Brainscape's Knowledge GenomeTM

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


See full index

Therapeutics III > Exam 5 (final) - Rogers > Flashcards

Exam 5 (final) - Rogers Flashcards

1
Q

what the CDC practice guidelines include

A

outpts >18
acute pain (<1 month)
subacute pain (1-3 months)
chronic pain (>3 month)

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

what the CDC practice guidelines do NOT include

A

management of pain related to sickle cell disease
management of cancer related pain
palliative care
end of life care

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

WHO analgesic ladder

A
  1. non opioid +/- adjuvant analgesic
  2. opioid for mild-moderate pain +non opioid +/- adjuvant analgesic
  3. opioid for moderate-severe pain +non opioid +/- adjuvant analgesic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

adjuvant options

A

gabapentanoids
SNRIs
TCAs
muscle relaxants
anti-epileptics
topical agents

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

pediatric acetaminophen dosing

A

10-15mg/kg po q4h prn
-max of 75mg/kg/day or 3-4g/day

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

pediatric dosing of aspirin

A

avoid (Reye’s Syndrome)

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

ibuprofen adult dosing

A

200-800mg PO q6-8h PRN
-max of 3200mg/day

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

ibuprofen pediatric dosing

A

> 6months: 5-10mg/kg po q4-6h prn
-max 40mg/kg/day or 2400mg/day, whichever is less

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

adult dosing diclofenac (Voltaren)

A

50mg po q8h
2-4g applied topically 4 times/day

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

naproxen (Aleve or Naprosyn) adult dosing

A

220-500mg po q6-12h
-max of 1000mg/day

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

ketorolac (Toradol) adult dosing

A

15-30mg IV/IM q6h prn
10mg po q6h prn

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

ketorolac (Toradol) peds dosing

A

0.5mg/kg/dose IV/IM q6h prn

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

max duration of ketorolac (Toradol)

A

5 days (parenteral and oral)
-reason is increased risk of GI bleed

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

celecoxib (Celebrex) adult dosing

A

200mg po BID

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

gabapentin (Neurontin) and pregabalin (Lyrica) uses

A

fibromyalgia
neuropathies
post-op pain

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

adult dosing for gabapentin (Neurontin) and pregabalin (Lyrica)

A

gaba: 100-300mg po TID
-max of 3600mg/day

pregaba: 75mg po BID
-max of 600mg/day

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

gabapentin (Neurontin) and pregabalin (Lyrica) side effects

A

sedation
dizziness
peripheral edema

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

gabapentin (Neurontin) and pregabalin (Lyrica) clinical pearls

A

titrate doses up to reduce sedation
use in combo with other analgesics to reduce sedation
renal dose adjustments

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

SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) uses

A

fibromyalgia
neuropathy

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

SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) dosing

A

V(E): 37.5-75mg po daily
-max of 225mg/day

D(C): 30mg po daily for 1 week, then increase to 60mg daily
-max of 60mg/day

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

SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) side effects

A

N
HA
HTN
sedation
weakness

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

SNRIs: venlafaxine (Effexor) and duloxetine (Cymbalta) clinical pearls

A

start low and titrate up to minimize SE
renal dose adjustments:
-CrCl<30: avoid duloxetine and use low dose of venlafaxine

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

TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) uses

A

fibromyalgia
neuropathy
migraine prophylaxis

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

TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) dosage forms

A

tablet (ami)
capsule (nor)
oral solution (nor)

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

TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) dosing

A

both: 10mg po QHS
-max of 150mg/day

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

TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) side effects

A

anticholinergic SEs
sedation

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

TCAs: amitriptyline (Elavil) and Nortriptyline (Pamelor) clinical pearls

A

last line for fibromyalgia and neuropathy due to SE

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

muscle relaxants class includes:

A

cyclobenzaprine (Amrix, Fexmid)
baclofen (Lioresal)
methocarbamol (Robaxin)
carisoprodol (Soma)
tizanidine (Zanaflex)

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

muscle relaxants clinical pearls

A

short term use only (<3 weeks)
carisoprodol is C-IV due to abuse potential

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

muscle relaxants SE

A

sedation/drowsiness
dizziness
dry mouth
vision changes

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

anti-epileptics: carbamazepine (Tegretol) use

A

neuropathic pain

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

anti-epileptics: carbamazepine (Tegretol) clinical pearls

A

increased risk of hypersensitivity rxn if pt has HLA-B*1502 allele
auto-induction of hepatic enzymes (levels will fall over first few weeks of use)

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

lidocaine SE

A

hypotension
arrhythmia (less risk with patch)

34
Q

lidocaine clinical pearls

A

tachyphylaxis with continued use
12hr break btwn patches
local effect - apply patch to site of pain

35
Q

capsacian uses

A

muscle/joint pain
neuropathic pain

36
Q

capsacian clinical pearls

A

do not get medicine into eyes (burns)
wash hands after applying
some forms are OTC

37
Q

BEERs criteria considerations NSAIDs

A

-be cautious with NSAID use in those >75
–use PPI or misoprostol in combo with them
-avoid indomethacin and ketorolac

38
Q

BEERs criteria considerations muscle relaxants

A

-avoid carisoprodol, cyclobenzaprine, and methocarbamol

39
Q

BEERs criteria considerations SNRIs, TCAs, carbamazepine

A

-be cautious with SNRIs, TCAs, carbamazepine due to changes in Na+

40
Q

BEERs criteria considerations opioids and benzo combo use

A

-avoid opioids and benzos combo therapy

41
Q

BEERs criteria considerations opioids and gabapentanoids combo use

A

-avoid opioids and gabapentanoids

42
Q

BEERs criteria considerations anticholinergics

A

-avoid anticholinergic with other anticholinergics and/or TCA or muscle relaxants
–decrease amount of anticholinergic effects pts is on in total

43
Q

BEERs criteria considerations CNS acting drugs:
anti-epileptics (including gabapentanoids)
antidepressants (TCAs, SSRIs, SNRIs)
antipsychotics
benzos
Z drugs
opioids
muscle relaxants

A

avoid use of 3 or more to reduce risk of falls and fractures

44
Q

tx of opioid withdrawal

A

clonidine
buprenorphine
methadone

45
Q

opioids uses

A

acute and chronic pain

46
Q

opioids SE

A

constipation
NV
itching
orthostatic hypotension
urinary retention
sedation
respiratory depression

47
Q

opioids clinical pearls

A

consider starting stool softener and/or stimulant laxative
potential for tolerance, dependance or addiction

48
Q

codeine (tylenol #3) clinical pearls

A

controlled substance (strengths determines what level)
metabolized by CYP2D6
-poor metabolizers get no effect from codeine
-ultra rapid metabolizers may experience OD, especially in children
-not recommended in breastfeeding mothers or children under 12

49
Q

tramadol (Ultram-d/c, ConZip, Qdolo) clinical pearls

A

risk of serotonin syndrome with other serotonergic agents
renally dose adjusted
boxed warning: use of CYP3A4 inducers, inhibitors and 2D6 inhibitors with tramadol requires careful consideration of the effects on the parent drug and metabolite

50
Q

morphine clinical pearls

A

itching more common than in other opioids
renally excreted and may accumulate in renal dysfxn
-avoid in AKI or ESRD
boxed warning: avoid alcohol while taking ER caps - leads to increased morphine levels and possible OD

51
Q

hydromorphone (Dilaudid) clinical pearls

A

boxed warning: dosing errors when prescribing, dispensing and administering
-oral solution: confusion in mg and mL
-IV: do not confuse high potency solution (10mg/mL) with others (1, 2, or 4mg/mL)

52
Q

hydrocodone +/- APAP clinical pearls

A

counsel pts on acetaminophen use and OD
boxed warning: use with CYP3A4 inhibitors may increase hydrocodone conc.

53
Q

allergy cross reaction between opioids recommendations - natural opiates (morphine and codeine)

A

avoid in pts with allergy to other natural opiates and semi synthetic opioids

54
Q

allergy cross reaction between opioids recommendations - semi synthetic opioids (hydrocodone, hydromphone, oxycodone, oxymorphone, buprenorphine)

A

avoid in pts with allergy to other semi synthetic opioids and natural opiates

55
Q

allergy cross reaction between opioids recommendations - synthetic opioids (fentanyl, methadone, meperidine, tramadol)

A

can be used if pt has allergy to another synthetic opioid, semi synthetic opioid or natural opiate

56
Q

oxycodone +/- APAP clinical pearls

A

APAP use and daily limit
boxed warning: use with CYP3A4 inhibitors may increase oxycodone conc.

57
Q

fentanyl clinical pearls

A

monitor pts also on CYP3A4 inhibitors or inducers
can use in renal impairment
less HTN risk

58
Q

besides injectable forms, fentanyl is only indicated for pts who are _______ _______, which means they have taken _____mg or more for at least __ week(s)

A

opioid tolerant, 60, 1

59
Q

T/F: you can use the fentanyl transdermal patch dose and convert to oral morphine equivalent dose to choose an appropriate opioid option

A

F

60
Q

T/F: you can use the oral morphine equivalent dose to calculate the fentanyl transdermal patch dose

A

T

61
Q

fentanyl patch counseling

A

1 patch q72h
do not cut the patch or use it if torn or damaged
do not use over broken skin
avoid heating the patch (could lead to OD)

62
Q

methadone clinical pearls

A

QTc prolongation
boxed warning: monitor pts receiving 3A4 inhibitors or inducers
long half life (8-59 hrs)

63
Q

who to avoid meperidine in

A

avoid in elderly
avoid in renal impairment
caution in hepatic impairment

64
Q

meperidine boxed warnings

A

boxed warning: monitor pts receiving 3A4 inhibitors or inducers
boxed warning: do not use within 14 days of MAOi

65
Q

T/F: meperidine is a prodrug

A

T

66
Q

list the opioids that may lower seizure threshold and may cause serotonin syndrome

A

TRAMADOL
oxycodone
fentanyl
methadone
meperidine
codeine
buprenorphine

67
Q

opioid naive pts should be initiated on _____ (IR or ER) forms

A

IR

68
Q

when should clinicians reevaluate benefits and risks of opioid use with pts

A

within 1-4 weeks of initiation

69
Q

when should clinician help pt reduce/taper opioids

A

-if pt requests it
-no improvement in pain
-if pt is on 50MME+/day with out benefit or also on benzos

70
Q

how to reduce/taper opioids

A

-decrease dose by 10% per month if pts have taken for more than a year
-decrease 10% per week if pts have taken for a shorter time (weeks-months)
-once lowest dose is reached, may alternate/extend days between doses (this is the point where they can be stopped)

71
Q

2017 opioid prescribing limit states what?

A

physicians prescribing initial opioid to pt may not prescribe more than 7 days supply
-first Rx from that prescriber to that pt
exceptions:
-cancer
-medication assisted tx for SUD
-palliative care
-professional judgement

72
Q

2019 inspect law requirements

A

-prescriber must check INSPECT each time they are prescribing an opioid or benzo to any pt
-must check INSPECT q90days
-no exceptions here

73
Q

when taking acetaminophen and ibuprofen together, you should alternate them at an interval of q__h

A

3

74
Q

pt education on pain

A

pain is normal while you are healing and recovering
goal is to manage it so you can do necessary tasks for yourself like:
-eat
-sleep
-walk
-breathe deeply

75
Q

T/F: pts in hospital for acute pain can only have one prescription for one pain severity, not one for each level of severity (ex.-1-3, 4-6, or 7-10)

A

F, they can have one prescription for each of the severity levels

76
Q

hospice - pain relief and air hunger

A

morphine IV or solution (20mg/mL) under tongue
-could use fentanyl or hydromorphone

77
Q

hospice - anxiety/agitation

A

lorazepam IV or SL prn

78
Q

hospice - N/V

A

ondansetron ODT

79
Q

hospice - secretions

A

-atropine ophthalmic drops under tongue
-glycopyrrolate IV prn
-scopolamine patch

80
Q

exception for using opioid and benzo together

A

hospice

Therapeutics III (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions