Pain Flashcards
What are the most commonly used analgesics?
Tylenol and NSAIDs
What is the MOA of tylenol?
Unclear, may inhibit COX-3 (centrally located)
Tylenol is not an NSAID, so which effects does it NOT have?
Anti-inflammatory and Anti-platelet
What is the dose limited adverse effect of acetaminophen?
Hepatotoxicity
What are the effects of NSAIDS?
Anti-inflammatory
Anti-pyretic
Analgesic
What type of NSAID would you chose in a patient with risk of GI bleed?
COX-2 selective
What is the biggest concern with prescribing NSAIDs?
Bleeding (specifically GI bleeding)
What type of patients should avoid NSAIDs besides those at risk for bleeding?
Renal insufficiency
CHF
HTN
What areas of the body can Voltaren gel be used for?
elbows, hands, knees
What joint would not be appropriate for voltaren gel?
Hip
Name a short acting systemic corticosteroid.
Hydrocortisone
Name a long acting systemic corticosteroid.
Dexamethasone
Name a two steroids with no minerocorticoid effect.
Methypredinosolone
Dexamethasone
Name the systemic corticosteroid with the most minerocorticoid activity.
Hydrocortisone.
What is the effect of minerocorticoid activity?
The ability of the medication to increase the reabsorption of sodium and excretion of potassium.
Which of the following is not a known adverse effect of systemic corticosteroids? Hyperglycemia Osteoporosis Hypotension Skin Atrophy Pyschiatric Disturbance Hypothalamic-pituitary axis supression
Hypotension
What receptor are opioids active at?
Mu
What is the primary risk for using opioids with other risks added such as use with benzos?
Respiratory Depression
What prescriptions should you consider alongside opioids?
Narcan (naloxone)
In addition to Mu receptor activity, what effect does Ultram have?
Inhibits reuptake of norepinephrine and 5-HT.
What type of laxative should be prescribed for those using opioids?
Stimulant (bisocodyl or senna)
What is the ideal way to stop opioid use?
Slowly, over time.
What are the three medications approved for opioid use disorder?
Full Mu agonist.
Partial Mu agonist.
Opioid antagonist.
… match with…
Methadone.
Buprenorphine.
Naltrexone.
Methadone: Full Mu Agonist (Access in methadone clinic only)
Naltrexone: Opioid antagonist (no benefit from using opioid)
Buprenorphine: Partial Agonist (relief but minimize resp. depression risk)
Common treatments for neuropathic pain.
Duloxetine Gabapentin Pregabalin Tricyclinc Antidepressants Topical Lido
What is the mechanism of action for triptans?
Stimulation of serotonin. This interrupts pain signals and causes vasoconstriction.
What are injectable CGRP medications mostly used for?
Migraine prophylaxis
What are some common adverse effects of triptans?
Paresthesia
Dizziness
Chest Pressure
Which triptan may be effective for patients that have not responded to other triptan?
Eletriptan
Which triptan has fewest side effects?
Axert (almotriptan)
Which triptan is the longest acting?
Frova (frovatriptan)
Which triptans are available as nasal spray?
zolmitriptan (Zomig)
sumatriptan (Onzetra)
What is the core treatment for fibromyalgia?
Norepinephrine reuptake suppression
(SNRI, tricyclic antidepressants, cyclobenzaprine)
Balance with non-pharm interventions.
