Pain

Question 1

FeverAll rectal

Answer 1

APAP

Question 2

Lortab

Answer 2

APAP + hydrocodone

Question 3

Excedrin

Answer 3

Caffeine + APAP

Question 4

Excedrin Extra, Excedrin Migrain

Answer 4

Caffeine + ASA + APAP

Question 5

Midol Complete

Answer 5

APAP + Caffeine + pyrilamine

Question 6

Ofirmev IV

Answer 6

APAP

Question 7

Main conceren with Tylenol

Answer 7

hepatotooxicity

< 4000 mg/day

n-acetylcysteine (NAC) as reversal agent

Question 8

Risk of non-aspirin NSAIDs

Answer 8

***require a MedGuide for prescriptions!!!!

-GI risk of bleeding and ulceration
-CV risk of MI and stroke
-CABG - contraindicated after!

Question 9

SE of NSAIDs

Answer 9

-renal damage
-increase BP
-premature closure of ductus arteriosus (do NOT use NSAIDs in 3rd trimester)
-Nausea (take with food)
-Photosensitivity

Question 10

Irreversible COX-1 and COX-2 inhibitor

Answer 10

Aspirin

Question 11

Caldolor

Answer 11

Ibuprofen

Question 12

What pain medication can you NOT use with a sulfonamide allergy?

Answer 12

Celecoxib (Celebrex)

Question 13

Vimovo

Answer 13

Naproxen + Esomeprazole

Question 14

Toradol

Answer 14

Ketorlac
**MAX duration is 5 days

• nasal spray - spray 5 times to prime before using

Question 15

COX-2 selective inhibitors

Answer 15

Diclofenac (Voltaren)
Celecoxib (Celebrex)

some:
-Meloxicam (Mobic)
-Nabumetone

Question 16

Salicylate overdose

Answer 16

tinnitus!!!!
AVOID ASA in children!!!

Question 17

Opioid SE

Answer 17

CONSTIPATION
N/V
respiratory depression
Pruiritus (especially morphine)

Question 18

When is it appropriate to use fentanyl?

Answer 18

NOT used in opioid naive patient…

patient who has been using equivalent to morphine 60 mg/day for at least 7 days!!!!!

Question 19

Fentanyl patch counseling

Answer 19

effect within 8-16 hours after applying
-apply to hairless skin
-do not cover with heating pad
-keep away from children!

Question 20

Codeine

Answer 20

Prodrug of morphine coverted by CYP 2D6

***ultra rapid metabolizers caution of death!

**DO NOT use in children < 12 years and in < 18 followed by tonsillectomy

Codeine + APAP = CIII
Codeine alone = CII
Codeine + solution = CV

Question 21

Actiq

Answer 21

Fentanyl “lollipop”

Question 22

Opioids that are CYP3A4 substrates

Answer 22

Hydrocodone
Methadone
Codeine
Fentanyl
Oxycodone

***caution with use of strong CYP inducers or inhibitors!!!!

Not: hydromorphone, morphine, meperidine

Question 23

What opioid has a risk of QTc prolongation?

Answer 23

Methadone (Dolophine)

Question 24

What opioid must you avoid with MAO inhibitors due to its seotonergiv effects?

Answer 24

Meperidine (Demerol)
Tramadol (Ultram)

Question 25

What is the main side effect of morphine (MS Contin)?

Answer 25

Pruiritis ***treat with diphenhydramine

Question 26

What are the POTENT opioids?

Answer 26

Fentanyl Hydromorphone (Dilaudid) Oxymorphone

Question 27

Coversion between Morphine IV to PO

Answer 27

1:3

Question 28

Coversion between Hydromorphone to Morphine

Answer 28

PO 7.5 : 30 IV 1.5:10

Question 29

Conversion between morphine PO to oxycodone PO

Answer 29

30:20

Question 30

What medications should you try to avoid with opioid use?

Answer 30

Benzodiazapines CNS depressants

Question 31

Which opioids do not cross react with opioid allergy?

Answer 31

Methadone Fentanyl Meperidine

Question 32

What are the best treatment recommendations for opioid-induced constipation?

Answer 32

Stimulant laxatives (Senna or Biscodyl) then PAMORAs: -Methylnatrexone (Relistor) -Naloxegol (Movantik) then Lubiprostone (Amitiza)

Question 33

Ultram

Answer 33

Tramadol C-IV Prodrug coverted by CYP 2D6 ***ultra rapid metabolizers caution of death! **DO NOT use in children < 12 years and in < 18 followed by tonsillectomy SEIZURES, and risk for HYPOglycemia

Question 34

What pain medication can lead to HYPOglycemia?

Answer 34

Tramadol

Question 35

What agents are available for opioid abuse?

Answer 35

Naloxone (Narcan) Buprenorphine (Butrans patch, Belcuca buccal patch) -- QTc prolongation Buprenorphine/Naloxone (Suboxone)

Question 36

What is required for prescribers in order for them to prescribe Suboxone for opioid dependence?

Answer 36

DATA 2000 waiver the DEA number will start with X

Question 37

What is approved for Post-herpic pain?

Answer 37

Gabapentin (Horizant) Pregabalin

Question 38

Side effects of gabapentin and pregabalin

Answer 38

Peripheral edema weight gain somnolence

Question 39

Which are muscle relaxants used as adjuvants for muscle pain or spams?

Answer 39

Baclofen (Lioresal) Cyclobenzaprine (Amrix, Flexeril) Tizanidine (Zanaflex) Carisoprodol (Soma) Methocarbamol (Robaxin) ****cause drowsiness!!!

Question 40

Lidoderm counseling points

Answer 40

Adjuvant topicals for pain **patch and you CAN cut do not apply more than3 at one time

Question 41

What are other topical adjuvants for pain?

Answer 41

Capsaicin (causes burning) Methyl salicylate (IcyHot0 Lidocaine Diclofenac gel

Question 42

Counseling for diclofenac gel

Answer 42

Use card to dose - hands or elbows 2 g - feet or knees 4 g do not shower for at least 1 hour after application

Question 43

What are the COX-2 selective drugs?

Answer 43

Celecoxib (Celebrex) Diclofenac (Voltaren or Flector patch) Meloxicam (Mobic) Etodolac Nabumetone