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Pharm 2 > Pain > Flashcards

Pain Flashcards

1
Q

ceiling dose for acetaminophen

A

4,000 mg/day if using for LESS than 7 days
• 3,000 mg optimal for long term use and may become our standard of care
• (Utilize ceiling of 2,000 mg in elderly, or those with organ (liver) dysfunction, or excessive alcohol use, cirrhosis)

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2
Q

ceiling dose for aspirin

A

4g/day

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3
Q

ceiling dose for ibuprofen

A

3200mg/day

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4
Q

ceiling dose for ketorolac

A

150 mg first day, 120mg/day thereafter – DO NOT USE longer than 5 days

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5
Q

NSAIDs contras

A

CABG, CHF, recent MI, renal dysfunction, aspirin allergy/ hypersensitivity

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6
Q

most common NSAID AE category

A

GI: Dyspepsia, gastritis, ulcers, bleeding. Protective mucus production is disrupted, increase in gastric acid production.

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7
Q

BBW for NSAIDs

A

increased risk of MI and stroke in all pts

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8
Q

NSAID interactions

A

ACE-I (risk of renal impairment), FQ (lowers seizure threshold), corticosteroids (risk of ulcers), anti-hypertensives (increases BP slightly), aspirin (can reduce antiplatelet effect), other NSAIDs (never combine)

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9
Q

GI AE from NSAIDs can be serious/fatal in whom?

A

GI can be serious/fatal in elderly, hx of PUD or GI bleeding, H pylori infx, heavy alcohol use, steroid use

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10
Q

pt counseling for NSAIDs

A

Onset will be in 20-30 min; take w/ food and full glass of water so it doesn’t irritate your stomach or cause an ulcer

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11
Q

NSAIDs need routine monitoring for what things

A

renal failure, hepatic dysfunction, and GI ulceration (gastric > duodenal)

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12
Q

age contra for ibuprofen

A

<6 mo

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13
Q

age contra for naproxen

A

<12 y/o

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14
Q

ibuprofen analgesic, etc dosing

A

Analgesic Dose = 1200 - 1800mg / day
Anti-Inflammatory Dose = 1800-2400mg/d
Anti-Rheumatic Dose = 2400-3200mg/day

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15
Q

ceiling max of ibuprofen is ok for how many days

A

3-5

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16
Q

ceiling dose for naproxen

A

ceiling = 500mg Q12 hr

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17
Q

go-to IV or IM NSAID

A

ketorolac

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18
Q

contras for Indomethacin (Indocin)

A

Caution: elderly, epilepsy, psych disorders, Parkinsons

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19
Q

pt counseling for voltaren gel

A

Voltaren: wash hands well after application; do not cover w/ dressings or apply heat; do not use w/ other topical lotions/meds; don’t wash off/shower for 1 hr

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20
Q

longest half life NSAID

A

Piroxicam (Feldene)

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21
Q

contras for Celecoxib (Celebrex)

A

post-CABG, aspirin or sulfa allergy

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22
Q

BBW for Celecoxib (Celebrex)

A

MI

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23
Q

indications: mild-mod pain and inflammation at high doses only, prevention of MI/stroke, ACS, Dressler’s syndrome, fever, prophylactic for colon cancer

A

aspirin

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24
Q

contra for aspirin

A

kids (Reye’s syndrome)

25
Q

aspirin toxicity signs

A

Toxicity: n/v, diaphoresis, tinnitus, hyperventilation

26
Q

treatment for aspirin toxcitiy

A

dialysis

27
Q

interactions: Anticoagulants, Lithium, Certain Antihypertensives

A

aspirin

28
Q

early symptoms of tylenol overdose

A

N/V/D, abdominal pain

29
Q

treatmetn for tylenol overdose

A

Acetylcysteine (Acetadote®, NAC, Mucomyst) or activated charcoal (if w/in 4 hrs)

30
Q

tylenol and NSAID combo that beats opioids

A

1g acet + 400mg ibuprofen > opioids

31
Q

AEs: “CNS depression (drowsiness/confusion)
Headache
Hypotonia (weakness/low muscle tone)”

A

baclofen

32
Q

baclofen withdrawal symptoms

A

PO: Seizures, hallucinations, etc.
Intrathecal: severe sequelae (hyperpyrexia, obtundation, rebound/exaggerated spasticity, muscle rigidity, and rhabdomyolysis), leading to organ failure and some fatalities
Slow taper over 2 weeks is needed

33
Q

interactions for diazepam (Valium)

A

Metabolised by CYP34A to active. Avoid opioids: respiratory depression. Avoid alcohol: Increased effect of alcohol. Excess grapefruit will increase effect of diazepam

34
Q

contra / interaction for •tizanidine (Zanaflex)

A

cipro

35
Q

AEs: “Drowsiness. Hypotension )Especially when combined with other antihypertensives)
Dizziness. Dry mouth. Hepatotoxicity: Monitor LFTs regularly with long-term use”

A

•tizanidine (Zanaflex)

36
Q

withdrawal symptoms of •tizanidine (Zanaflex)

A

Abrupt withdrawal may result in rebound hypertension, tachycardia, and hypertonia (if pt was receiving high doses for prolonged periods ≥9 weeks)

37
Q

indications for dantrolene

*dantrolene (Dantrium) PO for spasticity, IV

A

Chronic muscle spasms. Primarily to treat malignant hyperthermia- complication of general anesthesia

38
Q

AEs: respiratory tract infections, muscle weakness, urinary incontinence, falls, fever, pain

A

botox

39
Q

which spasmolytic is Structurally related to tricyclic antidepressants (TCAs)

A

cyclobenzaprine (Flexeril)

40
Q

is flexeril rec for low back pain

A

no

41
Q

cyclobenzaprine (Flexeril) CI

contras

A

Caution in elderly. Avoid use if history of arrhythmias, CHF, hyperthyroidism, glaucoma or MAOI use in the past 14 days

42
Q

SE of all antispasmodics

A

CNS depression / sedation

43
Q

cyclobenzaprine (Flexeril) interactions

interactions

A

serotoninergic drugs, alcohol, opioids

44
Q

Pt cousenling for flexeril

A

Counsel against operating heavy machinery or driving.

45
Q

how long to describe flexeril / antispasmodics

A

max 3 wks

46
Q

contras: metaxalone (Skelaxin)

A

“Caution in elderly.

Absolute: severe renal or hepatic dysfunction “

47
Q 
AEs: "Sedation, esp when combined w/ alcohol or opioids. CNS depression, Hallucinations, Anticholinergic effects (Dry mouth, blurred vision, urinary retention, dizziness, hypotension, constipation, increased intraocular pressure)
Serotonin syndrome (Monitor if on other serotoninergic drugs)"
A

flexeril

48
Q

AEs: Sedation, esp when combined w/ alcohol or opioids. CNS depression. Bradycardia, hypotension, syncope, flushing. Pruritus, rash, urticaria. Dyspepsia, N/V

A

methocarbamol (Robaxin) PO, IV, IM

49
Q

AEs: Sedation, esp when combined w/ alcohol or opioids. Fairly benign adverse effect profile…although fatalities attributed to its use have been reported. Hemolytic anemia. Leukopenia. Impaired liver function. CNS depression

A

metaxalone (Skelaxin)

50
Q

contras: carisoprodol (Soma)

A

Caution in elderly. patients with past substance abuse/addiction

51
Q

AEs: Sedation, esp when combined w/ alcohol or opioids. CNS depression (Very sedating), Seizures. Physical and psychological dependence (Schedule IV)

A

carisoprodol (Soma)

52
Q

AEs: “Sedation, esp when combined w/ alcohol or opioids. CNS depression. Urine discoloration (red or orange). Rash, petechiae, angioedema.
Hepatotoxicity: Rare, serious (including fatal) idiosyncratic and unpredictable hepatocellular reaction (discontinue)”

A

chlorzoxazone (Lorzone, Parafon Forte)

53
Q

2 categories that are first line for neuropathic pain

A

anticonvulsants, SNRI

54
Q

AEs: Significant dizziness and sedation. Serious and possibly fatal respiratory depression may occur (Risk increased when combined with opioids or other sedatives; Elderly/underlying respiratory disease at higher risk). Euphoria (abuse potential)

A

Gabapentin (Neurontin), Pregabalin (Lyrica)

55
Q

couseling for Duloxetine(Cymbalta)

A

Take on a full stomach to reduce nausea

56
Q

AEs: nausea, Drowsiness, fatigue, headache also common

A

Duloxetine(Cymbalta)

57
Q

AEs: Drowsiness, dizziness, diaphoresis, nausea, anorexia (all actually fairly common)

A

Venlafaxine(Effexor)

58
Q

AEs: Anticholinergic effects: dry mouth, urinary retention, constipation, delirium, sedation, orthostatic hypotension

A

TCAs: “Nortiptyline (Pamelor)

Amitriptlyine (Elavil)”

Pharm 2 (29 decks)

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