Ortho Pharm Review

Question 1

What two NSAIDs are preferred for most patients?

Answer 1

Naproxen and ibuprofen

Question 2

What does the inhibition of COX impair the transformation of?

Answer 2

Arachadonic acid → prostaglandins → prostacyclin and thromboxanes

Question 3

How soon does platelet function normalize after discontinuation of most NSAIDs?

Answer 3

within 3 days

Question 4

Adverse effect of NSAIDs which is why you may want to avoid NSAIDs for up to 90 days post fracture

Answer 4

may cause non-union

Question 5

How is aspirin different from other NSAIDs?

Answer 5

irreversible platelet inhibition for the life of the platelet

Question 6

Name the NSAID with less CV risk compared to others

Answer 6

naproxen (aleve)

Question 7

Good choice for treatment of acute or chronic pain if an NSAID is indicated

Answer 7

naproxen (aleve)

Question 8

What is the maximum dose of ibuprofen per day?

Answer 8

2400 mg per day

Question 9

Name the acetic acid NSAIDs

Answer 9

IV Ketorolac (Toradol)
Indomethacin (Indocin)

Question 10

Treatment of moderate to severe postoperative pain. Risk of gastropathy when used > 5 days

Answer 10

ketorolac (toradol)

Question 11

Used for treatment of acute gout and pericarditis mainly. May be associated with aplastic anemia

Answer 11

indomethacin (indocin)

Question 12

Name the oxicam NSAIDs

Answer 12

Meloxicam (Mobic)

Prioxicam (Feldene)

Question 13

Long duration of effect (Qday dosing). Relatively COX-2 selective at lower total dose of 7.5 mg

Answer 13

meloxicam (mobic)

Question 14

An option for treatment of chronic pain and inflammation poorly responsive to other NSAIDs. Daily doses of ≥ 20 mg increase risk of serious GI complications

Answer 14

piroxicam (feldene)

Question 15

Name the selective cox-2 inhibitor

Answer 15

Celecoxib (Celebrex)

Question 16

No effect on platelet function. Decreased GI toxicity. Dose related renal and CV effects

Answer 16

celecoxib (celebrex)

Question 17

Considered a weak opioid. For mild to moderate pain

Schedule III. Metabolized to morphine

Answer 17

codeine

Question 18

Schedule III. For moderate to severe pain. Onset of action 10-20 min. In combination with acetaminophen

Answer 18

hydrocodone (vicodin)

Question 19

Schedule II. Moderate to moderately severe pain. Onset of action 10-30 minutes. In combination with acetaminophen. Avoid long acting combinations for acute pain

Answer 19

oxycodone (percocet)

Question 20

Used to reverse respiratory depression, sedation and analgesia

Answer 20

naloxone

Question 21

What are the toxicities of all opioids in general?

Answer 21

sedation, constipation, decreased effectiveness of diuretics, QT prolongation

Question 22

Name the extended release and long acting opioid analgesics

Answer 22

morphine, buprenorphine, methadone, fentanyl, hydromorphone

Question 23

can increase release and absorption of transdermal opioid analgesics

Answer 23

heat exposure

Question 24

Not a controlled substance but high potential for physical and psychological dependence. Works at the mu receptors and also inhibits NE and serotonin. Effective for relief of neuropathic pain

Answer 24

tramadol

Question 25

Where is tramadol extensively metabolized?

Answer 25

liver

Question 26

Name the skeletal muscle relaxants

Answer 26

Cyclobenzaprine (Flexeril)
Tizanadine (Zanaflex)
Metaxalone (Skelaxin)
Diazepam (Valium)

Question 27

Where is most benefit of muscle relaxants observed?

Answer 27

first 1-2 weeks of therapy

Question 28

Which two muscle relaxants have a high potential for abuse and should be used for only a few days?

Answer 28

Diazepam (Valium) and carisoprodol (Soma)

Question 29

What drug class might muscle relaxants have a synergistic effect when used as treatment for acute low back pain?

Answer 29

NSAIDs

Question 30

When used in combination with narcotics offers the best relief

Answer 30

NSAIDs or acetaminophen

Question 31

When do you switch from a PCA pump to oral narcotics?

Answer 31

once patient is able to tolerate PO intake