Pain

Question 1

adjuvant pain management examples

Answer 1

ADs
AEDs
muscle relaxers

Question 2

non-opioid pain management examples

Answer 2

NSAIDs
APAP

Question 3

BBW for APAP

Answer 3

hepatotoxicity with doses >4g

Question 4

adult dosing for APAP

Answer 4

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

general MDD = 4,000mg

Question 5

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

Answer 5

325mg

Question 6

what is the pediatric dosing for APAP

Answer 6

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

Question 7

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

Answer 7

Rumack-Matthew nomogram
uses APAP Cp and time

Question 8

COX-1 vs COX-2

Answer 8

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

Question 9

what are the non-selective NSAIDs

Answer 9

ibuprofen
naproxen
ketorolac
indomethacin

Question 10

what are the COX-2 selective NSAIDs

Answer 10

celecoxib
meloxicam
diclofenac

Question 11

what are the six main SE of NSAIDS

Answer 11

• 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

Question 12

ibuprofen dosing in adults

Answer 12

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

Question 13

ibuprofen peds dosing

Answer 13

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

Question 14

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

Answer 14

10 days

Question 15

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

Answer 15

Neoprofen

Question 16

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

Answer 16

ibuprofen (Neoprofen) and Indomethacin
bothIV

Question 17

Naproxen OTC dosing

Answer 17

200mg q8-12 hours MDD 600mg

Question 18

Naproxen Rx dosing

Answer 18

500mg q12h MDD 1000mg

Question 19

Treximet is

Answer 19

naproxen + sumatriptan

Question 20

Vimovo is

Answer 20

naproxen + exomeprazole

Question 21

Naproxen base __mg = naproxen Na ___mg

Answer 21

base 200mg = 220mg Na

Question 22

Celecoxib dosing

Answer 22

100-200mg daily-BID

Question 23

Which NSAID is CI in sulfa allergy

Answer 23

celecoxib

Question 24

Celecoxib approved uses

Answer 24

RA
OA
juvenile RA
acute pain
primary dysmenorrhea
ankylosing spondylitis

Question 25

which NSAID has the highest COX-2 selectivity

Answer 25

calecoxib

Question 26

indomethacin should be avoided in patients with

Answer 26

psych diagnoses 2/2 CNS adverse effects

Question 27

indomethacin IR typically used for

Answer 27

gout!

Question 28

Ketorolac band name dosing

Answer 28

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

Question 29

excedrin contents

Answer 29

APAP/ASA/caffeine

Question 30

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

Answer 30

5 days

Question 31

when in pregnancy should NSAIDs especially be avoided

Answer 31

3rd trimester (30 weeks gestation)

Question 32

NSAIDs interact with

Answer 32

blood thinners ototoxins other NSAIDs

Question 33

NSAIDs increase plasma concentrations of (SATA) A. Lithium B. rifampin C. warfarin D. MTX E. carbamazepine

Answer 33

A. Lithium D. MTX

Question 34

opioid BBW

Answer 34

- 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

Question 35

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

Answer 35

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

Question 36

fentanyl brand names

Answer 36

duragesic, sublimaze

Question 37

hydromorphone brand dosing

Answer 37

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

Question 38

BBW for fentanyl

Answer 38

dosing conversion errors use with strong 3A4-i

Question 39

methadone brand SE

Answer 39

dolophine QTp serotonin syndrome 3A4 substrate

Question 40

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

Answer 40

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

Question 41

codeine is metabolized to morphine via

Answer 41

2D6

Question 42

codeine-specific BBW

Answer 42

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

Question 43

codeine is contraindicated in

Answer 43

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

Question 44

tylenol #3 contents

Answer 44

codeine 30mg / APAP 300mg

Question 45

tylenol #4 contents

Answer 45

codeine 60mg / APAP 300mg

Question 46

hydrocodone cold preparations are not for use in

Answer 46

<18 yo

Question 47

morphine brand names

Answer 47

ER = Ms Contin inj = duramorph, infumorph

Question 48

oxycodone brand names

Answer 48

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

Question 49

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?

Answer 49

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

Question 50

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

Answer 50

hydrocodone fentanyl methadone oxycodone

Question 51

how do we convert from one opioid to the other

Answer 51

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

Question 52

opioid dose equivalents

Answer 52

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

Question 53

first line for opioid-ind constipation

Answer 53

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

Question 54

second line for opioid-ind constipation

Answer 54

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

Question 55

tramadol brand

Answer 55

Ultram

Question 56

what CI do tramadol and codeine share

Answer 56

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

Question 57

tramadol warnings

Answer 57

similar to methadone seizure risk, serotonin syndrome risk

Question 58

tapentadol brand names

Answer 58

nucynta IR and ER

Question 59

warnings for tramadol and tapentadol

Answer 59

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

Question 60

gabapentin dosing

Answer 60

300mg PO TID MDD 3600mg

Question 61

when does gabapentin dose need to be adjusted

Answer 61

CrCl <60

Question 62

when does pregabalin dose need to be adjusted

Answer 62

CrCl <60

Question 63

off-label gabapentin uses

Answer 63

FM, neuropathy, HA, AUD, alcohol withdrawal

Question 64

FDA approved doses for pregabalin

Answer 64

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

Question 65

pregabalin dosing

Answer 65

75mg BID or 50mg TID MDD 450mg

Question 66

carbamazepine brand dosing FDA approval

Answer 66

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