OTC: 1.2 g/day
Pediatric dosing for Ibuprofen
5-10 mg/kg/dose Q6-8H
OTC self-treatment with ibuprofen should be limited to
< 10 days
Indomethacin brand name
Indocin
Indomethacin has a high risk for which side effects
CNS (avoid in psych conditions)
Naproxen brand name
Aleve
Naproxen + esomeprazole brand name
Vimovo
Ketorolac brand name
Toradol
How often is naproxen dosed
BID
How is Ketorolac nasal spray administered in patients < 65 years
1 spray in each nostril
How is Ketorolac nasal spray administered in patients 65+ years
1 spray in one nostril
Max combined duration IV/IM and PO/nasal for ketorolac is __ days in adults
5
Ketorolac warnings
acute renal failure, liver failure
How should ketorolac nasal spray be used
Prime 5x before use
Which NSAIDs have increased COX-2 selectivity
Celecoxib, diclofenac, meloxicam, nabumetone, etodolac
(C, D, E….M, N)
Benefit of COX-2 selective NSAIDs
lower risk for GI complications (but increased risk of MI/stroke), same renal risk
Diclofenac brand name
Voltaren
Voltaren gel total body max dose
32 g/day
Celecoxib CI
sulfonamide allergy
Which COX-2 selective NSAID has the most COX-2 selectivity
celecoxib
Diclofenac + misoprostol (Arthrotec) boxed warning
Avoid in women of childbearing potential
Why is misoprostol used with diclofenac
Used to replace the gut-protective PG to decrease GI risk
Meloxicam brand name
Mobic
ASA + omeprazole brand name
Yosprala
ASA dose for cardioprotection
81-162 mg once daily
ASA side effects
Dyspepsia, heartburn, bleeding
What may be used to protect the gut with chronic NSAID use
PPIs
Salicylate overdose can cause
tinnitus
What ingredient is found in Bengay, Icy Hot and Salonpas
Methyl salicylate
How should ASA and ibuprofen be used if taken together
Take ASA one hour before or 8 hours after ibuprofen
NSAIDs can increase the levels of which drug
Lithium
and methotrexate
Aspirin/acetylsalicylic acid brand names
Ascriptin, Bufferin, Ecotrin
all EC/buffered
Opioid MOA
Mu receptor agonists
What components of REMS do opioids have?
prescriber education and counseling requirements
Which opioids cannot be taken with alcohol
Kadian, Nucynta ER, Oxymorphone ER & Zohydro
can increase plasma levels and cause fatal overdose
What drug class (DEA) is codeine solution combination products (e.g, cough syrups)
C-V
Respiratory depression and death have occurred in children following tonsillectomy and/or adeoidectomy found to have evidence of being ultra-rapid metabolizers of codeine due to what polymorphism
2D6
Codeine should be avoided in children < __ years for any indication & < __ years following tonsillectomy/adenoidectomy surgery
12
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