Early Tests and Prognostication Flashcards
COPD relief before opioids:
oxygen, fans, pulmonary rehabc
Hiccup-genic meds:
benzos, dex
Drug of choice for hiccups:
baclofen
treats peripheral hiccups
reglan
30% of TIPS patients develope
encephalopathy
block for pelvic pain
hypogastric plexus
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SSRIs and tamoxifen
Some (fluoxetine, paroxetine) inhibit cyto 2D6 and cannot be given with tamoxifen
Target of Aprepitant
Antiemetic, targets Neurokinin receptors in the the CRTZ
Treat cholestatic pruritis
cholestyramine, rifampin, naltrexone for opioid build up, methotrexate, sertraline, paroxetine, dronabinol
RLS at EOL
same as ever: pramipexole, ropinerole
drugs metabolized to morphine
codeine, heroin (codeine would be drug screen positive for codeine and morphine)
false positive for morphine
quinolones: ciprofloxacin, doxifloxacin, moxifloxacin
fentanyl class
phenylpiperdine (with pethidine, alfentanil, fentanyl, sufentanil and remifentanil) (synthetic)
methadone class
diphenylheptane derivatives (methadone, propoxyphene), (synthetic)
Natural opioids
Morphine, codeine, thebaine, papaverdine
semi-synthetic opioids
diamorphine (heroin), diahydromorphone, oxycodone, buprnorphine
synthetic opioids
fentanyl, methadone, tapentadol
MOP/mu agonism
How opioids provide analgesia
MOP/mu neuro pathway
indirectly INHIBITS periaqueductal grey (PAG) and nucleus reticularis paragigantocellularis (NRPG). INCREASES signal to the nucleus raphe magnus (NRM), increasing stimulation of 5-hydroxytryptamine and enkephalin-containing neurons which connect directly with the substantia gelatinosa of the dorsal horn.
4 A’s of pain treatment outcomes
analgesia, activities of daily living, adverse effects, aberrant behaviors
oxycodone or morphine–higher oral bioavailability?
oxycodone
Logistics of filling opioids q3m
2 post-dated prescriptions are allowed for scheduled II opioids. When this is done, prescribing clinicians should counsel patients to leave the post-dated prescriptions with their pharmacist for safe keeping
incidence of epidural mets is highest in these cancers, which frequently spread to the axial skeleton
breast, lung, prostate, myeloma, melanoma and hypernephroma