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Pharm II > FINAL pain > Flashcards

FINAL pain Flashcards

1
Q

difference between acetaminophen and ASA

A

no gib no platelet issues to CV or respiratory symptoms with Tylenol but it is not an ant-iinflammatory

can be used in pts with aspirin hypersensitivity in children or pregnant women (category C)

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2
Q

what is the dosing of ibuprofen

A

3200mg max dose in day
MENSS

200-800mg TID/qid
NASSA- FASS

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3
Q

naproxen dosing

A

250-500mg BID/TID

NaLgas-LeZZ

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4
Q

nuisance se of NSAIDS

A

nausea and dyspepsia

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5
Q

most common sx of NSAID

A

mucosal lesions
less than max dose may provide analgesic effect with less GI irritation

also important to note is that daily NSAID use may increase CV risk factor (not NAPROXEN)

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6
Q

gastrointestinal protection for NSAIDS

A

misoprostol

NOT FOR PREGNANT WOMEN council ALLL PTs men too

can also use PPI or H2 with non-selective NSAID

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7
Q

MOA of misoprostol

A

synthetic PG EQ with antisecretory effect on gastric acid secretion and mucosal protective properties

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8
Q

what is the ASA sensitivity triad

A

20% of asthmatics are sensitive to ASA and NSAIDS

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9
Q

major med interactions with NSAIDS

A

warfarin –> increased bleeds
ACE: increased renal dz
loop or K sparing diuretics: decrease diuretic effect
lithium: increase lithium level s

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10
Q

additional signs of ASA toxicity include

A

hyperthermia
hyperventilation
respiratory alkalosis

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11
Q

interaction with ASA and protein binding drugs

A

plasma levels increase disproportionately as dosing increases

protein bound drugs will increase as dose increases . whattttttt

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12
Q

if pt is taking ASA for CV risk

A

wait at least two hours before taking another NSAID if you really need to

UNLESS it is celecoxib or diclofenac which don’t have interactions

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13
Q

NSAID most commonly used in the hospital

A

ketorolac
one of the only ones available inj

can decrease opiate dose whne used in conjunction

ALWAYS LIMIT TO 5 DAYS

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14
Q

Cox 1 is responsible for

A

renal and platelet function as well as protecting gastric mucosa

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15
Q

which cox 2 inhibitor is still on the market

A

celecoxib (celebrex)

less GI and slightly better at pain control

most pulled off the market because of increase risk of CV dz and SJS

don’t take with ASA or else it is useless

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16
Q

Vicoprofen

A

combination opiod NSAID

hydrocodone and ibuprofen

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17
Q

groups of opiates

A

diphenylheptane
methadone

phenylpipedrine
fentanyl, meperidine, sufentanil, alfentanil

phenanthrenes
morphine, codeine, hydrocodone

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18
Q

these two opiates can both be used for post op shivering

A

fentanyl and meperidine

both part of the phenypiperidine family

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19
Q

partial Mu agonists

A

tramadol
centrally acting synthetic opioid analgesic

binds to mu-opioid receptors and weak inhibition of NE and serotonin reuptake

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20
Q

very low bioavailability with this opioid

A

fentanyl

which is why we see it in a patch, suckers, IV,

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21
Q

This opioid is seen with a larger Vd in the elderly

A

meperidine

probably just shouldn’t use it

(post op for shivers but really just use meperidine)

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22
Q

opioids that are metabolized in the liver and should be avoided with hepatic dysfunction

A

codeine
meperidine
diacetylmorphine

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23
Q

opoid receptro types: kappa

A

alaos produces analgesia similar to Mu

psychosis
slowed GI

24
Q

AE of opioid use with acute use

A 
respiratory depression
N/V
constircted pupils
drowsy
decreased consciousness of awareness 
constipation
urinary retention
25
Q

tolerance will never be developed to this SE of opioids

A

CONVULSIONS
miosis
constipation

26
Q

sometimes you will see pts that build tolerance to this SE of opioids

A

bradycardia

27
Q

how do you convert between opioids

A

convert to total daily dose equivalent of PO morphine

then reduce 25-50% for cross tolerance EXCEPT in methadone

28
Q

weak inhibition of NE and serotonin uptake of this opioid means this drug has a max dose and has pasych and seizure caution

A

tramadol

29
Q

adj needed w/ tramadol

A

hepatic and renal impairment

30
Q

tramadol SE

A

can definitely cause respiratory depression

can see terrible effects in elderly with decreased renal infuction

31
Q

why does tramadol suck

A

basically just as good as ibuprofen

32
Q

when would you want to titrate fentanyl

A

not before the 6 day mark
it can take 6 days before you reach max

can technically do it day 3

removing the patch isn’t enough on overdose can take a day or two (usually 72 hours)

33
Q

fentanyl patch is only good for

A

three days.

34
Q

what are the adverse SE that should warrent caution with methadone

A

QT prolongation
hypotension
hypoglycemia

CVD dysrhythmia

35
Q

rapid onset and 8x more potent than morhphine

A

rapid onset hydromorphone

also a C2 no rela benefit over morphone

36
Q

what are we worried about with deMEROL (meperidine)

A

MEPERIDINE- can be used for shivering but

LITTLE ROLE IN PAIN MANAGMENET AND NO ROLE IN THE ELDERLY

TOXIC METABOLIE NORMEPERIDINE

renally excreted
longer half life so meds wear off before pain releif

you are going to be in perril if you try dem rolls but you can use it to try to stop rollin

37
Q

CI with meperidine

A

MAO syndrome if combined with MAOI

38
Q

opioid like compounds

A

dextromethorphan

robo tripping (robitussin)

codeine/guaifensesin

39
Q

diphenoxylate/atropine

A

lomotil antidiarrheal med

atropine is to avoid abuse potential

loperamide is similar but dose not cross BBB= no abuse

40
Q

what drugs would you not want to give to naive opioid user

A

fentanyl or methadone

41
Q

cardiovascular effects of opioids

A 
peripheral vasodilation (histamine release)
cerebral vasodilation (increase intracranial pressure)
orthostatic
42
Q

GI effects of opioids

A

increased tone and decreased activity lead to constipation

potential smooth muscle spasm

43
Q

what are the potential pt risk for severe SE w/ opioids

A

pts with head injuries with CO2 retnetion and ICP
BREASTFEEDING
imparied pulm function (OSA)
impaired hepatic or renal fucntion
endcrine disease can have prolonged exaggerated response

44
Q

opioids you want to avoid with impaired renal function

A

morphine
hydromorphone
codeine

45
Q

buprenorphene MOA

A

partial agonist

activates at lower levels
relatively less reinforcing

can displace full agonsits like heroin and methadone

disassociates very slowly blocking heroin and methadone binding

46
Q

CI of buprenorphine

A

can precipitate opioid WD similar to naloxone

but less dangerous because you fall to partial agonist

47
Q

shorter the half life the grater that abuse potential

what are other factors effecting abuse potential

A

lipophilicity (faster across BBB)
heroin>morphine>methadone

degree of Mu activity
will feel w/d much more quickly

48
Q

buprenorphine

A

can be used for pain but can’t prescribe without additional training

49
Q

preferred form form for unsupervised dosing

A

buprenorphine

methadone you need supervised

50
Q

Nalozone differs from buprenorphine because

A

it is an antagonist

completely blocks

51
Q

morphine and amphetamines are all what durg class

A

II

52
Q

VICODIN is what schedule of drug

A

III

53
Q

PB and ambien are both what durg class

A

IV

54
Q

lomotil and low amounts of codeine are what drug class

A

V

55
Q

refill restrictions for drug classes

A

CII- no refills

CIII-V: 5 refills

Pharm II (16 decks)

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