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CDM 2 Exam 2 > Lecture 4.3 - Pain management (APAP & NSAIDs) > Flashcards

Lecture 4.3 - Pain management (APAP & NSAIDs) Flashcards

1
Q

Primary indications for APAP & NSAIDs

A

pain relief for patients who do not respond to non-pharmacologic interventions

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2
Q

APAP vs NSAIDs

A

APAP: can be used in Mild-moderate pain but no chronic low back pain

NSAIDs: can be used n Mild, Moderate, Severe pain….they reduce inflammation unlike APAP

NSAIDs more effective but APAP better safety profile

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3
Q

APAP onset

A

30 min

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4
Q

APAP duration

A

about 4 hrs, 4-6hrs with ER formulation

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5
Q

Renal Dosing APAP

A

CrCl 10-50 = q6h

CrCl < 10 = q8h

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6
Q

SE APAP

A

Overall well tolerated

overdose
liver toxicity
GI ( 2g > day), nephrotoxicity (high dose, chronic use)

Max dose is 4g/day technically

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7
Q

When not to use APAP

A

Sig liver disease
Sig alcohol use > 3 drink/day
Achieving pain relief only at high dose

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8
Q

Should Not exceed how many days when using Ketorolac?

A

5 days of total use

inc in risk of adverse effects after that

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9
Q

Avoid oral diclofenac due to…

A

increased CV events
Causes more liver toxicity
More GI toxicity

topical is still okay

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10
Q

Max daily ibuprofen dose

A

RX: 3200mg

OTC: 1200mg

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11
Q

Max Naproxen sodium (IR) dosing

A

RX: 1375-1650mg

OTC: 660mg

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12
Q

General Naproxen Sodium & Ibuprofen Dosing RX vs OTC

A

RX: tend to be higher doses

OTC: tend to be lower

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13
Q

GI side effects from NSAID

A

Dyspepsia, ulcer, bleeding

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14
Q

How to protect Dyspepsia from NSAIDs

A
  1. Take w/ food
  2. Antacids
  3. Enteric coated, buffered, SR or PR dosage forms
  4. H2 blockers
  5. PPI
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15
Q

How to protect Ulcer/Bleed from NSAIDs

A

Enteric coating, buffering, SR DO NOT PROTECT FROM BLEEDING

using Selective NSAID (COX - 2 inhibitor) can help

negative effects due to COX-1 inhibition

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16
Q

Selective NSAID ulcer protection

A

Celecoxib

NTE: 200mg/day

If used with ASA, GI benefit is negated

Can also do a PPI add on, misoprostol, or high dose H2 blocker

17
Q

Non-selective NSAID ulcer protection

A

Ibuprofen likely more safe for GI compared to other non-selective NSAIDs

PPI add on is best, can also do misoprostol, or high dose H2 blocker

18
Q

When to stop NSAID prior to procedure?

A

Cox-2 inhibitor = stop day before

Non-selective NSAID = D/x 7 days prior

19
Q

Likely Safer nonselective NSAID for CV risk?

A

Naproxyn

20
Q

NSAIDs are CI in what surgery?

A

CABG

21
Q

Low CV Risk, Low GI Risk give….

A

Celecoxib or other low-risk NSAID

22
Q

Low CV risk, Moderate GI risk give…

A
  1. Celecoxib alone

2. NSAID + PPI, misoprostol, or double dose H2-blocker (2nd line)

23
Q

Low CV risk, High GI risk give…

A
  1. Avoid NSAID if possible

2. Celecoxib + PPI or misoprostol

24
Q

High CV risk, Low GI risk give….

A

Naproxen or low-dose celecoxib

If on ASA = naproxen + PPI

25
Q

High CV risk, Moderate GI risk give…

A
  1. Naproxen + PPI, misoprostol, or double dose H2-blocker

2. Low dose Celecoxib

26
Q

High CV risk, High GI risk give…

A

Avoid NSAIDs

27
Q

Low GI risk =

A

without risk factors

28
Q

Moderate GI risk =

A

1 or 2 risk factors

29
Q

Highest GI risk =

A

h/o complicated or recent ulcer, with more than 2 risk factors

30
Q

GI risk factors

A

> 60yrs old
current high dose of NSAID
uncomplicated peptic ulcer history
Concomitant use of ASA, Anticoagulants, corticosteroids

31
Q

High CV risk considerations

A

h/o CV event, diabetes, HTN, hyperlipidemia, obesity

32
Q

Taking NSAIDs with ASA then…

A

Take ASA first, NSAID 2nd and separate…dont take within 2hrs

33
Q

Concurrent drugs that increase bleeding risk with NSAIDs

A

anticoagulants
Steroids
SSRIs

34
Q

NSAID Kidney Adverse effects risk factors

A

Elderly
Decreased renal function
Volume depletion secondary to diuretics, cirrhosis or HF

35
Q

DI that put you at risk for NSAID Kidney issues

A

Diuretics
ACEi/ARBs
All ant-HTN meds
May inc toxicity of lithium and methotrexate

36
Q

Topical NSAIDs are effective in….

A

surface level joints….ie shoulder, knuckles,etc

CDM 2 Exam 2 (16 decks)

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