FINAL pain

Question 1

difference between acetaminophen and ASA

Answer 1

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)

Question 2

what is the dosing of ibuprofen

Answer 2

3200mg max dose in day
MENSS

200-800mg TID/qid
NASSA- FASS

Question 3

naproxen dosing

Answer 3

250-500mg BID/TID

NaLgas-LeZZ

Question 4

nuisance se of NSAIDS

Answer 4

nausea and dyspepsia

Question 5

most common sx of NSAID

Answer 5

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)

Question 6

gastrointestinal protection for NSAIDS

Answer 6

misoprostol

NOT FOR PREGNANT WOMEN council ALLL PTs men too

can also use PPI or H2 with non-selective NSAID

Question 7

MOA of misoprostol

Answer 7

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

Question 8

what is the ASA sensitivity triad

Answer 8

20% of asthmatics are sensitive to ASA and NSAIDS

Question 9

major med interactions with NSAIDS

Answer 9

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

Question 10

additional signs of ASA toxicity include

Answer 10

hyperthermia
hyperventilation
respiratory alkalosis

Question 11

interaction with ASA and protein binding drugs

Answer 11

plasma levels increase disproportionately as dosing increases

protein bound drugs will increase as dose increases . whattttttt

Question 12

if pt is taking ASA for CV risk

Answer 12

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

Question 13

NSAID most commonly used in the hospital

Answer 13

ketorolac
one of the only ones available inj

can decrease opiate dose whne used in conjunction

ALWAYS LIMIT TO 5 DAYS

Question 14

Cox 1 is responsible for

Answer 14

renal and platelet function as well as protecting gastric mucosa

Question 15

which cox 2 inhibitor is still on the market

Answer 15

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

Question 16

Vicoprofen

Answer 16

combination opiod NSAID

hydrocodone and ibuprofen

Question 17

groups of opiates

Answer 17

diphenylheptane
methadone

phenylpipedrine
fentanyl, meperidine, sufentanil, alfentanil

phenanthrenes
morphine, codeine, hydrocodone

Question 18

these two opiates can both be used for post op shivering

Answer 18

fentanyl and meperidine

both part of the phenypiperidine family

Question 19

partial Mu agonists

Answer 19

tramadol
centrally acting synthetic opioid analgesic

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

Question 20

very low bioavailability with this opioid

Answer 20

fentanyl

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

Question 21

This opioid is seen with a larger Vd in the elderly

Answer 21

meperidine

probably just shouldn’t use it

(post op for shivers but really just use meperidine)

Question 22

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

Answer 22

codeine
meperidine
diacetylmorphine

Question 23

opoid receptro types: kappa

Answer 23

alaos produces analgesia similar to Mu

psychosis
slowed GI

Question 24

AE of opioid use with acute use

Answer 24

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

Question 25

tolerance will never be developed to this SE of opioids

Answer 25

CONVULSIONS miosis constipation

Question 26

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

Answer 26

bradycardia

Question 27

how do you convert between opioids

Answer 27

convert to total daily dose equivalent of PO morphine then reduce 25-50% for cross tolerance EXCEPT in methadone

Question 28

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

Answer 28

tramadol

Question 29

adj needed w/ tramadol

Answer 29

hepatic and renal impairment

Question 30

tramadol SE

Answer 30

can definitely cause respiratory depression can see terrible effects in elderly with decreased renal infuction

Question 31

why does tramadol suck

Answer 31

basically just as good as ibuprofen

Question 32

when would you want to titrate fentanyl

Answer 32

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)

Question 33

fentanyl patch is only good for

Answer 33

three days.

Question 34

what are the adverse SE that should warrent caution with methadone

Answer 34

QT prolongation hypotension hypoglycemia CVD dysrhythmia

Question 35

rapid onset and 8x more potent than morhphine

Answer 35

rapid onset hydromorphone also a C2 no rela benefit over morphone

Question 36

what are we worried about with deMEROL (meperidine)

Answer 36

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

Question 37

CI with meperidine

Answer 37

MAO syndrome if combined with MAOI

Question 38

opioid like compounds

Answer 38

dextromethorphan robo tripping (robitussin) codeine/guaifensesin

Question 39

diphenoxylate/atropine

Answer 39

lomotil antidiarrheal med atropine is to avoid abuse potential loperamide is similar but dose not cross BBB= no abuse

Question 40

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

Answer 40

fentanyl or methadone

Question 41

cardiovascular effects of opioids

Answer 41

``` peripheral vasodilation (histamine release) cerebral vasodilation (increase intracranial pressure) orthostatic ```

Question 42

GI effects of opioids

Answer 42

increased tone and decreased activity lead to constipation potential smooth muscle spasm

Question 43

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

Answer 43

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

Question 44

opioids you want to avoid with impaired renal function

Answer 44

morphine hydromorphone codeine

Question 45

buprenorphene MOA

Answer 45

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

Question 46

CI of buprenorphine

Answer 46

can precipitate opioid WD similar to naloxone | but less dangerous because you fall to partial agonist

Question 47

shorter the half life the grater that abuse potential what are other factors effecting abuse potential

Answer 47

lipophilicity (faster across BBB) heroin>morphine>methadone degree of Mu activity will feel w/d much more quickly

Question 48

buprenorphine

Answer 48

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

Question 49

preferred form form for unsupervised dosing

Answer 49

buprenorphine methadone you need supervised

Question 50

Nalozone differs from buprenorphine because

Answer 50

it is an antagonist | completely blocks

Question 51

morphine and amphetamines are all what durg class

Answer 51

II

Question 52

VICODIN is what schedule of drug

Answer 52

III

Question 53

PB and ambien are both what durg class

Answer 53

IV

Question 54

lomotil and low amounts of codeine are what drug class

Answer 54

V

Question 55

refill restrictions for drug classes

Answer 55

CII- no refills | CIII-V: 5 refills