Non-opioid Pain Meds

Question 1

When are non-pharm therapies considered first line?

Answer 1

1. sprains
2. bumps and bruises
3. minor trauma
4. muscle cramps
5. burns
6. nail pain
7. dental pain

Question 2

What are the nonpharm therapies?

Answer 2

ice, epsom salt, heat, massage, and physical therapy

Question 3

What is the purpose of ice?

Answer 3

to reduce swelling and numb nociceptors

Question 4

Why is a 20 minute duration of ice recommended?

Answer 4

any more time will down regulate nociceptors and then you won’t feel tissue damage

Question 5

What is the purpose of epsom salt?

Answer 5

to draw out fluid in the associated area

Question 6

When is epsom salt most beneficial?

Answer 6

On day 2 of injury

Question 7

What is the purpose of heat?

Answer 7

to increase blood flow to the area and remove inflammatory mediators

Question 8

What is the WHO Ladder most directed towards

Answer 8

Acute and cancer pain

Question 9

What is considered mild pain?

Answer 9

1-3

Question 10

What non-narcotic agents are preferred for mild pain?

Answer 10

1. ASA
2. APAP
3. ibuprofen or NSAID

Question 11

What is considered moderate pain?

Answer 11

4-6

Question 12

What agents are recommended for moderate pain?

Answer 12

opioids added to step 1 therapies

Question 13

What is considered severe pain?

Answer 13

7-10

Question 14

What are the preferred agents for severe pain?

Answer 14

around the clock, strong opioids

Question 15

What is the activity of APAP?

Answer 15

analgesia with little antiplatelet or anti-inflammatory properties

Question 16

What is the MOA of APAP?

Answer 16

partially blocks COX-1 and COX-2

Question 17

What is the dosing of APAP

Answer 17

325-650 q4h or 1g q6h

Question 18

What is the max dose of APAP?

Answer 18

3000mg q24h

Question 19

What type of food affects the absorption of APAP

Answer 19

high carb meals decrease APAP absorption

Question 20

What toxic metabolite is APAP turned into by the liver?

Answer 20

NAPQ1

Question 21

What time of pain is APAP not effective in?

Answer 21

visceral pain

Question 22

What is APAP the first line treatment for?

Answer 22

osteoarthritis

Question 23

What is APAP not recommended for?

Answer 23

rheumatoid arthritis

Question 24

What factors increase the risk of hepatotoxicity with APAP?

Answer 24

concomitant use of alcohol or NSAIDs

Question 25

treatment of acute APAP overdose within the first four hours

Answer 25

gastric lavage

Question 26

What treatment is effective for APAP overdose after the acute window?

Answer 26

N-acetylcysteine

Question 27

How does activated charcoal treat an APAP overdose?

Answer 27

it binds to APAP

Question 28

What is the activity of aspirin?

Answer 28

anti-inflammatory, analgesic, antipyretic, and antiplatelet

Question 29

What is the MOA of aspirin?

Answer 29

acetylates COX enzyme and irreversibly deactivates the receptor. Prostaglandins are not made which helps decrease transduction and transmission of pain

Question 30

What is the max dose of aspirin?

Answer 30

4000 mg in a day

Question 31

What must aspirin be metabolized to in order to be active?

Answer 31

salicylate

Question 32

What is aspirin not effective for?

Answer 32

visceral pain

Question 33

In what group of patients is ASA not recommended for due to risk of Reye’s syndrome?

Answer 33

children

Question 34

Where does aspirin reach high concentrations?

Answer 34

in synovial fluid

Question 35

What disease stated is ASA good for since it reaches high concentrations in the synovial fluid?

Answer 35

arthritis

Question 36

When should ASA be avoided in pregnancy?

Answer 36

3rd trimester

Question 37

When can ASA be used in pregnancy?

Answer 37

low dose for preeclampsia to prevent clotting (benefit outweighs the risk)

Question 38

What is a hallmark sign of toxicity with ASA

Answer 38

tinnitus

Question 39

Why should ASA be avoided in asthma?

Answer 39

If ASA is given to a patient with asthma, nasal polyps, and ASA sensitivity, it could worsen asthma