Non-malignant Pain Part 3 Flashcards
T or F: opioid are only used for acute pain
False used for acute and chronic pain
list the side effects of opioids (8 of them)
Antitussive
Constipation
Nausea & vomiting
Itching
Orthostatic Hypotension
Urinary Retention
Sedation
Respiratory depression
What are the three clinical pearls of opioids
Consider starting stool softener and/or stimulant laxative
Potential for tolerance, dependence and addiction
Schedule II controlled substances Exceptions: tramadol, codeine
T or F: codeine can be Schedule V, III or II controlled substance, depending on strength
T
What is codeine metabolized by?
CyP 2D6 (metabolizes it to morphine)
T or F: poor metabolizers will get no effect from codeine
True
Ultra-rapid metabolizers can experience overdose
T or F: codeine is okay for breastfeeding mothers and children under 12
False not recommended
T or F: there is not a risk of serotonin syndrome when tramadol is used with other serotonergic medications
False there is
Why would you adjust the dose of tramadol?
A. hepatic
B. Renally
B. renally dose adjusted
What is the boxed warning for tramadol
Use of CYP 450 3A4 inducers, inhibitors and 2D6 inhibitors with tramadol it requires careful consideration of the effects on the parent drug and metabolite
T or F itching is more prominent with morphine compared to other opioids
T
T or F: morphine and its metabolites are hepatically secreted and accumulate in hepatic dysfunction
False: renally excreted and accumulate in renal dysfunction
avoid in patients with end stage renal disease or acute kidney injury
CRCl 30-60 consider alternate opioid <30 avoid use
What is the boxed warning for morphine
Avoid alcohol while taking ER capsules- leads to increased morphine plasma levels and potentially fatal overdose
What is the boxed warning for hydromorphone
warning about dosing errors when prescribing, dispensing an administering:
Oral solution- do not confuse mg and mL
IV solution- do not confuse high potency solution (10mg/mL) with other solutions (1, 2 or 4mg/mL
Hydrocodone +/- Acetaminophen Lortab clinical pearls
Counsel patients on acetaminophen use
US Boxed Warning: Use with CYP 3A4 inhibitors may increase hydrocodone plasma concentrations
Oxycodone(Oxycontin, Xtampza)
Oxycodone and Acetaminophen (Percocet) clinical pearls
Counsel patients on acetaminophen use with
combination product
Percocet 2.5/325mg, 5/325mg, 7.5/325mg, 10/325mg
ER capsule/tablets are abuse-deterrent
what is the boxed warning for Oxycodone and oxycodone and acetaminophen
US Boxed Warning: Use with CYP 3A4 inhibitors may
increase oxycodone plasma concentrations
What patients should receive monitoring while taking fetanyl
A. patients receiving 3A4 inhibitors and inducers
B. patients receiving 2D6 inhibitors and inducers
C.patients receiving 2B6 inhibitors and inducers
A
T or F: Fentanyl can be used in renal impairment
T
T or F: Fentanyl causes less hypotension than morphine or hydromorphone at similar doses
T
T or F: Non-injectable forms of Fentanyl are not indicated for patients who are opioid tolerant
False it is indicated
Fentanyl patch counseling
Apply one patch every 72 hours (3 days)
Apply the patch to the chest, back, flank, or upper arm
Do not cut the patches or use a patch that is torn or damaged, This could cause an overdose
Do not use the patch over broken skin
Do not let the patch get too warm while wearing
Avoid using heating pad, electric blanket, sauna, hot tub, heated waterbed, sunlight, or hot weather, Your body will absorb too much medication
What is the boxed warning for methadone
QTc prolongation check baseline ECG prior to initiation
Monitor patients receiving CYP 3A4 inhibitors or inducers
What is the last line of treatment for chronic pain
methadone
