module 4 non-opioid alagesics

Question 1

somatic pain

Answer 1

direct stimulation of afferent nerves

dull, aching, well-localized

Question 2

somatic pain examples

Answer 2

cuts
surgical incisions
burns
fractures
arthritis
cancer

Question 3

somatic pain managements

Answer 3

conventional analgesics

Question 4

visceral pain

Answer 4

direct stimulation of afferent nerves

poorly localized

Question 5

visceral pain examples

Answer 5

surgical pain:

- chest or abd. cavity

Question 6

visceral pain management

Answer 6

conventional analgesics

Question 7

neuropathic pain

Answer 7

injury to peripheral nerves

sharp, burning, shooting

Question 8

neuropathic pain examples

Answer 8

surgical interruption of intercostal nerves (mastectomy)
HZ
HIV
DM

Question 9

neuropathic pain management

Answer 9

antidepressants
anticonvulsants
non-drug therapy

Question 10

non-opioid analgesic drugs

Answer 10

acetaminophen
non-acetylated salicylates
acetylated salicylate (aspirin) 
selective COX-2 inhibitor (celecoxib)
Traditional NSAIDS

Question 11

non-acetylated salicylate drugs

Answer 11

choline magnesium trisalicylate
diflunisal
magnesium salcylate

Question 12

traditional NSAIDS

Answer 12

ibuprofen
naproxen
diclofenac
oxaprozin
etodolac
indomethacin
ketorolac
nabumetone
sulindac
tolmetin
piroxicam
meloxicam 
flurbiprofen

Question 13

non-opioid analgesic considerations

Answer 13

• first line agents for mild to moderate pain
• ceiling effect of ASA and APAP between 650 and 1300mg
• NSAID other than ASA have higher ceiling effect
• tolerance does not develop

Question 14

Acetaminophen

Answer 14

similar efficacy and potency as ASA
no anti-inflammatory effect
max safe dose 4g per day

Question 15

acetaminophen AE

Answer 15

hepatic injury

Question 16

acetaminophen caution/interactions

Answer 16

isoniazid, ETOH use

-> hepatotoxicity

Question 17

Salicylates (aspirin)

Answer 17

effective for most mild to moderate pain
Irreversible COX inhibition
- single dose inhibits plt for its lifetime

Question 18

aspirin AE

Answer 18

precipitate asthma
GI bleeding 
PUD 
overdose: metabolic acidosis, tinnitus
Reye's syndrome

Question 19

aspirin analgesic/antipyretic dose

Answer 19

325-600 mg

Question 20

aspirin anti-inflammatory dose

Answer 20

1000mg (3-5g/day)

• inc. dose gradually
• follow serum salicylate levels
• rarely used d/t GI AE

Question 21

non-acetylated salicylates

Answer 21

more favorable toxicity profile

• do not interfere with plts
• rarely assoc. with GI bleeding
• well tolerated with asthmatics