Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adv Pharm I > Exam 1 Pain & RA > Flashcards

Exam 1 Pain & RA Flashcards

1
Q

Types of pain

A

Nociceptive and neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Damage to body tissue causes what type of pain?

A

Nociceptive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of pain is caused by nerve damage?

A

Neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the goal of pain management?

A

Reduce peripheral sensation and decrease central simulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

1-10 assessment of mild pain?

A

1-3. OTC analgesics such as APAP, ASA, NSAIDs, COX2 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1-10 assessment of moderate pain?

A

4-7. Combination therapy such as NSAIDs, Opioid + APAP, Tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

1-10 assessment of severe pain

A

8-10, opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MOA of APAP

A

Tylenol. Inhibit synthesis of prostaglandins in CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

APAP Dose

A

325-650 mg q4h OR 1000mg Q6h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Max APAP dose

A

4g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

APAP- Max dose for liver impairment or alcoholism

A

2g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Only true analgesic

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Black box warning for APAP

A

Liver toxicity with 4g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COX 1 INHIBITION

A

Vasoconstriction, platelet aggregation. Cytoprotective. Prostaglandins and thromboxane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

COX-1 INHIBITION location

A

GI, kidney, lung protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

COX-2 INHIBITION

A

Inflammatory, prostaglandins, prostacyclin. Inflammation, pain, antiplatelet, vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Aspirin - what type of drug?

A

Salicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MOA Aspirin

A

IRREVERSIBLY binds to COX-1 and COX-2 enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Adverse Effect of Aspirin

A

Irreversible antiplatelet. Prevents synthesis of thromboxane A, vasoconstrictor and inducer of platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NSAIDs - adverse events

A

GI irritation, respiratory bronchospasms, renal insufficiency or FAILURE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

OTC NSAIDs

A

Ibuprofen, naproxen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ibuprofen half life

A

2-4h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ibuprofen onset

A

30m-1h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ibuprofen duration

A

4-6h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Max dose ibuprofen/day

A

2400 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Naproxen half life

A

12-17h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Naproxen onset

A

1h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Naproxen duration

A

7h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Naproxen max dose per day

A

600mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Indomethacin max dose/day

A

200mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Ketorolac max dose/day

A

120mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Warning for NSAIDs

A

Black box - thrombotic events, GI ulcer/bleeding, thyroid of periop pain in setting of CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Why are NSAIDs so dangerous?

A

Easy access, we believe they are safe, combination therapy with other nephrotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Ketorolac indications

A

Short term tx of moderate to severe pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Maximum therapy for ketorolac?

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

COX-2 inhibitor

A

Celecoxib (Celebrex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

COX 2 inhibitor advantages

A

Selective, minimal GI effects, no effect on platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Disadvantages of COX-2 inhibitor

A

Renal dysfunction, sulfa allergy, CVS EVENTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Phenanthrenes - which medications?

A

Morphine, hydromorphone, levorphenol, oxymorphone, codeine, hydrocodone, oxycodone
End in “one” or “enol” except “morphine” and “codeine”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Phenylpiperidines - which medications?

A

Meperidine, fentanyl, sufentanil, alfentanyl, remifentanyl

End in “nyl”, “nil” — except meperdine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Phenylheptanes - which medications?

A

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Morphine - what is an adverse effect and UNIQUE to morphine?

A

Histamine release - hypotension, pruritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is morphine metabolized?

A

RENAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Morphine - metabolism properties

A

2 active metabolites, 3-glucuronide (myoclonus, confusion, hallucinations), 6-glucuronide (active analgesia)

45
Q

Morphine dosage — KNOW THIS

A

IV 2-4mg q4h PRN; PO 15-30 q4h PRN

**Not the same for opioid dependent people

46
Q

Hydromorphone metabolism

A

Non-renal, short half life, no active metabolites

47
Q

Hydromorphone IV dosage

A

IV 0.2-1mg q2-4h PRN

48
Q

Hydromorphone PO dosage

A

2-4mg q4-6h PRN

49
Q

Methadone metabolism

A

Renally cleared - adjust for CrCL less than 10 mL/min

50
Q

Patient with advanced CKD, concerned about accumulation of morphine, what is a potential alternative?

A

Dilaudid. Concerned with lack of renal elimination.

51
Q

Risk of methadone

A

Prolongation of QTc. Hold or reduce dose if QTc greater than or equal to 500. Caution when using other medications that increase QTc. OR history of seizures

52
Q

Methadone dosage PO

A

2.5 mg q8-12

53
Q

Methadone dosage IV

A

2.5-10 mg q8-12h

54
Q

Methadone metabolism

A

Long half life - biphasic, 8-12h, terminal half life 24-36h. Renally cleared - adjust for CrCL less than 10ml/min

55
Q

Meperidine alternate name

A

Demerol

56
Q

Meperidine adverse effect

A

Active metabolite - neurotoxic effects, increased with renal dysfunction

57
Q

Current uses for meperidine

A

Post-op shivering

58
Q

Codeine unique features

A

Active metabolite is morphine, major CYP 2D6 substrate, used in combination with APAP or ASA, for mild to moderate pain, low risk for abuse

59
Q

Major feature of codeine

A

Antitussive

60
Q

Hydrocodone unique features

A

Combo product with APAP (Vicodin), ibuprofen (vicoprofen), or ER (zohydro, hysingla)

61
Q

Hydrocodone uses

A

Moderate to severe pain in patients with limited opioid use

62
Q

Fentanyl dosage

A

IV 25-50 mcg q2-3h

63
Q

Fentanyl metabolism

A

Preferred for liver failure patients, metabolized by CYP3A4, high potency and lipid solubility - rapid onset

64
Q

Fentanyl routes of administration

A

Everything but oral, IV or patch, parenteral

65
Q

Fentanyl unique factor

A

Completely synthetic

66
Q

Fentanyl adverse effects

A

Bradycardia, chest wall rigidity

67
Q

Naloxone used for what?

A

Opiate antidote

68
Q

Naloxone metabolism

A

Repeated dosing may be necessary due to half life of agonist. Not good PO due to extensive first pass

69
Q

Naltrexone

A

Used PO and IM depot for opioid dependence. Not for acute reversal/toxic effects

70
Q

Naltrexone cautions

A

Hepatotoxic

71
Q

Methylnaltrexone indicated for?

A

Opioid induced constipation

72
Q

Methylnaltrexone routes

A

SubQ

73
Q

Methylnaltrexone metabolism and adverse effects

A

Renally eliminated, potential risk for GI perforation

74
Q

Tramadol unique aspects

A

Inhibition of norepinephrine and serotonin reputable, weak opiate mu receptor binding. Less respiratory depression, GI dysmotility

75
Q

Tramadol adverse effects

A

Decreased seizure threshold

76
Q

Tramadol metabolism

A

Renal/hepatic, adjust in dysfunction

77
Q

Class wide opioid adverse effects

A

Respiratory depression, constipation, sedation

78
Q

Important for individuals on opioids

A

Bowel regimen - stool softener AND stimulant

79
Q

Can you die from opioid withdrawal?

A

No

80
Q

Addiction vs. dependence

A

Addiction is mental. Dependence is physical.

81
Q

What are the effects of opioids that you do not develop tolerance to?

A

Miosis, constipation, seizures

82
Q

Why would you administer a long acting opioid?

A

Reserved for opioid tolerant patients with chronic pain

83
Q

When would you administer short acting opioids for chronic pain?

A

For breakthrough pain. Take 10-15 percent of total daily dose of regular schedule and offer immediate release q2-4h PRN

84
Q

When would you increase a long acting dose of opioids for chronic pain individuals?

A

If pt uses 3 or more doses of breakthrough pain Rx

85
Q

What medications are used for neuropathic pain?

A

SSRI/SNRI duloxetine, venlafaixine. Tricyclic antidepressants nortiptyline, despiramine. Calcium channel a2 ligands gabapentin, pregabalin

86
Q

Treatment for mild to moderate migraine attack

A

APAP used with caffeine, NSAIDs

87
Q

Treatment for moderate to severe migraines when nonspecific Rx does not work

A

Triptans - selective agonists. 5HT (serotonin). Targeted therapy to vasoconstrict intracranial arteries. Most effective when taken 4 hours+ after onset.

88
Q

Triptan contraindications

A

Heart disease, PVD, CVA, HTN. 2w hx of MAOI.

89
Q

Examples of triptan medications

A

End in “triptan” — sumatriptan (Imitrex), zolmitriptan (Zomig)

90
Q

Chronic migraines treatment

A

Prophylactic therapy with a goal to reduce frequency, severity, duration, and improve responsiveness to therapy.

91
Q

Chronic migraine therapy uses what type of medication?

A

Non-traditional pain medications. Beta blockers, antidepressants, calcium channel blockers, anticonvulsants.

92
Q

Types of medications used for RA

A

NSAIDs, DMARDs…disease modifying anti rheumatic drugs

93
Q

When should a DMARD medication be started?

A

Within first 3 months of symptom onset

94
Q

What is a similarity of all DMARDs?

A

They all effect immune system

95
Q

Characteristic of DMARD?

A

Reduce mortality, prevent progression of RA

96
Q

First line DMARD for all patients?

A

Methotrexate

97
Q

Frequency of methotrexate?

A

Once weekly

98
Q

Characteristic of methotrexate that makes this ideal medication

A

May be used in combination with any other DMARD

99
Q

Tx for mild forms of RA with less side effects

A

Hydroxychloroquine (Plaquenil)

100
Q

Humira adverse effects

A

Risk for infections

101
Q

Alternate name for humira

A

Adalimumab

102
Q

Reason humira is a favorite tx

A

One SubQ every other week

103
Q

First oral RA biologic agent

A

Xeljanz - brand name. Tofacitinib

104
Q

What must RA patients be tested for prior to tx?

A

TB

105
Q

How often must RA patients be tested for TB?

A

Annual

106
Q

Cautions for methotrexate & RA medications

A

Do not initiate or resume while pregnant or breastfeeding

107
Q

Phenanthrenes - all end in?

A

-ine, -one, -enol

108
Q

Phenylpiperidines all end in?

A

-nyl, -nil, meperidine

109
Q

Phenylheptanes - end in?

A

Methadone - only medication

Adv Pharm I (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions