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Clin Pharm Exam Two > MSK Case Wrap Up > Flashcards

MSK Case Wrap Up Flashcards

1
Q

What is the MOA of acetaminophen?

A

Inhibits the synthesis of prostaglandins in the CNS and works peripherally to block pain impulse generation.

-It is a poor inhibitor of platelet fxn with very little anti-inflammatory properties.

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2
Q

What are two types of acetaminophen and how are they metabolized?

A

APAP, tylenol

Metab in liver

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3
Q

What is the max dose of APAP recommended per day? What about in the elderly?

A

4 grams daily or 3 grams daily

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4
Q

What type of pain reliever is best in pregnangy?

A

APAP

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5
Q

What is the antidote for APAP?

A

N-acetylcystine (Mucomyst)

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6
Q

What is the MOA of salicylates (Aspirin/ASA)?

A

Reduces prostaglandin and thromboxane A2 synthesis

-Also inhibits platelet aggregation (blood thinning component) which also irreversibly inhibits platelet fxn for the life of the platelet, and interferes with hemostasis and prolongs bleeding time.

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7
Q

Reye’s syndrome is associated with what non-opioid analgesic?

A

ASA

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8
Q

What doses does APAP normally come in and then what is the extra strength one?

A

325mg

extra strength: 500mg

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9
Q

What is the dose for APAP and arthritis?

A

650mg

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10
Q

What are the two normal doses of ASA and what is the extra strength dose?

A

81, 325mg

Extra strength 500mg

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11
Q

What are the three main non-selective NSAIDs?

A

Ibuprofen, Naproxen and naproxen sodium

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12
Q

What is the selective NSAID?

A

Celecoxib

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13
Q

T/F: just because a patient does not respond to one NSAID it doesn’t mean they wont respond to another

A

True

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14
Q 
Which med is mc used for:
-Anti-coagulation
-Anti-pyresis
oRelief of pain from:
• Osteoarthritis •Migraine headaches •Muscular pain
A

ASA

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15
Q 
Which med is mc used for:
oAnti-pyresis
oRelief of pain from: 
• Osteoarthritis
•Migraine headaches •Skeletal pain •Muscular pain
oPain in pregnant women
A

APAP

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16
Q 
Which med is mc used for:
oAnti-pyresis
oRelief of pain/inflammation from:
•Dysmenorrhea
•Migraine/tension headaches •Muscular/tendinous pain/strain/sprain
A

NSAID

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17
Q

NSAIDs reduce ____ &____ whereas APAP only reduces ___

A

pain & inflammation vs pain only

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18
Q

NSAIDs are to be avoided in _______ because can cause inhibition of bone healing and _____ should be used instead

A

fracture, APAP

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19
Q

NSAID can increase ____ so it is best to avoid in these patients

A

BP, pt with uncontrolled hypertension

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20
Q

Name a parenteral (other than mouth) NSAID

A

Ketorolac (tordol)

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21
Q

How many days can you use Ketorolac (tordol) for?

A

injectable and 5 days

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22
Q

Beware of this side effect of ketorolac (tordol) esp in the elderly?

A

Severe GI toxicity

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23
Q

Beware of this side effect of tordol in all age groups.

A

Acute renal failure after a single dose of tordol

(recommended that dosage should be adjusted downward by 50% if given in the elderly) but should generally be avoided

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24
Q

This med is mc used for:
oOutpatient relief of pain/inflammation from:
•Migraine headaches •Severe pain

A

Tordol

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25
Q

What are two adverse effects of non-selective NSAIDS?

A

exacerbation of CHF and increased BP and can also cause renal failure

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26
Q

______ Can precipitate asthma and anaphylactoid rxn in aspirin-sensitive patients

A

Non-selective NSAIDs

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27
Q

_______ can interfere with the antiplatelet effect of aspirin. Aspirin for CV protection should not take ibuprofen regularly; Taken ___ hrs after taking aspirin

A

Ibuprofen, ASA

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28
Q

Can you combine NSAIDs?

A

No

29
Q

What doses does ibuprofen come in? What is the dose freq and what is the max dose?

A

Ibuprofen 200, 400, 600 (800)

  • Max = 2400 (3200)
  • q4-6 hr (q8hr)

-I think the 800 is for RA or OA

30
Q

What doses does naproxen come in?What is the dose freq and what is the max dose?

A

Naproxen 250, 375 (500)

  • Max = 1000
  • Freq 6-8 hr (12h)
31
Q

What doses does naproxen sodium come in?What is the dose freq and what is the max dose?

A

Naproxen Sodium 220, 550

  • Max = 1100
  • Freq 6-8 hr (12h)
32
Q

What is the dosing of celebrex?

A

100-200 BID

33
Q

What is one advantage of celebrex over other non-selective NSAIDs?

A

less GI toxicity BUT there is an increased MI and CVA risk

34
Q

What is the antidote for NSAIDs?

A

None

35
Q

There are stronger and weaker opioids. What are the weaker ones? What is the most potent one?

A

Weaker: hydrocodone, codeine, tramadol
Strongest: fentanyl

36
Q

What are two other names for Oxycodone?

A

Percocert, OxyContin

37
Q

What are two other names for Oxycodone?

A

Percocet, OxyContin

38
Q

This opioid is derived from morphine and is only available in oral formulations

A

oxycodone

39
Q

This opioid is available in IV, IM, SubQ, rectal and short and long acting formulations and is preferred over morphine in renal failure

A

hydromorphone

40
Q

This drug has only approximately 10% effectiveness of morphine with significant anticholinergic and
local anesthetic properties

A

Meperidine (Demerol)

41
Q

What drug should NOT be used with Meperidine because it can cause severe encephalopathy and death

A

MAOI (Isocarboxazid, Phenelzine, Selegiline)

42
Q

What is a common side effect of opioids?

A

constipation, sedation, n/v, resp depression

43
Q

Another name for opioids is _______

A

narcotics

44
Q

What is an antidote for narcotics?

A

Naloxone (narcan)

45
Q

______ appear to be less effective than tricyclic antidepressants for treatment of neuropathic pain

A

SSRIs

46
Q

What would be the best option for a patient with diabetic peripheral neuropathy or fibromyalgia to treat pain with minimal side effects?

A

Antidepressants
Duloxetine (Cymbalta)
-Can also use Venlafaxine (effexor) or TCAs (amitryptline)

47
Q

What anticonvulsant is best effective for postherpetic neuralgia and diabetic neuropathy?

A

Gabapentin

48
Q

What other categories of meds can be used for pain?

A

Antidepressants and anticonvulsants

49
Q

What are two mc sxs of gabapentin?

A

Dizziness and somnolence

50
Q

This drug has been used in postherpetic neuralgia, diabetic peripheral neuropathy, fibromyalgia but it is a schedule V controlled substance due to reports of ______ when taking it

A

euphoria

51
Q

These two meds are used for treatment of pain due to trigeminal neuralgia?

A

oxcarbazepine > carbamazepine

52
Q

This drug can cause rash that has sometimes progressed to Stevens-Johnson syndrome.

A

lamotrigine

53
Q

______ may enhance the analgesic effect of acetaminophen, aspirin or ibuprofen

A

caffeine

54
Q

______ in doses of 25-50 mg given parenterally may add to the analgesic effect of opioids in postoperative and cancer pain while reducing the incidence of nausea and vomiting.

A

hydroxizine

55
Q

______ can produce analgesia in some patients with inflammatory diseases or tumor infiltration of nerves.

A

corticosteroids

56
Q

What are some main s/e of corticosteroids?

A
  • Increased appetite.
  • Weight gain.
  • Changes in mood.
  • Muscle weakness.
  • Blurred vision.
  • Increased growth of body hair.
  • Easy bruising.
  • Lower resistance to infection.
57
Q

This alpha2- adrenergic agonist may improve pain and hyperalgesia.

A

clonidine

58
Q

What are common muscle relaxants and what is the evidence behind them?

A

Cyclobenzaprine (Flexeril), Metaxalone (Skelaxin), Carisoprodol (Soma)

They do not work well and they don’t have strong evidence for them

59
Q

T/F: muscle relaxants are considered safe in pregnancy?

A

No muscle relaxants are considered safe during pregnancy and lactation

60
Q

What does abortive migraine treatment mean?

A
  • Stops or prevent the progression of a headache or reverse a headache that has started
  • Treats pain and other symptoms after the attack has begun
61
Q

What does prophylactic migraine treatment mean?

A

o Frequent headaches that cause disability(=>2 per month)
-Overuse of acute medication (> 2 times per week)
-Acute medications are not effective, well tolerated or are
contraindicated
-Reduce the frequency and severity of the migraine attack

62
Q

What are first line abortive pharmacological agents?

A

NSAID, APAP, ASA/APAP/Caffeine (Excedrin)

63
Q

What are second line abortive pharmacological agents?

A
  • Triptans
  • ASA or APAP/Caffeine/Butalbital (Fioricet/Fiorinal)
  • Ergotamines
  • Injectable ketorolac (Torodol)
64
Q

What is the MOA of triptans?

A
  • serotonin receptor agonist of the 5-HT1b and 5-HT1D with normalization of dilated intracranial arteries thru:
  • enhanced vasoconstriction
  • peripheral neuronal inhibition
65
Q

What is the fastest acting triptan and which is the slowest?

A

Sumatriptan (Imitrex®) (go to)

66
Q

What are the two fastest acting triptans?

A
  1. Sumatriptan (Imitrex®)
    - Subcutaneous
    - Nasal spray
    - Tablets
  2. Zolmitriptan (Zomig®)
    - Tablets ODT (ZDT) Nasal -Spray
  3. Rizatriptan (Maxalt®)
    - Tablets ODT (MLT)
67
Q

This is an amazing class of drugs that functions as a vasodilator on the trigeminovascular system that involves once monthly SQ injections

A

Calcitonin gene-related peptide antagonists (CGRP)

  • Aimovig
  • Ajovy
  • Emgality
68
Q

The goal of pain management is ______

A

function

69
Q

What are first line prophylaxis meds for migraine?

A

Divalproex (Depakote), topiramate (Topamax), metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered as first-line treatment.

Clin Pharm Exam Two (6 decks)

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