Pain Flashcards
Select the correct MOA for naproxen.
a. Antagonist at the mu-opioid receptor in the CNS
b. Inhibits cyclooxygenase, which reduces prostaglandin formation and decreases pain and inflammation
c. Serotonin/norepinephrine reuptake inhibitor
d. Agonist at the mu-opioid receptor in the CNS
e. Decreases substance P and reduces pain transmission from the nerve ending (localized effect)
b
A pt developed trouble breathing with laryngospasm after receiving an injection of morphine in the hospital. Which of the following would not present a risk of cross-reaction for this type of allergy?
a. Fentanyl
b. Methadone
c. Meperidine
d. Tapentadol
e. Oxymorphone
a, b, c, d
-The US tapentadol labeling doesn’t include a CI for pts with an opioid allergy of the morphine type. The package insert for tramadol does have this CI, and the two drugs are structurally similar.
Which of the following agents have a BBW to avoid any amount of alcohol as it could result in fatal OD due to increased absorption?
a. Norco
b. Soma
c. Zohydro ER
d. Kadian
e. Nucynta ER
c, d, e
Alcohol use should be avoided with any opioids, but with these agents, the opioid level could become toxic (fatal) d/t altered absorption of the ER formulation.
A prescriber wishes to use hydromorphone in his 55 y/o pt, who’s beginning opioid therapy. The pt had been misdiagnosed with rheumatoid arthritis but was found to have pain d/t cancer with metastases to the bone. Select a reasonable PO hydromorphone starting dose for an opioid-naive pt with an avg pain level of 8-9. He’s currently taking no other meds. Choose the correct initial dose.
a. 0.5 mg PO Q4-6H
b. 2 mg PO Q4-6H
c. 6 mg PO Q4-6H
d. 8 mg PO Q4-6H
e. 8 mg PO Q12H
b
CP is well-known to your pharmacy. Whenever she picks up her medication, she checks her BP on the machine and yells out, “Gosh, it’s always so high!” CP uses Zestril, Procardia XL, Tenormin, Celexa, and Celebrex. She purchases OTC ibuprofen, magnesium, and vit. D supplements. Which agent/s may be contributing to her elevated BP?
a. Ibuprofen
b. Celecoxib
c. Magnesium
d. Zestril
e. Procardia XL
a, b
-All NSAIDs can increase BP, including the COX-2 selective agent celecoxib (Celebrex).
-Magnesium can lower BP
-Pts shouldn’t be using 2 NSAIDs concurrently, with the possible exception of low-dose aspirin for cardioprotection.
Which of the following signs and symptoms would be present in a pt who’s received an OD of Dilaudid?
a. Sedation
b. Shallow breathing, faint breath sounds
c. Cold and clammy skin
d. Tachypnea
e. Pinpoint pupils
a, b, c, e
S/sx include: Extreme sleepiness, slow or shallow breathing, fingernails or lips turning blue or purple, extremely small “pinpoint” pupils, slow HR and/or BP, cold and clammy skin
JS has been hospitalized for many months receiving chemo. He’s stabilized, and his pain is manageable on Dilaudid 2 mg IV Q3H. In anticipation of discharge, the med team would like to convert him to an PO pain medication regimen. The palliative care physician wants to switch to MS Contin Q12H. How many mg of MS Contin PO Q12H is equivalent to JS’s current Dilaudid regimen? (Round to the nearest WHOLE number.)
160 mg PO Q12H
Hydromorphone 1.5 mg IV is equivalent to morphine (MS Contin) 30 mg PO
(16 mg hydromorphone IV) / (X mg morphine PO) = (1.5 mg hydromorphone IV) / (30 mg morphine PO)
16 x 30 = 1.5x
x = 320 mg morphine PO QD (or MS Contin 160 mg PO Q12H)
A pt regularly uses OTC pain relieving creams such as BenGay and Icy Hot that she applies to the painful, tender skin around the Achilles tendon. What’s the common ingredient in these OTC products?
a. A salicylate
b. Diclofenac
c. Capsaicin
d. Ibuprofen
e. Naproxen
a
Menthol and camphor are common additives; every pharmacy has its own store versions of these popular, topical analgesics, in various strengths
Which of the following meds and doses are roughly equivalent to 30 mg PO morphine?
a. 10 mg PO hydrocodone
b. 10 mg IV oxycodone
c. 10 mg IV morphine
d. 7.5 mg IV hydromorphone
e. 1.5 mg PO hydromorphone
c
-Oxycodone isn’t available in an IV form
Correct equivalent doses to 30 mg PO morphine:
-30 mg PO hydrocodone
-20 mg PO oxycodone
-7.5 mg PO hydromorphone or 1.5 mg IV hydromorphone
EJ has been using IR oxycodone PRN for pain management for the past several months. She can’t swallow most pills and crushes her meds. The Dr wishes to provide better pain control and wants to use a long-acting medication. Which of the following meds would be an appropriate recommendation?
a. Excedrin
b. Dilaudid
c. MS Contin
d. Kadian
e. Roxicodone
d
-Long-acting opioid tabs can’t be crushed; this could be fatal
-Kadian is a long-acting morphine capsule form that can be opened, but the beads can’t be chewed or crushed.
A Dr has received a DATA 2000 waiver from the DEA to prescribe buprenorphine. The pharmacist will know that the Dr is authorized to write for this drug if:
a. The DEA number begins with a B
b. The DEA number begins with a C
c. The DEA number begins with a P
d. The DEA number begins with an X
e. No special designation is required
d
The Drug Addiction Treatment Act of 2000 (DATA 2000) allows physicians who meet certain qualifications to treat opioid addiction with Schedule III, IV, and V meds that have been specifically approved by the FDA for addiction, such as buprenorphine forms (which are C-III).
A pt has chronic back pain and requires both analgesic and anti-inflammatory effects. Previously, the pt had a GI bleed from chronic use of ibuprofen that he was purchasing OTC. The physician will begin celecoxib therapy. The pt has the following med hx: HTN, elevated triglycerides, MI (twice), HF, and alcoholism. Choose the correct statement regarding celecoxib use in this pt.
a. Celecoxib use must be limited to < 5 days in this pt
b. Celecoxib isn’t an appropriate choice for this pt
c. A more appropriate option is Kadian
d. A more appropriate option is Nucynta ER
e. A more appropriate option is the Lidoderm patch
b
-The pt has a high CV risk and shouldn’t use celecoxib
-Nucynta ER and Kadian are long-acting forms of morphine that can’t be used with alcohol; alcohol increases the absorption and could cause the pt to receive a dangerous or even fatal dose
-The lidocaine patch would provide analgesia but no anti-inflammatory effects
NSAIDs have BBWs related to which of the following serious AEs and conditions?
a. GI AEs including bleeding, ulceration, and perforation of the stomach or intestines
b. CV thrombotic events, MI, and stroke, possibly within the 1st weeks of use
c. Risk of severe rash, including SJS and TEN
d. NSAIDs are contraindicated for peri-operative pain management in pts receiving coronary artery bypass graft (CABG) surgery
e. Risk of certain types of cancer, including skin cancer and lymphomas
a, b, d
-Although there’s not a BBW for severe rash, there have been cases of SJS in recent years from the use of ibuprofen and acetaminophen. Even these relatively safe agents are dangerous in some pts.
Choose the correct statement concerning tramadol.
a. The brand name is Ultracet
b. It’s a C-IV drug
c. There’s no risk of serotonin syndrome if used with serotonergic drugs
d. Diarrhea can occur with chronic use
e. It’s converted to an active metabolite by CYP3A4
b
-Caution in using tramadol with other serotonergic agents and in pts with seizure hx (do not use)
-Tramadol is constipating (the more used, the worse the problem) and is C-IV
Which of the following isn’t used for opioid-induced constipation (OIC)?
a. Relistor
b. Amitiza
c. Senna
d. Belbuca
e. Movantik
d
What is the scheduled category for Norco?
a. C-I
b. C-II
c. C-III
d. C-IV
e. C-V
b
All opioids are C-II, except where noted otherwise:
-Codeine tablet/capsule combo products are C-III
-Codeine PO solution combo products are C-V
A hospitalized pt is being switched from morphine to hydromorphone. The pharmacist first calculates the TDD and then reduces the dose of the new drug. Why did the pharmacist make a reduction after calculating the TDD of hydromorphone?
a. The pt may be addicted to the morphine.
b. The pt may have developed pseudo-addiction to the morphine and therefore requires a lower hydromorphone dose.
c. The pt may have developed tolerance to the morphine and therefore requires a lower hydromorphone dose.
d. The pt may absorb less morphine than hydromorphine.
e. The pt may have been selling the morphine on the street.
c
A pt has received an Rx for oxycodone-acetaminophen (Percocet). Choose the correct statement/s.
a. This is a C-II medication
b. CYP3A4 inhibitors will increase the concentration of this med
c. CYP3A4 inducers will increase the concentration of this med
d. Healthcare providers should be able to report abuse of this med
e. OxyContin contains only oxycodone
a, b, d, e
A hospitalized pt who had a hip replacement has been receiving hydromorphone. The opioid wasn’t dosed correctly for the pt. The nurse finds the pt with cold, clammy skin. On exam, the pupils are pinpoint, and the breathing is shallow and labored. Choose the correct antidote.
a. Suboxone
b. Naloxone
c. Flumazenil
d. Deferoxamine
e. Physostigmine
b
An elderly gentleman has been taking tramadol 50 mg 5-8x daily for 12 months for back and joint pain. The pt also used lorazepam 1 mg 4-5x daily over the same time period. If the pt attempts to stop either of these meds, he will experience shakiness, agitation, and tachycardia d/t which of the following?
a. Pseudo-addiction
b. Opioid hyperalgesia
c. Physiological adaptation
d. Addication
e. Tolerance
c
-All pts using enough opioids (or BZDs or barbiturates) will develop physical dependence if used chronically at regular dosing intervals.
-Physical withdrawal symptoms (e.g., shakiness, tachycardia, and agitation) can develop when the opioid or BZD is abruptly stopped.
-Addiction implies a psychological need to use the drug, such as getting a “high” from the drug.
