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therapeutics > Non-Malignant Pain part 2 > Flashcards

Non-Malignant Pain part 2 Flashcards

1
Q

List adjunctive therapies in pain management

A

Gabapentinoids
Serotonin norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
Skeletal muscle relaxants
Antiepileptics
Topical agents

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2
Q

T or F: Gabapentinoids are used in fibromyalgia, neuropathies and in post operative pain.

A

T

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3
Q

List the three available formulations of gabapentin and pregabalin

A

tablets/capsule
Er tablet
Liquid solution

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4
Q

Select the recommended dosing for Gabapentin
A. 100-300mg PO daily
B. 100-200mg PO BID
C.100-300mg PO TID
D. 200-300 PO TID

A

C (max of 3600mg/day)

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5
Q

Select the recommended dosing for pregabalin
A.75-100mg PO daily
B.100mg PO BID
C.50mg PO BID
D. 75mg BID

A

D. max 600mg/day

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6
Q

list the three side effects of gabapentinoids

A

sedation
diziness
peripheral edema

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7
Q

T or F Gabapentinoid dosing does not have to be adjusted with renal complications

A

F (must be renally dose adjusted)

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8
Q

What can you do to limit the sedation side effect of gabapentin?

A

titrate up dose to limit sedation

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9
Q

T or F: Pregabalin is a schedule V controlled substance, gabapentin is unscheduled

A

T

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10
Q

Why are gabapentinoids used

A

adjunct tx used in combination to decrease requirements of other analgesics

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11
Q

Which SNRIs are used as adjuncts to treat fibromyalgia and neuropathy?

A

Venlafaxine and Duloxetine

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12
Q

list the available formulations of SNRIS

A

Tablet
ER tablet
DR capsule

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13
Q

What is the recommended dosing for Duloxetine
A. 37.5-75mg PO daily x 1week then increase to 60mg PO daily
B. 60mg mg PO daily x 1week then increase to 120mg PO daily
C. 30mg PO daily x 1week then increase to 60mg PO P)

A

C (max 60mg daily)

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14
Q

list the 5 SE associated with SNRIs

A

nausea, headache, hypertension, sedation, and weakness

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15
Q

What are the clinical pearls for SNRIs

A

Start low dose and titrate up to minimize SE
renally dose adjust venlafaxine and avoid duloxetine for CrCl< 30ml/min

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16
Q

What is the recommended dosing for venlafaxine
A. 37.5 – 75mg PO daily
B. 75mg Po daily
C. 60mg daily

A

A

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17
Q

Which TCAs are used as adjuncts to treat fibromyalgia neuropathy, and migraine prophylaxis?

A

Amitriptyline and Nortriptyline

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18
Q

List the three available formulations for TCAs

A

Tablet (amitriptyline)
Capsule (nortriptyline)
Oral solution (nortriptyline)

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19
Q

What is the correct dosing for TCAs?
A. 10mg PO QHS
B. 20mg PO QHS
C. 30mg PO QHS

A

A max of 150mg/day

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20
Q

What are the side effects of TCAs

A

Anti-cholinergic SE and sedation

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21
Q

T or F: TCAs are the last line option for neuropathy and fibromyalgia due to side effects

A

T

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22
Q

What muscle relaxants are used to treat musculo-skeletal pain/spasms

A

Cyclobenzaprin
Baclofen
Methocarbamol
Carisoprodol
Tizanidine

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23
Q

What is the dosing of Cyclobenzaprine
A. 5 mg PO TID
B. 5mg PO TID
C. 250-350 mg PO TID
D. 1.5 g PO 3-4x/day
E. 2-4 mg PO q8-12h

A

A (max 30mg/day)

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24
Q

What is the dosing of Baclofen
A. 5 mg PO TID
B. 5mg PO TID
C. 250-350 mg PO TID
D. 1.5 g PO 3-4x/day
E. 2-4 mg PO q8-12h

A

B (max 80mg/day)

25
What is the dosing of Carisprodol A. 5 mg PO TID B. 5mg PO TID C. 250-350 mg PO TID D. 1.5 g PO 3-4x/day E. 2-4 mg PO q8-12h
C (max 1050mg/day)
26
What is the dosing of Methocarbamol A. 5 mg PO TID B. 5mg PO TID C. 250-350 mg PO TID D. 1.5 g PO 3-4x/day E. 2-4 mg PO q8-12h (max 24mg/day.
D. (max 8g/day)
27
What is the dosing of Methocarbamol A. 5 mg PO TID B. 5mg PO TID C. 250-350 mg PO TID D. 1.5 g PO 3-4x/day E. 2-4 mg PO q8-12h
E. (max 24mg/day)
28
List the SE of muscle relaxants
sedation/drowsiness, dry mouth and vision changes
29
Clinical pearls of muscle relaxants
Short term use (<3 weeks) Carisoprodol is schedule IV due to abuse potential
30
What is the antiepileptic, Carbamazepine, used for?
neuropathic pain
31
What is the recommended dosing for carbamazepine
200mg-400mg PO daily in 2-4 divided doses (max 1200mg/day
32
what are the clinical pearls of Carbamazepine
Increased risk of hypersensitivity reaction in patient with HLA-B*1502 allele Autoinduction of hepatic enzymes (levels will fall over first few weeks of use)
32
What is the recommended dosing for topical lidocaine agents
Apply 1 patch to affected area daily and remove 12 hours later (can vary by manufacturer)
33
What are the SE of topical agents like lidocaine
Hypotension, arrythmia (minimal risk with patch
34
What are the clinical pearls of lidocaine topical agents?
Tachyphylaxis with continuous use 12 hour break between patches Local effect- apply to site of pain
35
what is the use of Capsacian
Muscle/joint pain Neuropathic pain
36
Side effects of Capsacian
Skin irritation and pain
37
What are the clinical pearls of capsacin
Do not get medicine into eyes (burning) Wash hands after applying Some formulations available OTC
38
Considerations for NSAIDs (like aspirin) in older adults
increased risk GI bleed >75 can increase BP avoid chronic use
39
Considerations for Indomethacin or Ketorolac in older adults
increased risk of GI bleeding and AKI Indomethacin has most AE AVOID
40
Considerations for muscle relaxants in older adults
Carisoprodol, cyclobenzaprine, and methocarbamol poorly tolerated in older adults bc of anticholinergic effects avoid
40
Considerations for SNRIs and TCAs in older adults
may exacerbate or cause SIADH or hyponatremia (monitor NA closely) use with caution
41
Considerations for opioids and benzos in older adults
Increased risk of overdose and adverse events Avoid
41
Considerations for opioids gabapentinoids in older adults
Increased risk of severe sedation- related adverse events in older adults including respiratory depression and death Avoid Exceptions Transitioning from opioid to gabapentinoid Using gabapentinoid to reduce opioid dose
42
Considerations for Anticholinergics and Anticholinergic in older adults
Increased risk of cognitive decline, delirium, and falls or fractures. Avoid; minimize the number of anticholinergic drugs
43
Considerations for using a combination of pain medications in older adults
increased risk of falls and fracture with concurrent use of three or more CNS-active agents Avoid concurrent use of three or more CNS-active drugs
44
Which is an opioid antagonist A. Codeine B.Morphine C.Tramadol D. Naloxone
D
45
Which drugs are a weak opioid agonist (select all) A. Codeine B.Morphine C.Tramadol D. Naloxone E.oxycodone
A and C
46
List all the full opioid agonist drugs
Morphine Hydrocodone Hydromorphone Oxycodone Meperidine Fentanyl Methadone
47
T or F: Medication becomes less effective over time and it takes a higher dose of the drug to achieve the same effect
True this is known as tolerance
48
T or F: addiction is when when a patient stops using a drug, their body goes through withdrawal
False (that is dependence)
49
What is addiction?
Continued use of a drug despite negative consequences
50
List the signs of opioid overdose
Sedation/decreased level of consciousness (LOC) Pinpoint pupils Decreased respiratory rate Bradycardia Hypotension Pale, clammy skin
51
list the signs of withdrawal
Insomnia/Agitation Dilated pupils Increased respiratory rate Tachycardia Hypertension Sweating
52
What forms is naloxone available in
IV and intranasal prescribed to any patient on opioids
53
What is the onset and duration of opioid withdrawal for short acting opioids
(e.g. heroin): 8-24 hours after last use; duration 4-10 days
54
What is the onset and duration of opioid withdrawal for long acting opioids
(e.g. methadone): 12-48 hours after last use; duration 10- 20 day
55
What is the Tx for opioid withdrawal
Clonidine: Helps with symptoms of withdrawal such as HTN, sweating, vomiting and anxiety Buprenorphine Methadon

therapeutics (29 decks)

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