non opioid pharmacologic treatment

Question 1

acetaminophin

Answer 1

not an NSAID, antipyretic that reduces pain

Question 2

NSAIDs

Answer 2

inhibit COX1 and COX2 prostaglandins which decreases inflammation and weakens stomach lining

Question 3

tricyclic antidepressants reason for use

Answer 3

used for depression and anglesia, normally takes 4-6 days for it to fully work. anticholinergic effects common (sedation)

Question 4

alpha 2 adrengeric agonists

Answer 4

clonadine and tizanidine sued for chronic pain of any type. Tizanidine ussually tolerated better. (1-2mgday max dose = 40mg/day)

Question 5

corticosteroids reasons for use

Answer 5

reduce metastatic bone pain, headache, due to increase in intracranial pressure, relieve pain from spinal cord compression, tumor compression, and infiltration of spinal nerve plexus.
improve sense of well being similar to a manic phase

Question 6

anaglesia given for neuropathic pain

Answer 6

gabapentin (sleepiness) commonly used
valoproate (depakanate)- GI effects
phenytoin- least toxic
carbamazepine- lancing pain. N/V dizziness, lethargy, ataxia
clonzepam- effective, causes the most drowsiness

Question 7

local anesthesia given for neuropathic pain

Answer 7

PO mexiletine, tocainide
not FDA approved
or IM/SD lidocaine
useful for any type of nerve pain

Question 8

caution with NSAIDs in patients with what

Answer 8

renal insufficency, atherosclerotic disease, CHF, HTN

Question 9

ideal way to manage chronic pain

Answer 9

non opioid/ non pharmacologic pain management

Question 10

when DRs are giving long term opioids the patient must do what before hand?

Answer 10

pass a tox screen

Question 11

how often do opiate patients need to be reassessed

Answer 11

1-4 weeks

Question 12

mixing of what two drugs can be fatal?

Answer 12

benzodiazepines and opioids

Question 13

immediate-release preparations

Answer 13

used mainly for acute pain
for dosing during initial TRX
“rescue” dosing
long term management in patients

Question 14

opioid naive patient

Answer 14

given every 3-4 hours 
10-15 mg of hydrocodone/oxycodone 
2-4mg of hydromorphone 
30-60mg codine 
15-30mg morphine

Question 15

what needs to be avoided with fetnyl patches

Answer 15

direct heat, heated blankets/ heating pads can lead to an OD

Question 16

advantages for using long acting opioid agents

Answer 16

steady serum levels prevent rebound, minimize withdrawal, sleep patterns are normal, compliance is increased because dosing is more convenient
by eliminating pills pt does not have to focus as much on somatic concerns, less reinforcement of inappropriate use

Question 17

morphine

Answer 17

1st sustained release opioid
nausea and puritis
has some metabolitess

Question 18

fetanyl

Answer 18

derivative of merperdine 
lipophilic and faster acting 
way more potent 
less constipating 
no active metabolites 
provides pain relief for 72 hrs

Question 19

oxycodone

Answer 19

more potent then morphine with fewer side effects

active metabolites, which relieves visceral pain

Question 20

methadone

Answer 20

long acting drug with a variable half life

carefully monitor until dosed properly, may lead to toxicity

Question 21

rescue medications

Answer 21

5-15% of long acting dose

increases rescue dose as baseline dose increases

Question 22

side effects of opioid use

Answer 22

constipation, mental clouding, n/v, myoclonus, itch, urinary retention, sweating, dizzy, amenorrhea, sexual dysfunction, h/a

Question 23

nodding off on opioids indicates what?

Answer 23

an issue with the dosing

Question 24

most side effects go away with opioid use except for what?

Answer 24

constipation, must be treated

Question 25

myoclonus

Answer 25

jerky muscle contractions due to build up of metabolites in the muscles

Question 26

assessing the effectiveness of an opioid

Answer 26

it is on an individual basis, it can be increased until pain relief is effective, unmanageable, intolerable side effects, or toxicity occurs

Question 27

misconception of opioid side effects

Answer 27

respiratory depression, it does not occur if the medication is titrated to the pain levels.

Question 28

PO to IV

Answer 28

IV is much stronger, 1 mg IV is equal to 30mg PO

Question 29

Bisphosphates

Answer 29

given to decrease bone pain and hypercalcemia, tylenol prevents pamidronate

Question 30

managing bowel obstruction

Answer 30

anticholengerics, octerocide

Question 31

antihistamines

Answer 31

given with opioids, as well as antiemetic/ antispasmodic effects, sedates, may relieve puritis

Question 32

amphetamines and opioids

Answer 32

may potentiate opioid, but useful in counteracting drowsiness

Question 33

never give an ER medication when?

Answer 33

if the pt has never had the medication before, in case they are allergic

Question 34

what is tramadol?

Answer 34

mixed opioid and norepinephrine or SSRI mechanism od action

Question 35

baclofen

Answer 35

muscle relaxant given for MS