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NAPLEX 21 > Pain > Flashcards

Pain Flashcards

1
Q

this type of pain occurs when sensory nerves (nocipetors) identify tissue damage

A

nociceptive pain

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2
Q

What is the treatment for mild pain (score 1-3)

A

non-opioid +/- adjuvant

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3
Q

What is the treatment for moderate pain? (score 6-4)

A

opioid for mild-moderate pain
+- non opioid
+- adjuvant

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4
Q

What is the treatment for severe pain?

A

opioid for moderate-severe pain
+- non opioid
+- adjuvant

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5
Q

APAP reduces pain and fever but it does not provide _____ effect

A

anti-inflammatory

inhibition of PG synthesis

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6
Q

Brand: Ofirmev

A

generic: APAP

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7
Q

What ist he recital suppository for APAP?

A

FeverAll

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8
Q

What is the pediatrics dose <12y

A

10-15mg/kg Q4-6H

infants –160mg/5mL

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9
Q

What is the antidote for APAP overdose?

A

NAC/Acetadote

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10
Q

How does NAC/Acetadote work?

A

restores hepatic glutathione

administered IV or PO

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11
Q

What nomogram uses the serum APAP Level and the time since ingestion to determine whether hepatoxocity is likely (and for the need of NAC)?

A

rumack-matthew nomogram

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12
Q

When should a pregnant patient not use an NSAID to avoid premature closing of the ductus arteriosus?

A

third trimester

IV NSAIDS can be used within 14 days of birth to close a patient ductus arteriosus (PDA)

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13
Q

Brand: Caldolor

A

generic: ibuprofen

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14
Q

OTC dosing for ibuprofen adults

A

200-400mg Q4-6H

peds: 5-10mg/kg/dose Q6-8h

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15
Q

What are the side effects of all NSAIDs?

A

dyspepsia, abdominal pain, nausea

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16
Q

What NSAID should you avoid in psych patients?

A

Indomethacin (Indocin) high risk for CNS side effects

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17
Q

Wit the Ketorolac nasal spray when the patient is <65, how is it administered?

A

in EACH nostril (prime five times before use)

> 65, in one nostril

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18
Q

What is the MAX duration of ketorolac in adults?

A

5 days

warnings - acute renal failure, liver failure

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19
Q

This COX2 selective NSAID has a contraindication for sulfa allergy

A

celecoxib

highest cox 2 selectivity

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20
Q

Brand: Voltaren

A

generic: diclofenac

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21
Q

What is the total body max of dicloenac per day? (for gel)

A

32g/day

patch is applied BID

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22
Q

What is arthrotec?

A

diclofenac + misoprostol – used to replace the gut protective PG to decrease GI risk (also used for abortions)

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23
Q

Brand: Mobic

A

generic: meloxicam

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24
Q

What is the cardio protection dose for aspirin?

A

81-162mg once daily

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25
Q

Methyl salicylate is a popular OTC topical found in what agents?

A

Bengay

Icy Hot

Salonpas

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26
Q

What is an example of non-acetylated salicylates?

A

Mg salicylate (Doans)

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27
Q

What if a patient is taking ibuprofen for pain and aspirin for protection? How should they take their doses?

A

aspirin one hour before or eight hours after ibuprofen

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28
Q

NSAIDs can increase the level of

A

lithium and methotrexate

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29
Q

Which opioids should you not consume alcohol with?

A

Kadian

Nucynta ER

oxymorphone ER

Zohydro

FATAL OVERDOSE

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30
Q

Where do opioids act?

A

mu receptor agonists

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31
Q

Which opioids have REMS?

A

ALL!

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32
Q

What are side effects of all opioids?

A

constipation
n/v
somnolence

dizziness/lightheadedness

respiratory depression

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33
Q

What control is codeine tablets?

A

CII

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34
Q

What control is codeine tablet/capsule combinations products?

A

CIII

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35
Q

What control is codeine oral solution combination products?

A

CV

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36
Q

Do not use codeine in children

in tonsillectomy/adenoitecomy surgery

A

<12

<18

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37
Q

Brand: Sublimaze

A

generic: Fentanyl

38
Q

Brand: Actiq

A

generic: fentanyl oral trans mucosal lozenge

39
Q

A patient was newly started on opioids. when can they start using the fentanyl patch?

A

a patient who has been using 60mg/day or equivalent for at least 7 days can be converted to a fentanyl patch

40
Q

Can a fentanyl patch be covered with an adhesive or dressing?

A

only with Bioclusive or tegaderm

41
Q

Where do you dispose a fentanyl patch?

A

toilet

42
Q

Brand: Lorcet, Lortab

A

generic: hydrocodone IR + APAP

43
Q

Which opioid has a BBW for initiation of CYP3AF inhibitors due to a potential fatal overdose?

A

hydrocodone IR and ER
oxycodone
fentanyl
methadone

44
Q

Dosing for hydromorphone

A

2-4mg Q4-6H PRN

IV: 0.2-1mg Q2-3H PRN

45
Q

Due to variability, this opioid is hard to dose safely

A

methadone

also, QT!!!

46
Q

Brand: Demerol

A

generic: meperidine
* serotonergic

not really used anymore

47
Q

What can be used with morphine to block histamine induced pruritus

A

benadryl

48
Q

Brand: Kadian

A

generic: morphine ER

49
Q

which opioid do you take on an empty stomach?

A

oxymorphone (Opana)

50
Q

What is morphine IV/IM (in mg)

A

10mg

51
Q

What is morphine PO (in mg)

A

30mg

52
Q

What is hydromorphone IV/IM

A

1.5mg

53
Q

what is hydromorphone PO in mg

A

7.5

54
Q

when converting opioids, do you round up or down?

A

down! to reduce OD

55
Q

after calculating the 24 hour dose of the new drug, how much do you reduce it by?

A

25% for cross tolerance

56
Q

The common drugs in the same chemical class that cross-react with each other have ____ or ____ in the name

A

cod or morph

codeine, hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, buprenorphine, heroin -diacetyl-morphine

57
Q

if using opioids - what formulation should you start with?

A

IR - start low and go slow

58
Q

what is the first line treatment for OIC?

A

stimulant laxatives (including Senna) with or without a stool softener

bisacodyl

59
Q

If laxatives are not sufficient, specific medications for IOC that counteract the effects of the opioid receptor in the gut can be used - called

A

PAMORAs

  • methylnaltrexone (Registro)
  • naloxogel (Movantik)
60
Q

Brand: Amitiza

A

generic: lubiprostone

* can be used after trial of laxatives or PAMORAs

61
Q

Tramadol control

A

C-IV

62
Q

What opioid?

  • seizure risk
  • risk of serotonin syndrome
  • do not use with MAO inhibitors (14 days)
  • requires conversion to active metabolite by CYP2D6
A

tramadol
tapentadol

  • cross reactivity, if allergy to one, allergy to the other
  • caution with seizures!!!
63
Q

What control is tapentadol?

A

CII

64
Q

At what dose of an opioid would a patient require naloxone?

A

greater than or equal to 50 morphine milligram equivalent dose

65
Q

What opioid abuse detterant is an agonist at low doses and an antagonist at high doses?

A

buprenorphine

66
Q

What is naloxone called as an auto injector?

A

Evzio - provides one dose

67
Q

What is naloxone called as a nasal spray?

A

Narcan (a dose is in ONE nostril, may need to repeat in other)

naloxone - injection, repeat every 2-3 minutes

68
Q

Buprenorphine control?

A

CIII

69
Q

Brand: Butrans

A

generic: buprenorphine patch

70
Q

How often does the patient change Butrans?

A

weekly

71
Q

To prescribe for opioid dependence, a prescriber needs what waiver

A

DATA 2000 waiver

72
Q

What are common adjutants for pain management?

A

muscle relaxants

AEDs (pregabalin, gabapentin)

antidepressants

topical anesthetics

73
Q

Brand: Horizant

A

generic: gabapentin ER

used for PHN and restless leg syndrome

74
Q

What are common side effects of gabapentin?

A

dizziness

somnolence

peripheral edema

75
Q

What control is Lyrica?

A

CV

76
Q

what are the side effects of Lyrica?

A

dizziness

somnolence

peripheral edema/weight gain

mild anxiolytic

*actually approved for indications

77
Q

What is the only FDA approved medication for the treatment of trigeminal neuralgia?

A

carbamazepine (Tegretol)

78
Q

Brand: Elavil

A

generic: amitriptyline

79
Q

What are some SNRI and TCAs used as adjuvants

A

elavil

cymbalta

80
Q

What are the oral adjuvants for musculoskeletal pain/spasms

A

baclofen

cyclobenzaprine

tizanidine

81
Q

Brand: Zanaflex

A

generic: tizanidine

* dry mouth, hypotension

82
Q

Brand: Amrix, Fexmid, Flexeril

A

generic: cyclobenzaprine

* dry mouth

83
Q

Brand: Lioresal

A

generic: baclofen

84
Q

antispasmodics that exert their effects by sedation

A

carisoprodol (Soma)

methocarbamol (Robaxin)

85
Q

How long are lidocaine patches worn for?

A

up to 12 hours/day – 1-3 patches/day

86
Q

Can you cut lidocaine patches?

A

yes!

87
Q

How do you apply diclofenac gel?

A

use the reusable dosing card inside the package to correctly measure each dose

88
Q

The dose for hands, wrists or elbows of diclofenac gel is ____ applied four times daily

A

2 grams

do not exceed 8g each day
*do not shower for at least one hour

89
Q

The dose for feet, ankles or knees of diclofenac gel is ____ applied four times daily

A

4 grams

do not exceed 16g/day
*do not shower for at least one hour

90
Q

Which opioid can be opened and the contents sprinkled on applesauce immediately before ingestion?

A

Kadian

91
Q

Unless treating hand pain, wash hands thoroughly with soap and water immediately after use of this drug

A

capsaicin tropical

  • if treating hands, wash after 30 mins

NAPLEX 21 (60 decks)

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