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Therapeutics 3 - Spring 2018 > Final - Issacs > Flashcards

Final - Issacs Flashcards

1
Q

question to asks pts in pain?

A 
PQRSTU
palliative/precipitating
quality
region
severity
time
U - impact on U....
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2
Q

what are the physiological changes seen in a patient who is in pain

A 
dilated pupils (mydriasis)
paleness
sweating
tachycardia
tachypnea
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3
Q

wong baker pain scale is described how and is for who?

A

its the faces

and for young kids

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4
Q

FLACC scale stands for what? and is used for who?

A

FLACC = Face, legs, activity, cry, and consolability

is for infants or unconscious people

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5
Q

Non-Pharm Options for Pain

A 
CORRECT UNDERLYING CAUSE!! (Surgery or avoidance)
RICE (rest/ice/compression/elevation)
Psychotherapy/behavioral modifications
Massage
Acupncture
Physical Therapy
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6
Q

________ made an analgesic ladder for pharm treatment options

A

WHO - World health organization

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7
Q

how many steps are in the WHO analgesic ladder

A

3

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8
Q

what is step 1 in the WHO analgesic ladder

A

non opioid +/- adjuvant analgesic

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9
Q

what is step 2 in the WHO analgesic ladder

A

opioid for mild - moderate pain + non-opioid +/- adjuvant analgesic

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10
Q

what is step 3 in the WHO analgesic ladder

A

opioid for moderate to severe pain +/= adjuvant analgesic

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11
Q

PRN or Scheduled analgesics minimize exposure to limit toxicity

A

PRN (only treating when pain is above a threshold)

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12
Q

PRN or Scheduled analgesics may be a better option in chronic/continual pain

A

scheduled…

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13
Q

What are the non-opioid analgesics

A

NSAIDs and APAP

Adjuvants – aka for Neuropathic Therapies

  • Gabapentinoids
  • SNRIs
  • TCAs
  • Skeletal Muscle Relaxants
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14
Q

NSAIDs or APAP is the gold standard for OA in geriatric patients? and why?

A

APAP! because fewer side effects in geriatric patients

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15
Q

Patients with liver disease can or cannot take APAP?

A

can!

limit is < 2G/day though

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16
Q

APAP Peds dosing?

A

10 - 15 mg/kg PO Q4H prn

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17
Q

Ibuprofen doing for peds?

A

5 - 10 mg/kg PO Q6H prn

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18
Q

NSAIDs or APAP have a black box warning for increased cardiovascular events?

A

NSAIDs

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19
Q

NSAIDs or APAP?

leads to fluid retention

A

NSAIDs

increased CV events!!

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20
Q

NSAIDs or APAP?

causes hepatoxicity

A

APAP

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21
Q

If patient has hx of cardiac history, can you still use topical NSAIDs?

A

yes

topical is ok, systemic is less ok

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22
Q

why do we titrate gabapentinoids?

A

to limit sedation

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23
Q

ADEs of SNRIs

A

HTN
Sedation
HA
weakness

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24
Q

if CrCl is < 30 mL/min – what do you do for the SNRIs

A

NO duloxetine

Can do venlafaxine but decrease daily dose by 50%

25
Q

list the drugs that are skeletal muscle relaxants

A 
carisoprodol (Soma)
Chlorzoxane (Lorzone)
Cyclobenzaprine
Metaxalone (Skelaxin)
Methocarbamol (Robaxin)
26
Q

what opioids are typically used in step 2 in WHO analgesic ladder aka for mild - moderate pain

A

tramadol
codeine
morphine
hydrocodone

27
Q

what opioids are typically used in step 3 in WHO analgesic ladder aka for moderate - severe pain

A 
oxycodone (+/- APAP)
hydromorphone
fentanyl
methadone
meperidine
28
Q

codeine is used for pain and ?

A

for cough

codeine is an antitussive

29
Q

how old does someone have to be to use codeine?

A

12 y.o +

because rate of metabolism is wack in kids under 12 for codeine

30
Q

which opioid can lower seizure threshold?

A

tramadol

31
Q

which opioid can cause itching/histamine release

A

morphine

32
Q

what 2 opioids are save in renal impairment

A

fentanyl
and
methadone

33
Q

which opioid can be used by certain prescribers for opioid detox

A

methadone

34
Q

which opioid can cause neurotoxicty

A

meperidine

35
Q

which drug comes in a patch and what is a note about giving the patch to patients?

A

fentanyl!

do not give the patch if the patient is “opioid naive”

also dont cut patches…

36
Q

which drug is used for opioid reversal

A

naloxone

opioid antagonist

37
Q

which drug is used for opioid dependence

A

buprenorphine/naloxone (Suboxone)

38
Q

when naloxone is given does HR go up or down

A

up!!

39
Q

which drugs may need to be avoid if patient has derm issues

A

fentanyl PATCH
and
morphine (bc itching side effect)

40
Q

If a patient is experiencing acute pain —-

should pt use parenteral, IR, or CR?

A

parenteral and IR are appropriate

41
Q

what patients are typically eligible for PCA (patient controlled analgesia)

A

post-op
pancreatitis
sickle cell crisis

42
Q

for PCA dosing about how often are the opioids given?

A

about evert 4 - 10 minutes - aka hella often!!

43
Q 
Switching b/w Opioids:
Drug:                  Parenteral:                     Oral:
Fentanyl
Hydrocodone
Hydromorphone
Morphine
Oxycodone
A

Drug: Parenteral: Oral:
Fentanyl 0.1
Hydrocodone 30
Hydromorphone 1.5 7.5
Morphine 10 30
Oxycodone 20

44
Q

Switching b/w Opioids:
Hydromorphone Conversion b/w parenteral and Oral

Morphine Conversion b/w parenteral and Oral

A

Morphone: Parenteral: 1.5 —-> Oral: 7.5 (5 x)

Morphine: Parenteral 10 —–> Oral: 30 (3x)

45
Q

Opioid Conversion Steps?

A

1 - collect ALL opioid consumption from any route for 24 hour time frame
2 - convert each dose to oral morphine
3 - add all together to get total daily oral morphine dose
4 - reduce 25 - 50% due to cross tolerance
5 - determine appropriate agent for pt based on pt and med specific factors

46
Q

Opioid Related Side Effects

A 
Constipation
N/V
Itching
Respiratory depression
Sedation
addiction/abuse
tolerance
overdose
withdrawal
47
Q

opioid induce N/V- how to manage?

A

take with food!!!
also consider is dose too high?
may add antiemetics— but try not to

48
Q

3 main options for opioid induced constipation

A

Non-pharm: water + fiber + physical activity

OTC: STIMULANT laxative
(senna/bisacodyl)

Rx: Movantik or Relistor (the peripherally mu opioid antagonists) - $$$$$

49
Q

When using a laxative for opioid induced constipation - use bulk or stimulant laxatives? (and examples)

A

stimulant

senna, bisacodyl

50
Q

how to treat itching caused by opioids (usually morphine tho)

A

antihistamines!! (oral, topical, or parenteral)

or

reduce dose of opioid (because it is dose dependent)
switch to alternative opioid
Change route of administration

51
Q

respiratory depression (An ADE of opioids) is usually defined by a RR < ____ BPM

A

8 BPM

52
Q

Symptoms of opioid withdrawal

A 
agitation
anxiety
increased sweating
insomnia
restlessness
53
Q

What drugs can be used for symptom management in opioid withdrawal

A

clonidine - to decrease tachycardia

Methodone - for detoxification

54
Q

CCD Guidelines for Prescribing Opioids:

- for chronic pain – start with ____ opioids and start with _______ dosage

A

IR

lowest effective

55
Q

CCD Guidelines for Prescribing Opioids:

Avoid concomitant used of opioids with ______ if possible

A

BZDs

56
Q

CCD Guidelines for Prescribing Opioids:
For chronic pain:
avoid titrating to > _____ mg of oral morphine equivs/day
AND
evaluate every ______ for opioid benefit/harm

A

90 mg

1 - 4 weeks

57
Q

Indiana Opioid Law:

Initial Prescriptions for opioid therapies cannot be greater than _____ days UNLESS its for what 3 things?

A

7 days

Cancer, Palliative care, medication assisted tx of substance abuse

58
Q

if pt is in hospice — opioids are used why?

A

well pain duhhh/providing comfort at end of life
and
decreasing respiratory drive (to aid in natural end of life processes)

Therapeutics 3 - Spring 2018 (20 decks)

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