non opioid pharmacologic treatment Flashcards
acetaminophin
not an NSAID, antipyretic that reduces pain
NSAIDs
inhibit COX1 and COX2 prostaglandins which decreases inflammation and weakens stomach lining
tricyclic antidepressants reason for use
used for depression and anglesia, normally takes 4-6 days for it to fully work. anticholinergic effects common (sedation)
alpha 2 adrengeric agonists
clonadine and tizanidine sued for chronic pain of any type. Tizanidine ussually tolerated better. (1-2mgday max dose = 40mg/day)
corticosteroids reasons for use
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
anaglesia given for neuropathic pain
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
local anesthesia given for neuropathic pain
PO mexiletine, tocainide
not FDA approved
or IM/SD lidocaine
useful for any type of nerve pain
caution with NSAIDs in patients with what
renal insufficency, atherosclerotic disease, CHF, HTN
ideal way to manage chronic pain
non opioid/ non pharmacologic pain management
when DRs are giving long term opioids the patient must do what before hand?
pass a tox screen
how often do opiate patients need to be reassessed
1-4 weeks
mixing of what two drugs can be fatal?
benzodiazepines and opioids
immediate-release preparations
used mainly for acute pain
for dosing during initial TRX
“rescue” dosing
long term management in patients
opioid naive patient
given every 3-4 hours 10-15 mg of hydrocodone/oxycodone 2-4mg of hydromorphone 30-60mg codine 15-30mg morphine
what needs to be avoided with fetnyl patches
direct heat, heated blankets/ heating pads can lead to an OD
advantages for using long acting opioid agents
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
morphine
1st sustained release opioid
nausea and puritis
has some metabolitess
fetanyl
derivative of merperdine lipophilic and faster acting way more potent less constipating no active metabolites provides pain relief for 72 hrs
oxycodone
more potent then morphine with fewer side effects
active metabolites, which relieves visceral pain
methadone
long acting drug with a variable half life
carefully monitor until dosed properly, may lead to toxicity
rescue medications
5-15% of long acting dose
increases rescue dose as baseline dose increases
side effects of opioid use
constipation, mental clouding, n/v, myoclonus, itch, urinary retention, sweating, dizzy, amenorrhea, sexual dysfunction, h/a
nodding off on opioids indicates what?
an issue with the dosing
most side effects go away with opioid use except for what?
constipation, must be treated
myoclonus
jerky muscle contractions due to build up of metabolites in the muscles
assessing the effectiveness of an opioid
it is on an individual basis, it can be increased until pain relief is effective, unmanageable, intolerable side effects, or toxicity occurs
misconception of opioid side effects
respiratory depression, it does not occur if the medication is titrated to the pain levels.
PO to IV
IV is much stronger, 1 mg IV is equal to 30mg PO
Bisphosphates
given to decrease bone pain and hypercalcemia, tylenol prevents pamidronate
managing bowel obstruction
anticholengerics, octerocide
antihistamines
given with opioids, as well as antiemetic/ antispasmodic effects, sedates, may relieve puritis
amphetamines and opioids
may potentiate opioid, but useful in counteracting drowsiness
never give an ER medication when?
if the pt has never had the medication before, in case they are allergic
what is tramadol?
mixed opioid and norepinephrine or SSRI mechanism od action
baclofen
muscle relaxant given for MS
