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NAPLEX Prep > Pain > Flashcards

Pain Flashcards

patho, non-opioids, opioids, opioid overdose, OUD, common adjuvants, key counseling points

1
Q

adjuvant pain management examples

A

ADs
AEDs
muscle relaxers

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2
Q

non-opioid pain management examples

A

NSAIDs
APAP

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3
Q

BBW for APAP

A

hepatotoxicity with doses >4g

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4
Q

adult dosing for APAP

A

325mg: 2t q4h / MDD 10t
500mg: 2t q6h / MDD 6t
650mg ER 2t q8h / MDD 6t

general MDD = 4,000mg

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5
Q

what is the max permissible amount of APAP allowed in combination products

A

325mg

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6
Q

what is the pediatric dosing for APAP

A

10-15mg/kg q4-6h
MDD = 5 doses

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7
Q

what nomogram is used in APAP overdose to determine the likelihood of hepatotoxicity and need for NAC?

A

Rumack-Matthew nomogram
uses APAP Cp and time

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8
Q

COX-1 vs COX-2

A

COX-1 protects the gastric mucosa
COX-2 converts arachadonic acid to PG + TXA2

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9
Q

what are the non-selective NSAIDs

A

ibuprofen
naproxen
ketorolac
indomethacin

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10
Q

what are the COX-2 selective NSAIDs

A

celecoxib
meloxicam
diclofenac

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11
Q

what are the six main SE of NSAIDS

A
  • dec renal BF leading to dec renal CL: caution in renal failure or use with nephrotoxins
  • inc BP: avoid in uncontrolled HTN
  • can cause premature closing of the ductus arteriosus leading to HF in baby: do NOT use NSAIDs in the 3rd trimester
  • GI bleed
  • nausea
  • photosensitivity
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12
Q

ibuprofen dosing in adults

A

OTC: 200-400mg po q4-6h MDD 1.2g
Rx: 600-800mg po q6-8h MDD 3.2g

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13
Q

ibuprofen peds dosing

A

10 mg/kg/dose q6-8h
MDD 40mg/dose

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14
Q

if a patient is taking OTC ibuprofen, what is the max # of days they should take it for

A

10 days

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15
Q

brand name for ibuprofen form used to close the DA in newborns

A

Neoprofen

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16
Q

NSAIDs ______ and _______ are used to close the DA in newborns

A

ibuprofen (Neoprofen) and Indomethacin
bothIV

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17
Q

Naproxen OTC dosing

A

200mg q8-12 hours MDD 600mg

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18
Q

Naproxen Rx dosing

A

500mg q12h MDD 1000mg

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19
Q

Treximet is

A

naproxen + sumatriptan

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20
Q

Vimovo is

A

naproxen + exomeprazole

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21
Q

Naproxen base __mg = naproxen Na ___mg

A

base 200mg = 220mg Na

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22
Q

Celecoxib dosing

A

100-200mg daily-BID

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23
Q

Which NSAID is CI in sulfa allergy

A

celecoxib

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24
Q

Celecoxib approved uses

A

RA
OA
juvenile RA
acute pain
primary dysmenorrhea
ankylosing spondylitis

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25
Q

which NSAID has the highest COX-2 selectivity

A

calecoxib

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26
Q

indomethacin should be avoided in patients with

A

psych diagnoses 2/2 CNS adverse effects

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27
Q

indomethacin IR typically used for

A

gout!

28
Q

Ketorolac
band name
dosing

A

toradol
po 10-20mg x1 then 10mg q4-6h prn
iv 30mg x1 or 30mg q6h

29
Q

excedrin contents

A

APAP/ASA/caffeine

30
Q

ketorolac BBW: max duration of therapy of all combined dosage forms

A

5 days

31
Q

when in pregnancy should NSAIDs especially be avoided

A

3rd trimester (30 weeks gestation)

32
Q

NSAIDs interact with

A

blood thinners
ototoxins
other NSAIDs

33
Q

NSAIDs increase plasma concentrations of (SATA)

A. Lithium
B. rifampin
C. warfarin
D. MTX
E. carbamazepine

A

A. Lithium
D. MTX

34
Q

opioid BBW

A
  • addiction abuse and misuse
  • resp dep, possibly fatal
  • inc risk of death when combined with benzo, etOH, CNS depressants
  • absolutely no alcohol with ER forms
  • accidental exposure to children can be fatal
  • crushing LA products can cause fatal overdose
  • life-threatening neonatal withdrawal if used during gestation
35
Q

fentanyl patch
what are the criteria to be on a patch
how is the patch used

A

need to be on at least 60mg morphine or equivalent for >/= 7 days
patch is once q72h and can be covered with Tegaderm or Bioclusive

36
Q

fentanyl brand names

A

duragesic, sublimaze

37
Q

hydromorphone
brand
dosing

A

dilaudid
po 2-4mg q4-6h
iv 0.2-1mg q2-3h

38
Q

BBW for fentanyl

A

dosing conversion errors
use with strong 3A4-i

39
Q

methadone
brand
SE

A

dolophine
QTp
serotonin syndrome
3A4 substrate

40
Q

codeine is a C-___
codeine w APAP is a C-___
codeine solutions are C-__

A

codeine is a C-II
codeine w APAP is a C-III
codeine solutions are C-V

41
Q

codeine is metabolized to morphine via

A

2D6

42
Q

codeine-specific BBW

A

BBW in children due to 2D6 polymorphisms of rapid metabolizers to morphine

43
Q

codeine is contraindicated in

A

brastfeeding
<12
<18 for post-op tonsillectomy or adenectomy pain

44
Q

tylenol #3 contents

A

codeine 30mg / APAP 300mg

45
Q

tylenol #4 contents

A

codeine 60mg / APAP 300mg

46
Q

hydrocodone cold preparations are not for use in

A

<18 yo

47
Q

morphine brand names

A

ER = Ms Contin
inj = duramorph, infumorph

48
Q

oxycodone brand names

A

IR = roxicodone
ER = oxycontin
ER w APAP = percocet, endocet, Xtamza ER

49
Q

74 yo female patient reports to pain manage for post operative back pain after a knee surgery. PMH sig for COPD on LABA/LAMA/ICS, depression on sertraline and mirtazepine, OA on APAP and GERD on PPI
provider wants to initiate opioid for pain management. what are the concerns?

A

elderly patient - inc fall risk, fractures, renal function
COPD - inc risk hypoxemia 2/2 resp depression

50
Q

which opioids are CYP3A4 substrates and should be avoided with 3A4-i

A

hydrocodone
fentanyl
methadone
oxycodone

51
Q

how do we convert from one opioid to the other

A

1) calculate the total daily dose of drug A
2) using the opioid equivalence chart, convert to the other opioid (Drug B)
3) DECREASE dose of Drug B by 50% to account for cross tolerance
4) split new total daily dose of Drug B into appropriate regimen (BID, TID, etc.)
5) BTP is 10-15% of the TDD once q1-2h

52
Q

opioid dose equivalents

A

——————-IV/IM (mg)————-po (mg)—
morphine 10 30
hydromorphone 1.5 7.5
oxycodone 20
hydrocodone 30

53
Q

first line for opioid-ind constipation

A

stimulant (bisacodyl, senna) or
osmotic (PEG) laxitives

54
Q

second line for opioid-ind constipation

A

naloxegol (Movantik)
Lubipristone (Amitiza)
methylnaltrexone (relistor)

55
Q

tramadol
brand

A

Ultram

56
Q

what CI do tramadol and codeine share

A

avoid in <12
avoid in <18 for post-op tonsillectomy or adenectomy pain

57
Q

tramadol warnings

A

similar to methadone
seizure risk, serotonin syndrome risk

58
Q

tapentadol
brand names

A

nucynta IR and ER

59
Q

warnings for tramadol and tapentadol

A

avoid MAO-i within 14 days
poss increased INR w warfarin
caution with seizures
caution with serotonergics
avoid tramadol w 2D6 inhibitors

60
Q

gabapentin dosing

A

300mg PO TID MDD 3600mg

61
Q

when does gabapentin dose need to be adjusted

A

CrCl <60

62
Q

when does pregabalin dose need to be adjusted

A

CrCl <60

63
Q

off-label gabapentin uses

A

FM, neuropathy, HA, AUD, alcohol withdrawal

64
Q

FDA approved doses for pregabalin

A

FM, PHN, neuropathic pain 2/2 DM or sp cord injury

65
Q

pregabalin dosing

A

75mg BID or 50mg TID
MDD 450mg

66
Q

carbamazepine
brand
dosing
FDA approval

A

Tegretol
100mg BIG, MDD 1200mg
FDA approved for trigeminal neuralgia

NAPLEX Prep (57 decks)

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