Gout And Pain (Opioids, Opiates) Flashcards

Question

Dosage Forms - Colchicine

Answer 1

Tablet: 0.6 mg Capsule: 0.6 mg Oral Solution: 0.6 mg/5 mL

Answer 2

Tablet: 40 mg, 80 mg

Answer 3

SL Tablet: 0.7/0.18, 1.4/0.36, 2/0.5, 2.9/0.71, 5.7/1.4, 8.6/2.1, 11.4/2.9 SL Film: 2/0.5, 4/1, 8/2, 12/3 Buccal Film: 2.1/0.3, 4.2/0.7, 6.3/1

Answer 4

Tablet: 15, 30, 60 W/ APAP: 300/15, 300/30, 300/60 Elixir (APAP/Codeine): 120/12

Answer 5

``` Transdermal Patch (mcg/hr): 12.5, 25, 50, 75, 87.5, 100 Transdermal Iontophoretic System: 40 mcg/actuation ```

Answer 6

Tablet (w/ APAP): 2.5/325, 5/325, 7.5/325, 10 mg/325 mg ER Tablet (24-hr, abuse-deterrent): 20, 30, 40, 60, 80, 100, 120 mg ER Capsule (12-hr, abuse-deterrent): 10, 15, 20, 30, 40, 50 mg Oral Elixir, Solution (w/ APAP per 15 mL): 7.5/325, 10/325

Answer 7

Tablet: 5 mg, 10 mg Soluble Tablet: 40 mg Oral Solution: 5 mg/5 mL, 10 mg/5 mL, 10 mg/1 mL

Answer 8

Tablet: 15 mg, 30 mg ER Tablet: 15, 30, 60, 100, 200 mg ER Abuse-Deterrent Tablet: 15, 30, 60, 100 mg Capsule (24 hr): 10, 20, 30, 40, 45, 50, 60, 75, 80, 90, 100, 120, 200 mg Oral Solution (mg/mL): 10/5, 20/5, 20/1, 100/5 Rectal Suppository: 5 mg, 10 mg, 20 mg, 30 mg

Answer 9

IR Tablet: 5, 10, 15, 20, 30 mg ER Tablet (12-hr Abuse-Deterrent): 10, 15, 20, 30, 40, 60, 80 mg Capsule: 5 mg 12-hr Abuse-Deterrent: 9, 13.5, 18, 27, 36 mg Oral Solution: 5 mg/5 mL Oral Solution Concentrate: 100 mg/5 mL

Answer 10

Tablet: 50 mg, 100 mg ER Tablet: 100, 200, 300 mg ER 24-Hour Capsule: 100, 150, 200, 300 mg Oral Solution: 5 mg/5 mL

Answer 11

Decreases the uric acid content by inhibiting xanthine oxidase, which is the enzyme responsible for converting hypoxanthine to xanthine and xanthine to uric acid

Answer 12

Decreases the uric acid content by inhibiting xanthine oxidase, which is the enzyme responsible for converting hypoxanthine to xanthine and xanthine to uric acid

Answer 13

Unknown. Thought to interrupt the cycle or monosodium urate crystal deposition in join tissues and therefore interrupts the inflammatory response that initiates and sustains an acute attack. Inhibits urate crystal deposition, which is enhanced by low pH in the tissues, likely by inhibiting oxidation of glucose and subsequent lactic acid production in leukocytes

Answer 14

Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation. It also decreases gastric, biliary, and pancreatic secretion, induces peripheral vasodilation, and promotes opioid-induced hypotension due to histamine release. Buprenorphine: a) Mu-opioid receptor partial Agonist b) Kappa-opioid receptor ANTAgonist Naloxone: Mu-opioid receptor ANTAgonist (causes opioid withdrawal when injected parenterally; used as an abuse deterrent)

Answer 15

3-methylmorphine that functions as a phenanthrene opioid, analgesic activity through conversion to morphine

Answer 16

Mu agonist and weak inhibitor of serotonin and norepinephrine reuptake

Answer 17

Unknown but opioid analgesic with antitussive properties

Answer 18

Pure mu agonist

Answer 19

Pure mu agonist

Answer 20

Phenylpiperidine opioid agonist with predominant effects on mu opioid receptor 50-100x more potent than morphine

Answer 21

Binds to opiate receptors in CNS therefore inhibiting ascending pain pathways, changing perception to pain and producing generalized CNS depression. Phenylethylamine opioid agonist that is qualitatively similar to morphine but chemical structure is unrelated to alkaloid-type structures of opium derivatives Analgesic activity of (R)-methadone is 8-50x (+ a tenfold higher affinity for opioid receptors) that of (S)-methadone

Answer 22

1. Gout, mild: 100-300 mg/day up to 800 mg 2. Gout, moderate-severe: 400-600 mg/day up to 800 mg 3. Hyperuricemia, tumor lysis syndrome (adults): 600-800 mg/day in 2-3 divided doses 4. Nephrolithiasis and prophylaxis due to calcium stones: 300 mg/day in 1-3 divided doses

Answer 23

1. Hyperuricemia in patients unable to tolerate or inadequately treat will allopurinol: 40 mg QD (up to 120 mg)

Answer 24

1. Gout, acute: 1.2 mg at first sign of flare, can add 0.6 mg in 1 hour (max: 1.8 mg over 1 hour) 2. Gout, prophylaxis: 0.6 mg QD to BID (MDD = 1.2 mg, or at onset of diarrhea) 3. Familial Mediterranean Fever (can adjust dose in 0.3 mg increments/day) a) Children 4-6 years: 0.3-1.8 mg QD b) Children 6-12 years: 0.9-1.8 mg QD c) Adults: 1.2-2.4 mg QD

Answer 25

1. Opioid use disorder (>16 years): 12-16 mg (buprenorphine component) QD sublingually, titrate to response [typical dosing rage: 4-24 mg/day]

Answer 26

1. Pain: 15-60 mg q4h PRN; w/APAP 300-1000 mg (MDD APAP = 4000 mg)

Answer 27

1. Pain, chronic, moderate to moderately severe: a) IR: 50 mg a4-6h PRN (MDD = 400 mg) b) ER: 100 mg QD (MDD = 300 mg) Converting IR:ER is 1:1 - round down to the nearest 100 mg

Answer 28

1. Pain, severe: 10 mg q12h, titrate to response

Answer 29

1. Pain, chronic, moderate to severe (opioid naïve patient): a) IR: 5-15 mg q4-6h PRN b) ER: 10 mg q12h PRN

Answer 30

1. Acute pain in hospitalized patients with low risk of respiratory depression: 10 mg q4h PRN (max 30 mg q4h) 2. Chronic pain, moderate to severe: a) IR: 10-20 mg q12h, titrate to response (use IR formulations to calculate patient's morphine requirement) b) ER: dosed q12-24 hours

Answer 31

1. Pain, chronic (moderate to severe): >2 years old, opioid-tolerant, with pain than cannot be managed by other meals a) Transdermal fentanyl dosage based on patients 24-hour ORAL morphine requirement b) Replace patch q72hr, can replace q48 if uncontrolled pain

Answer 32

1. Pain, chronic (moderate-severe) opioid-naïve patients: 2.5 mg q8-12h, may titrate to response 2. Drug detoxification, opioid abuse: 15-30 mg q8h (usual range 80-120 mg/day) - when used for treatment of opioid addiction (detoxification or maintenance), can only be dispensed by certified opioid treatment programs

Answer 33

1. Nephrolithiasis prophylaxis due to uric acid stones: 300 mg/day in 1-3 divided doses

Answer 34

1. Amyloidosis: 0.6 mg BID 2. Behcet syndrome: 0.6 mg BID-TID 3. Constipation: 0.6 mg q30min until diarrhea onset 4. Pericarditis: a) Adults > 70kg: 0.6 mg BID b) Adults < 70kg: 0.6 mg QD

Answer 35

1. Cough: 7.5-120 mg/d in divided doses

Answer 36

1. Restless leg syndrome: a) IR: 50 mg QHS b) ER: 100 mg QHS

Answer 37

``` Absorption: F = 80-90% Distribution: Vd = 1.6-2.43 L/kg Metabolism: hepatic (78%) and RBC Elimination: renal 80%; T1/2 parent = 2 hours; T1/2 active metabolite = 15-25 hours Hepatic Dose Adjustment: none Renal Dose Adjustment: a) 30-60mL/min: 50mg QD b) 15-30mL/min: 50mg every other day c) 5-10mL/min: 50mg 2x/week d) <5mL/min: 50mg once weekly ```

Answer 38

Absorption: F = 45% Distribution: Vd = 5-8 L/kg; 39% protein bound Metabolism: Partial CYP3A4/5, P-gp substrate Elimination: renal 40-65%; T1/2 = 26-32 hours Hepatic Dose Adjustment: severe, hepatic failure - once every 2 weeks Renal Dose Adjustment: <30mL/min: only once every 2 weeks

Answer 39

Absorption: F > 49% Distribution: Vd = 50L; 99% protein bound Metabolism: numerous enzymes Elimination: renal 50%; T1/2 = 5-8 hours Hepatic Dose Adjustment: caution if severe Renal Dose Adjustment: <30mL/min: max 40mg/day

Answer 40

Absorption: F = 15% (buprenorphine); 3% (naloxone) Distribution: Vd = 97-187 L (buprenorphine) Metabolism: a) Buprenorphine: hepatic, major CYP3A4 substrate b) Naloxone: hepatic via glucuronidation Elimination: renal 30%; T1/2 = 33 hours (buprenorphine) 6 hours (naloxone) Hepatic Dose Adjustment: caution Renal Dose Adjustment: none

Answer 41

Absorption: well absorbed Distribution: Vd = 2.6 L/kg; 7-25% protein bound Metabolism: prodrug activated by CYP2D6 to morphine; 2D6 substrate Elimination: renal ~100%; T1/2 = 2-4 hours Hepatic Dose Adjustment: AVOID chronic use in hepatic impairment Renal Dose Adjustment: a) 10-50mL/min: 75% of dose b) <10mL/min: 50% of dose

Answer 42

Absorption: F = 92% Distribution: Vd = 6 L/kg; 80-85% protein bound Metabolism: extensive hepatic, CYP3A4 substrate Elimination: renal 75%; T1/2 = 20-24 hours Hepatic Dose Adjustment: none Renal Dose Adjustment: <10mL/min: 50% dose reduction

Answer 43

Absorption: well absorbed Distribution: unknown Metabolism: prodrug activated to hydromorphone by CYP2D6; then CYP3A4 substrate Elimination: renal 26%; T1/2 = 8 hours Hepatic and Renal Dose Adjustment: severe - start with < 10 mg dose

Answer 44

Absorption: F = 85% Distribution: Vd = 3.6 L/kg; 85-90% protein bound Metabolism: hepatic, CYP2B6 and 3A4 substrate; moderate 2D6 inhibitor Elimination: renal 10-20%; T1/2 = 48-60 hours Hepatic Dose Adjustment: none Renal Dose Adjustment: none

Answer 45

Absorption: F <40%; food slows rate but not extend of absorption Distribution: Vd = 1.6 L/kg; 20-36% protein bound Metabolism: hepatic by glucuronidation Elimination: renal 90%; T1/2 = 15 hours Hepatic Dose Adjustment: Severe impairment, extend dosing interval or lower starting dose Renal Dose Adjustment: a) 10-50mL/min: decrease dose by 25% b) <10mL/min: decrease dose by 50%

Answer 46

Absorption: F= 60-87%, food enhances absorption Distribution: Vd= 2.6L/kg, 45% protein bound Metabolism: Hepatic, CYP3A4 substrate Elimination: renal 20%; T1/2 = 3-4 hours (IR); 5-18 hours (ER) Hepatic Dose Adjustment: titrate w/ caution a) IR: initiate lose dose; b) ER: initiate at 1/3-1/2 usual dose Renal Dose Adjustment: <60mL/min: reduce starting dose

Answer 47

``` Absorption: a) IR: F= 75% b) ER: F= 70% w/ variable food effect Distribution: Vd= 3L; 20% protein bound Metabolism: Hepatic via CYP3A4 and 2D6 Elimination: Renal 30%; T1/2 6 hour Hepatic Dose Adjustment: Moderate or severe, IR: 50mg PO q12h; AVOID ER Renal Dose Adjustment: <30mL/min, IR: extend interval to q12h (MDD: 200 mg); AVOID ER ```

Answer 48

1. Didanosine = AVOID 2. Azathioprine = reduce azathioprine dose by 1/3 or avoid use 3. Cyclophosphamide = monitor for toxic effects

Answer 49

1. Substrates for xanthine oxidase 2. Contraindicated with azathioprine or mercaptopurine 3. Caution with didanosine, theophylline

Answer 50

1. Lipid-lowering agents (fibrates, statins) = AVOID | 2. CYP3A4 inducers/inhibitors = monitor

Answer 51

1. CYP3A4 inducers/inhibitors = monitor and consider dose adjustments 2. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = monitor

Answer 52

1. CYD2D6 inhibitors = AVOID 2. Opioid agonists/antagonists = AVOID d/t withdrawal 3. CNS depressants (opioids, alcohols) = AVOID 4. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = AVOID 5. SSRIs, SNRIs, TCAs, Triptans = counsel when takin in combination with

Answer 53

1. CYP3A4 inducers/inhibitors = consider dose increase w/inducers, avoid w/strong or moderate inhibitors 2. Opioid agonist/antagonist = AVOID d/t withdrawal 3. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines 4. Beta-blockers and calcium channel blockers = AVOID 5. MAOIs = AVOID 6. SSRIs, SNRIs, TCAs, Triptans = counsel when taken in combination with

Answer 54

1. CYP2D6 inhibitors = monitor and consider dose increase 2. CYP3A4 inducers/inhibitors = monitor and consider dose increase w/inducers; avoid with strong inhibitors; caution with moderate inhibitors and consider dose decrease 3. Opioid agonist/antagonist = AVOID d/t withdrawal 4. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = AVOID 5. MAOIs = AVOID 6. SSRIs, SNRIs, TCAs, Triptans = counsel when taken in combination with

Answer 55

1. CYP2B6 inhibitors/inducers = monitor 2. CYP2D6 substrates = AVOID 3. CYP3A4 inducers/inhibitors = monitor 4. Opioid agonists/antagonists = AVOID d/t withdrawal 5. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = AVOID 6. MAOIs = contraindicated 7. SSRIs, SNRIs, TCAs, Triptans = counsel when taken in combination with 8. Amiodarone, agents that prolong QT interval = AVOID 9. Didanosine = separate use by 1-2 hours

Answer 56

1. Opioid agonist/antagonists = AVOID d/t withdrawal 2. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = AVOID 3. MAOIs = contraindicated 4. SSRIs, SNRIs, TCAs, Triptans = counsel when taken in combination with

Answer 57

1. CYP3A4 inducers/inhibitors = caution 2. Opioid agonists/antagonists = AVOID d/t withdrawal 3. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = AVOID

Answer 58

1. CYP2D6 inhibitors = consider dose decrease 2. CYP3A4 inducers/inhibitors = consider dose changes 3. Opioid agonists/antagonists = AVOID d/t withdrawal 4. Barbiturates, benzodiazepines, muscle relaxants, phenothiazines = AVOID 5. MAOIs = contraindicated 6. SSRIs, SNRIs, TCAs, Triptans = counsel when taken in combination with

Answer 59

Pregnancy: caution Lactation: compatible

Answer 60

Pregnancy: compatible Lactation: probably compatible

Answer 61

Pregnancy: caution Lactation: possibly toxic

Answer 62

Probably compatible

Answer 63

Contraindicated

Answer 64

Pregnancy: risk Lactation: compatible

Answer 65

Pregnancy: risk Lactation: compatible

Answer 66

Increased risk of death (cardiac, all-cause)

Answer 67

1. Serious risks of misuse, abuse, addiction, overdose, and death 2. Concurrent use with benzodiazepines/CNS depressants/ethanol 3. Hepatotoxicity 4. Neonatal opioid withdrawal 5. Accidental Ingestion 6. Children who are CYP2D6 ultra-rapid metabolizers

Answer 68

1. Concurrent use with benzodiazepines/CNS depressants/ethanol 2. Respiratory Depression 3. CYP3A4 interactions 4. REMS 5. Accidental Ingestion 6. Transdermal not for use post-operatively; fatalities in children; formulations not interchangeable; fever; care with disposal

Answer 69

1. Serious risks of misuse, abuse, addiction, overdose, and death 2. Concurrent use with benzodiazepines/CNS depressants/ethanol 3. Respiratory Depression 4. Hepatotoxicity 5. Neonatal opioid withdrawal 6. CYP3A4 interactions 7. REMS 8. Accidental Ingestion

Answer 70

1. Serious risks of misuse, abuse, addiction, overdose, and death 2. Concurrent use with benzodiazepines/CNS depressants/ethanol 3. Respiratory Depression 4. Neonatal opioid withdrawal 5. REMS 6. Accidental Ingestion 7. QTc prolongation; conditions for use in opioid addiction; CYP interactions

Answer 71

1. Serious risks of misuse, abuse, addiction, overdose, and death 2. Concurrent use with benzodiazepines/CNS depressants/ethanol 3. Respiratory Depression 4. Neonatal opioid withdrawal 5. REMS 6. Accidental Ingestion 7. Medication errors

Answer 72

1. Serious risks of misuse, abuse, addiction, overdose, and death 2. Concurrent use with benzodiazepines/CNS depressants/ethanol 3. Respiratory Depression 4. Neonatal opioid withdrawal 5. CYP3A4 interactions 6. REMS 7. Accidental Ingestion 8. Medication errors with oral solution

Answer 73

1. Serious risks of misuse, abuse, addiction, overdose, and death 2. Concurrent use with benzodiazepines/CNS depressants/ethanol 3. Respiratory Depression 4. Neonatal opioid withdrawal 5. REMS 6. Accidental Ingestion 7. CYP2D6, drug interactions, errors

Answer 74

Patients with renal and/or hepatic failure

Answer 75

Avoid use in < 12 years of age or aged 12-18 years post-op after tonseillectomy

Answer 76

Avoid in acute or post-operative pain, bronchial asthma, mild or intermittent pain, opioid non-tolerant patients and paralytic ileus

Answer 77

Avoid in paralytic ileus, respiratory depression, severe asthma

Answer 78

Avoid in bronchial asthma, paralytic ileus, respiratory depression, hypercarbia

Answer 79

Avoid in acute or severe asthma, paralytic ileus, respiratory depression, GI obstruction, concurrent use or within 14 days of MAOI

Answer 80

Avoid with asthma, paralytic ileus, respiratory depression, hypercarbia

Answer 81

Avoid with paralytic ileus, respiratory depression, bronchial asthma, age < 12 years, hypercapnia, current MAOI use or use within the last 14 days

Answer 82

Common: none Less common: Rash, maculopapular eruption, acute attacks of gout with initiation Rare but serious: Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia, granulomatous hepatitis, hepatotoxicity, immune hypersensitivity reaction, renal failure

Answer 83

Common: D/N Less common: vomiting Rare but serious: agranulocytosis, rhabdomyolysis

Answer 84

Common: none Less common: rash, nausea, elevated LFTs, arthralgia Rare but serious: ECG abnormalities, hypersensitivity, stroke, mood changes, drug reaction rash with eosinophilia and systemic symptoms

Answer 85

Common: Vasodilation, sweating, headaches, insomnia, constipation, GI distress, opioid withdrawal, dizziness Less common: Dyspnea, respiratory depression, glossodynia Rare but serious: Stevens-Johnson syndrome, physical dependence, tolerance, elevated liver functions tests, seizures

Answer 86

Common: Nausea, vomiting, constipation, somnolence Less common: Pruritus, euphoria, dizziness Rare but serious: Stevens-Johnson syndrome, GI bleeding, elevated liver functions, thrombocytopenia, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones

Answer 87

Common: Application site reactions, sweating, constipation, GI distress, confusion, headache, anxiety, urinary retention, fatigue Less common: Arrhythmias, chest pain, dyspnea, respiratory depression upper respiratory tract infection Rare but serious: Stevens-Johnson syndrome, physical dependence, tolerance

Answer 88

Common: Constipation, GI distress, somnolence Less common: Rash, respiratory depression, euphoria, pruritus Rare but serious: Stevens-Johnson syndrome, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones

Answer 89

Common: Constipation, GI distress, hypotension, dizziness, sedation Less common: Diaphoresis, physical dependence, tolerance Rare but serious: Respiratory depression, arrhythmias, Stevens-Johnson syndrome, QTc prolongation, serotonin syndrome, adrenal insufficiency, hypogonadism

Answer 90

Common: Constipation, nausea, vomiting, hypotension, dizziness, sedation, diaphoresis, headaches, depression, xerostomia Less common: Dyspnea, urinary retention, edema, pruritis Rare but serious: Cardiac arrest, physical dependence, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones

Answer 91

Common: Constipation, GI distress, sedation, sweating, pruritus Less common: Asthenia, dyspnea, hypotension, euphoria, nausea, vomiting Rare but serious: Cardiac arrest, respiratory depression, physical dependence, tolerance, severe hypersensitivity, serotonin syndrome, adrenal insufficiency, decreased sex hormones

Answer 92

Common: Constipation, GI distress, dizziness, sedation, edema, sweating, pruritus, headaches, flushing Less common: Dyspnea, xerostomia, depression, orthostatic hypotension Rare but serious: Cardiac arrest, physical dependence, tolerance, seizures, pancreatitis, suicidal ideation, anemia, serotonin syndrome, adrenal insufficiency, decreased sex hormones

Answer 93

Efficacy: Resolution of signs of gout, serum uric acid measured 48 hours after therapy Toxicity: LFTs, renal function, CBC

Answer 94

Efficacy: Resolution of gout s/sx Toxicity: CBC, Alk Phos at baseline & periodically, s/sx of agranulocytosis or myotoxicity, renal & hepatic function

Answer 95

Efficacy: Reduction in uric acid levels < 6mg/dL, decrease in gout attacks Toxicity: LFTs baseline & periodically, s/sx of CV events, s/sx of hypersensitivity or severe skin reactions

Answer 96

Efficacy: UDS(-) for illicit drugs, relief of s/sx associated with narcotic addiction Toxicity: Severe skin rash, excessive drowsiness, decreased breathing, severe constipation

Answer 97

Efficacy: Decreased pain Toxicity: LFTs, SCr Chronic use: severe skin rash, black tarry stools, excessive drowsiness, yellowing of eyes & skin, change in urination

Answer 98

Efficacy: Relief of pain Toxicity: Severe skin rash, excessive drowsiness, decreased breathing, HR, severe constipation, chest pain, inability to urinate, constipation

Answer 99

Efficacy: Relief of pain Toxicity: Seek medical attention if severe skin rash, excessive drowsiness, decreased breathing, severe constipation, black tarry stools or yellowing of eyes or skin

Answer 100

Efficacy: Relief of pain, relief of s/sx associated with opioid addiction Toxicity: Seek medical attention if severe skin rash, excessive drowsiness, decreased breathing, severe constipation, chest pain or dizziness; vital signs. Consider ECG if on other QTc prolonging agents

Answer 101

Efficacy: Relief of pain Toxicity: Excessive drowsiness, decreased breathing, severe constipation, chest pain, dizziness , vital signs

Answer 102

Efficacy: Relief of pain Toxicity: Excessive drowsiness, severe skin rash, decreased breathing, severe constipation, chest pain, dizziness. Monitor vital signs, specifically RR and BP

Answer 103

Efficacy: Relief of pain Toxicity: Excessive drowsiness, decreased breathing, severe constipation, chest pain, dizziness, signs of tolerance. Monitor vital signs

Answer 104

Counseling: Take at after meals to lessen gastric irritation. Adequate hydration to prevent kidney stones. Avoid alcohol and caffeine. Seek medical attention if s/sx of myelosuppression, agranulocytosis or SJS occur. Pearls: Not for acute treatment therefore patient adherence is crucial. Full effect can take 2-6 weeks. Recommend slow dose titration.

Answer 105

Counseling: Ensure patient is aware of proper dosing strategy for gout flares (dosing to symptom relief or onset of ADR, particularly diarrhea) Pearls: Medication guide required for dispensing. A natural alkaloid found in plants like the autumn crocus and glory lily

Answer 106

Counseling: Take at without food. Recommend weight loss and limitation of alcohol to reduce gout attacks. Seek medical attention for severe mood swings, rashes or abnormal heartbeat. Pearls: More effective in lowering uric acid levels but caused higher LFT levels than allopurinol. Associated with greater risk of CV-related death and all cause death. May need prophylactic therapy with NSAID or Colchicine for the first 6 months of initiation due to an increase in gout flares.

Answer 107

Counseling: Use a stool softener and/or laxative to prevent constipation. Avoid driving and tasks requiring motor coordination due to drowsiness. Avoid alcohol and other CNS depressants. Do not crush or swallow tablet. Place tablet(s)/film under the tongue until it dissolves. If a second film is needed, place on the opposite side from the first film. For buccal film, press and hold firm by finger against moist cheek for 5 seconds, do not use more than 2 buccal films at a time. If a second film is needed, place on the opposite cheek. Pearls: Monitor for signs of diversion. Concurrent use with opioids with precipitate withdrawal symptoms. There is a ceiling effect which limits the analgesic properties. Sublingual film and tablet strengths are NOT interchangeable. Do not substitute within products. REMS program. Additional counseling and psychosocial support is recommended. Not recommended for treatment of dependence on long-acting opiates or methadone but useful for withdrawal of short-acting opiates and heroin.

Answer 108

Counseling: If using chronically, laxative is recommended to prevent constipation. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol. Pearls: Caution in elderly as they are more sensitive to effects. Caution with other CNS depressants due to additive effects. Avoid use with benzodiazepines. Tolerance and physical dependence may occur; avoid abrupt discontinuation. Oral solution has 7% alcohol. Has a liquid formulation combination with guaifenesin for cough. CYP2D6 gene interaction Multiple genes - ultra-rapid metabolism Lack functional genes - do not metabolize codeine to morphine

Answer 109

Counseling: Use stool softener and/or laxative to prevent constipation. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol and CNS depressants. Pearls: Caution in elderly. Avoid use with benzodiazepines. Tolerance and physical dependence may occur  do not abruptly stop. If using with APAP, do not exceed > 3 grams of APAP/day

Answer 110

Counseling: Use motility-promoting laxative to prevent constipation. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol and CNS depressants. Seek medical attention if SOB or extremely drowsy. Breast-feeding women should monitor child for signs of sedation & respiratory depression. Pearls: Tolerance and physical dependence may occur  do not abruptly stop. High patient variability therefore careful initiation and titration dosing. Fatal respiratory depression has occurred with the highest risk at initiation and with dosage increases. For oral administration only. Do not chew or swallow table for suspension-dissolve in liquid and drink. Keep away from children and pets. Should avoid use with benzodiazepines. Medication guide required at dispensing. REMS requirements.

Answer 111

Counseling: Use laxative to prevent constipation. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol and CNS depressants. Apply to clean, dry skin. Skin breaks may increase absorption. Remove old patch when new one applied. Febrile patients may have increased absorption. Monitor carefully Pearls: Not for acute pain. Caution in elderly, due to increased sensitivity for ADR. Tolerance and dependence can occur, avoid abrupt discontinuation. REMS requirements. Also available as injectable, nasal spray, oral liquid, buccal film, buccal tablet, and sublingual tablet. Substantial differences exist in the pharmacokinetic profile of fentanyl products. Do not convert patients on a mcg-per-mcg basis from one fentanyl product to another fentanyl product; the substitution of one fentanyl product for another fentanyl product may result in a fatal overdose. Do not cut patch. Contraindicated in opioid-naïve patients; use limited to opioid tolerant patients. Avoid concomitant use with benzodiazepines, alcohol or other CNS depressants. Absorption from patch is delayed 12-24 h after patch placement due to depot effect in the outer layer of skin. Skin depot also results in lingering presence of drug in serum after patch removal.

Answer 112

Counseling: Use stimulant laxative to prevent constipation. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol and CNS depressants. ER products should not be crushed or chewed as it will release the total morphine dosage at once and increase the risk of respiratory depression. ER capsule can be opened and sprinkled on soft food but must be swallowed whole and not chewed. Pearls: Avoid use with benzodiazepines. Tolerance and physical dependence may occur  do not abruptly stop. 20mg/mL concentration is only for opioid-tolerant patients. REMS requirements. ER products should not be used in children. Fatal respiratory depression has occurred but commonly at dose start or change. Avinza cannot be administered with alcoholic beverages or ethanol-containing products.

Answer 113

Counseling: Use laxative to prevent constipation. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol and CNS depressants. Pearls: Significant drug of abuse. Tolerance and physical dependence may occur  do not abruptly stop. ER products cannot be crushed or chewed because it will release total oxycodone dose and increase risk of respiratory depression. ER products should not be used in children. Keep in safe space away from children. Do not use with benzodiazepines. REMS requirements. Preferred to be used in combination with APAP due to beneficial pain management effect abuse potential.

Answer 114

Counseling: Use laxative to prevent constipation if used chronically. May cause drowsiness, avoid driving or other tasks requiring motor coordination. Avoid alcohol and CNS depressants. ER products cannot be crushed or chewed, but can be taken with or without food, but always take the same way to avoid absorption variability. Pearls: Tolerance and physical dependence may occur  do not abruptly stop. Tramadol related deaths have been reported in patients with histories of emotional disturbances, suicidal ideation/attempts, or misuse of tranquilizers, alcohol and other CNS-active drugs. Suspension and creams are available in compounding kits. Avoid use with benzodiazepines. Tramadol does not appear to produce significant respiratory depression or CV effects in most patients.