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PAIN Flashcards

1
Q

what is considered the fifth vital sign?

A

pain

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2
Q

what is the right dose for pain?

A

the lowest dose that treats the pain is the right dose

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3
Q

what are withdrawas symptoms of opioids?

A

Anxiety, tachycardia, shakiness,SOB

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4
Q

what is addiction?

A

using the medication despite harm to oneself along with drug seeking behavior

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5
Q

what is tolerance

A

needing a higher dose with time to achieve the same analgesi effect

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6
Q

what is a typical pain regimen consist of in terms of agents ?

A

long acting pain agent,break through pain agent , constipation prophylaxis,sometimes may use an adjuvant

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7
Q

How do you go about choosing a pain medication?

A

decide whehter the pain is mild, moderate or severe and where it is found (what is the quality)

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8
Q

what type of agents to use for mild pain?

A

use APAP or an NSAID

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9
Q

what agents to use for moderate pain

A

combination agents like apap/hydrocodone

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10
Q

what agents to use for severe pain?

A

opioids

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11
Q

how do you choose an adjuvant?

A

neuropathic pain: use an antidepressant like amitryptiline or duloxetine or anticonvulsant for shooting pain: pregabalin

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12
Q

what is the name of the injectible APAP?

A

OFIRMEV

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13
Q

Tylenol

A

APAP

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14
Q

vicodin

A

apap+ hydrocodone

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15
Q

norco

A

apap+hydrocodone

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16
Q

lortab

A

apap+hydrocodone

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17
Q

APAP+hydrocodone brands

A

vicodin, norco, lortab

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18
Q

percocet apap+ oxycodone

A

apap+ oxycodone

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19
Q

endocet

A

apap+oxycodone

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20
Q

apap+ oxycodone brands

A

percocet , endocet

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21
Q

apap + codeine

A

tyelone 2, 3, 4

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22
Q

ultracet

A

apap+ tramadol

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23
Q

apap+ tramadol

A

ultracet

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24
Q

what is the maximum APAP dose?

A

4g max per day

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25
Q

typical apap dosing

A

325 mg 2 tabs q 4-6 hr,500mg 2tabs q 6h, 650mg ER 2 tabs q8h

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26
Q

children dosing for APAP

A

10-15mg/kg q 4-6 hours max 5 doses per day

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27
Q

can apap cause renal toxicity?

A

very rarely yes but generally safe in renal disease

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28
Q

main toxicity of apap?

A

liver toxicity

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29
Q

what is the DOC for pain in pregnancy?

A

APAP

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30
Q

maximum daily dose of APAP in heavy drinking?

A

3g per day

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31
Q

what is the antidote for APAP?

A

N-acetylcysteine PO or IV

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32
Q

what is the MOA of NAC?

A

resptores intracellular glutathione which basically helps the liver detoxify the toxic metabolite (NAPQI)

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33
Q

when to administer NAC

A

within 8 hours of acute injection

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34
Q

what is the PO dose fo NAC?

A

140mg/kg po loading dose then 70mg/kg q 4h x 17 doses

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35
Q

can you use APAP with warfarin?

A

yes its the doc but if used chronically can affect the INR

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36
Q

what is the MOA of NSAIDS?

A

they depelete prostaglandins by inhibitin COX-1/COX-2

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37
Q

which COX inhibition increases bleeding risk?

A

cox-1

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38
Q

what are the BBW for NSAIDS? “

A

CV risk: MI, stroke, thrombotic risk, GI bleed ulcer at high and chronic use

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39
Q

ASA brands

A

bayer, ascriptin, bufferin, ecotrin, excedrine

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40
Q

what is the MOA of ASA?

A

irreversible inhibition of COX

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41
Q

which NSIAD has the lowest risk of GI toxicity

A

celebrex, IBU and NAPROX have low risk but can be risky at high/chronic dosing”

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42
Q

what is the danger with chronic PPI use?

A

decreased bone density and increased infection risk

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43
Q

who should avoid aspirin?

A

pregnant women esp in 3rd trimester,children <16yo with any viral infection due to risk of reyes syndrome

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44
Q

reye’s sydrmoe symptoms

A

sleepiness, nausea, lethargy, confusion

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45
Q

what can you do if you are having nausea w/ NSAIDS?

A

take with food

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46
Q

effect of bP from nsaids?

A

increase

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47
Q

main side effects from ASA? “

A

dyspepsia, heartburn, gi bleed & irritaiton ,inc in bp

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48
Q

when should you stop NSAID before elective surgery?

A

1 week before

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49
Q

symptom of ASA overdose?

A

ringing of the ears

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50
Q

motrin

A

ibuprofen

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51
Q

advil

A

ibuprofen

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52
Q

vimovo

A

naproxen and esomprazole

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53
Q

otc vs rx dose fo ibuprofen

A

OTC up to 400 q q-6 h max 10 days use or less, max 1.2 g/day , RX up to 800 q 6-8 max 3.2 grams /day

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54
Q

what are the diff use of IBU depediong dose?

A

OTC: mild/mod pain , fever, dysmenrorrea, RX: moderate pain or inflammation

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55
Q

dosing frequency of naproxen

A

all twice daily

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56
Q

use of naproxen OTC?

A

typical pain

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57
Q

use of naproxen RX

A

mild-mod pain and ifnlamation

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58
Q

max naproxen dose otc

A

1250mg/day

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59
Q

max naproxen rx dose

A

1.5 /aday

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60
Q

otc vs rx dose of naproxen

A

otc 500mg dose then 250m g q6-8 h, rx: 250-bid to 500mg bid

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61
Q

diclofenac brands

A

voltaren, cataflam, arthrotec

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62
Q

arthrotec

A

diclofenac + misoprostol

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63
Q

what is the purpose of the misoprosotl in te arthortec?

A

to repace the gut-protective prostaglanding to reduce GI risk of the NSAID

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64
Q

what tis the pregancy category of misprostol?

A

X because can also be used as an abortifacent

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65
Q

indocin

A

indomethacin

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66
Q

indomethacin doses

A

IR 25-50mg CR 75 mg

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67
Q

main indication for indomethacin?

A

approved for gout

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68
Q

main side effect of indomethacin?

A

increased risk of cn Ses and GI toxiicty. CNS depresssant

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69
Q

feldene

A

piroxicam

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70
Q

typical dose of prioxicam

A

10-20mg daily

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71
Q

side effects with piroxicam

A

increased risk of gi toxicyt and sever skin reactions including sjs/TEN . Use only if the pt has ailed outher NSAIDs

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72
Q

toradol

A

ketorolac

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73
Q

sprix NS

A

ketorolac

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74
Q

typical ketorolac dose?

A

10-20mg

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75
Q

when should you not use ketorloac?

A

in any situation iwn which the pt has an increased risk of bleeding

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76
Q

what is the total max tx for ketorolac?

A

5 days PO max

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77
Q

how should you start ketorolac?

A

always start IV, IM or nasal sparay and then continue with orla if necessary

78
Q

what are serious consecuenses dfron ketorloac?

A

severe bleeding, gi perforamtion, acute renal failure and liver failure, anaphylactic shoc. Use only in cmocerate to sever acute pain and MAX 5 days. Only for after the opeartion NEVER before the operation

79
Q

what are the cox- 2 selective NSAIDS

A

celecoxib meloxicam etodolac nabumetone

80
Q

whay use the cox-2 selective saisned over cox-1 ?

A

lower risk of GI complicaitons

81
Q

which are the cox non selective NSAIDS?

A

all others

82
Q

celebrex

83
Q

mobic

84
Q

lodine

85
Q

relafen

A

nabumetone

86
Q

osteoarthryits dose of celbrex?

A

100mg po bid or 200 daily

87
Q

Rheumatoid arthritis dose fore celebrex?

A

100-200 BID

88
Q

what is a contraindiation of celcoxib?

A

SULFA ALLERGY

89
Q

nsaid counseling?

A

take with food if this upsets your stomach, -can inc MI, stroke esp in pts w/ heart disease can cuase uslcers and bleeding in the stomach -do not use this medicaiton if pregnant -increases blood pressure

90
Q

is there a ceiling for opioid doses?

A

no, u can go higher to achieve more pain relief but you should rotate them because it reduces tolerance

91
Q

what are the main requirements by the FDA for opioids in the REMS program?

A

to education prescribrs and to counsel patients

92
Q

MS contin

A

long-acting morphine

93
Q

avinza

A

long acting morphine

94
Q

kadian

A

long acting morphine

95
Q

oramorph SR

A

long acting morphine

96
Q

roxanol

A

long acting morphine

97
Q

what is th dosing for AVINZA

A

once daily

98
Q

what available PRN doses for IR morhpine exist?

A

10-30mg Q 4h as needed

99
Q

what ER concentrations iexist for morphine?

A

15, 30, 60, 100, 200 q 8-12 hours

100
Q

how often is kadian dosed

A

daily or twice daily

101
Q

can you sprinke avinza and kadian on applesauce ?

102
Q

can you open kadian beads and put them down an NG tube?

103
Q

Embeda

A

morphone/naltrexone

104
Q

what is the advantage of embeda

A

conatins naltrexone which is an apioid blocker that deters abuse since crussion the drug will lead to release of naltrexone

105
Q

if allregic to morphine group, which agents can you use instead?

A

fentanyl, meperidine, mehtadone, tapentadol

106
Q

if allergic to morphine group, which agents can you not used

A

morhphine, oxymorhpone, hydromophonem codeine, oxycodone, hydrodone

107
Q

symptoms of an allergy to opoid?

A

Difficulty breaty, sever drop in bp, sever rash, swelling of face, lips , tongue,

108
Q

main side effects of opioids?

A

constipation, nausea, vominting sedation, mood changes flushin prurritis, diaphoresis (can give antihistamine)

109
Q

to which side effects does somoen not become tolerate of for opioids?

A

constipation

110
Q

what strengths does fentanyl come in?

A

patch: 12, 25, 50, 75, 100 mcg/h

111
Q

how often should you change fentanyl patch?

A

every 3 days

112
Q

if using the fentanyl pathc and the pain relief does not last long enough, what do you do? i

A

shorten the dosing indterval, do not increase the dose (applies to all long acting opioids)

113
Q

duragesic?

114
Q

abstral

A

sublingual fentanly

115
Q

fentora

A

SL fentanyl

116
Q

when should you start fentanyl?

A

for chronic pain only . Patient on 60mg morphine equivalent x at least 7 days

117
Q

how does heat affect the fentanyl patch?

A

can increase the dose that the patient gets. Avoid heating pads or if pt gets fever call the doctor.

118
Q

how long after applying patch should pt see effect?

A

8-16 hours after

119
Q

can fentanyl patch be flushed down the toilet/

A

YES, which is typically not what should be done with most patches

120
Q

which fentanyl type is a REMS drug?

A

the Sublingual forms

121
Q

if fentanyl transdermal gel touches skin, what to do?

A

wash with large amounts of water ONLY

122
Q

dilaudid

A

hydromorphone

123
Q

exalgo

A

hydromorphone extended release products

124
Q

CI exalgo?

A

opioid NAÏVE patients

125
Q

what dose to start for opioiod haive patients for hydromophone?

A

2-4mg po or 1-2 mg by injection q 4-6 h

126
Q

oxycontin

A

CR oxycodone

127
Q

coxycontin OP

A

controled release oxycodone

128
Q

entocet, percoet, roxicet

A

oxycodone with apapa

129
Q

what DDI is important with oxycodone?

A

cyp 3A4 inhibitors

130
Q

opana

A

oxymorphone

131
Q

whats the diff between opana ER and IPAN IR?

A

ER you take twice daily while the IR is used PRN

132
Q

how should you take opana?

A

on ana empty stomach, most other analgesic should be take with food to avoid stoamch upset

133
Q

what to avoid wit opan ER?

134
Q

contraidiation of ER Opana?

A

mod to sever liver impairment

135
Q

dolophine

136
Q

methadose

A

methadone liquid

137
Q

methadone dependeance tx tdose?

A

40mg daily

138
Q

methadone pain tx dose?

A

2.5mg to 10mg q 8-12 hours

139
Q

demerol

A

meperidine

140
Q

can you use meperidine for chronic pain?

A

no only for acut pain

141
Q

biggest concertn for meperidine use in certain poulations

A

renal impairment/ elderly because of increased risk of toxicity. Has a metabolite that is renally cleared and can accumulate and cuase renal toxicity

142
Q

Opoid DDIs

A

CNS depressants , aclochol etc

143
Q

which agent should you be cuathious of for QT prolognation?

144
Q

ultram

145
Q

ryzolt

A

trmaalod ER tabs

146
Q

ultracet

A

tramadol + apap

147
Q

concerns with tramadol?

A

increases seizure risk, risk of serotonin syndrome, SAME side effects as opioids

148
Q

nycynta

A

tapentadol

149
Q

why use nuycnta?

A

less gi side effect that opioikds

150
Q

MOA of tramadol and tapentadol?

A

mu opioid agonists and Norepinephrie reuptake inhibtors

151
Q

countsilin for opioids

A

don’t chew or crush controlled release forms all opioids NO ALCOHOL will cause drwosineess and fatigue take with full galss water & food if upset stomach will cause consipation

152
Q

memorize the dose conversion table

A

OK will do

153
Q

when dose converting fentanyl and morphine equivlants what must you always remember?

A

fentanyl is in MCG while morphine is in MG

154
Q

equivalent fentanyl patch / morhine equivlanet

A

60mg morphine equals 25mcg/hr fentanyl

155
Q

if an opioid dose does not last long enough what should you do?

A

increase to more frequent dosing interval rather than increasing the dose

156
Q

know ho to calculate equivalent doses between opiods

157
Q

what agents available to antagonize opioids from overdose?

158
Q

what are opoid antagonists used for?

A

when a patient has overdose and is undergoing respiratory depression, they give this so the patient can wake up

159
Q

dosin of noloxone

A

0.4 to 2mg every 2-3 minuts or IV infusion at 100ml/hr= 0.4mg/hr

160
Q

what are signs and symptoms of an acute opoid overdose/

A

somonlonece, dec RR, cold clammy skin, constricted pupils

161
Q

suboxone

A

buprenorpine and naoloxone

162
Q

moa of buprenorpine

A

opioid agonist

163
Q

moa of naloxone

A

opiod antagonist

164
Q

bbw for buprenorphine patch?

A

do not exceed a dose of one 20mcg/hour butrans patch systme because of risk of qt prolongation

165
Q

two main side effects of buprenorphine?

A

causes CNS depression and possible qt prolongation

166
Q

butrans patch counseling

A

don’t place any heat on patch wear one patch for 7 days continuously place on upper arm, upper chest, side of chest or upper back , don’t use same site in 21 days don’t drink alcohol , will make us sleepy an could kill you can flush or coffee grounds

167
Q

soma

A

carisoprodol

168
Q

lioresal

169
Q

flexeril

A

cyclobenzaprine

170
Q

skelaxin

A

metalaxone

171
Q

muscle relaxants generic names

A

carisoprodol, baclofen, cyclobenzaprine, metalaxone

172
Q

SE for muscle relaxants?

A

excessive sedation, dizziness, confusion

173
Q

dosing for carisoprodol

A

250-350m QID prn

174
Q

dosing baclofen

A

5-20mg tid-qid prn

175
Q

flexeril dosing

A

5-10 mg tid prn , er 15-30 prn

176
Q

zanaflex

177
Q

what is the moa of tizanidine?

A

it is a skeletal muscle relaxant

178
Q

muscle relaxant counseling?

A

causes sedation, avoid alcohol or other sedatives

179
Q

four adjuvants used for pain relief?

A

pregabalin and gabapentin, duloxetine and amytryptiline

180
Q

lyrica

A

pregabalin

181
Q

cymbalta

A

duloxetine

182
Q

neurontin

A

gabapentin

183
Q

elavil

A

amitriptyline

184
Q

main SE’s of pregabalin?

A

dizziness, somonolence, PERipheral edema

185
Q

topical pain agent for local pain

A

lidocaine, capsaicin, diclofenac topical

186
Q

zostrix

187
Q

lidoderm

188
Q

can you cut lidocaine patches

A

surprisingly YES

189
Q

maximum patches can put at one time?

190
Q

for what type of pain is lidocaine FDA approved/

191
Q

lidocaine time duration of application

A

12 hours on, 12 hours off

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