Pain Flashcards
Is physiological adaptation and addiction the same?
No!
All pts become physiologically adapted to opioid after repeated exposure
T/F? It’s preferable to treat severe pain at initial onset?
T
What’s addiction?
Involves a strong desire or compulsion to take the drug despite harm and is manifested by drug-seeking behaviors
What’s pseudo-addiction?
Pt may be anxious about running out of drug and may have used up the med too quickly - signs which can be mistaken for addiction, but may actually be due to poorly treated pain
Whats Tolerance?
Tolerance to opioids develops over time and necessitates a higher dose to produce the same analgesic response
What’s opioid hyperalgesia?
Chronic opioid use that actually worsens pain sensitivity
What’s breakthrough pain (BTP)?
Acute pain that occurs despite use of long-acting or scheduled opioid
It’s best treated with fast relief agent - such as immediate release opioid
Whats an essential component of chronic opioid regimen?
Constipation prophylaxis
What must inpatients on IV opioids be monitored for?
Sedation - most imp predictor of respiratory depression (usual cause of fatality with an opioid overdose)
Name agents for mild pain (rx and OTC)?
Acetaminophen (Tylenol, “non-Aspirin” pain relievers)
Acetaminophen + Hydrocodone (Vicodin, Norco, Lortab)
Acetaminophen + Oxycodone (Percocet, Endocet)
Acetaminophen + codeine (Tylenol #2, 3, 4)
Acetaminophen + tramadol (Ultracet)
Brand name of Acetaminophen?
Tylenol
Brand name of Acetaminophen + Hydrocodone?
Vicodin
Norco
Lortab
Brand name of Acetaminophen + Oxycodone?
Percocet
Endocet
Brand name of Acetaminophen + Codeine?
Tylenol #2, 3, 4
Brand name of Acetaminophen + Tramadol?
Ultracet
What’s the max daily dose of Acetaminophen in adults?
Keep below 4,000 mg/day (3,000-3,900 mg/day)
To prevent hepatoxicity
Children’s dosing of Acetaminophen? Max daily dose?
10-15 mg/kg Q4-6H
Max 5 doses/D
What’s the conc of Acetaminophen in infants and children’s suspension?
160mg/5mL
SEs of Acetaminophen use?
Hepatoxicity (with overdose)
What’s the DOC in pregnancy for pain?
Acetaminophen
Antidote for Acetaminophen overdose?
N-acetylcysteine (NAC, oral and IV)
Moa of N-acetylcysteine (Antidote for Acetaminophen overdose)?
Restores intracellular glutathione (acts as a glutathione substitute)
NAC should be admin IMMEDIATELY
MOA of Aspirin and other NSAIDs (not acetaminophen)?
Aspirin - irreversibly
Other NSAIDs - reversibly
Block the activity of thromboxane and prostaglandins
While cox-2 selective agents have lower bleeding risk, but what risk increases with their use?
Cardiovascular risk
List NSAIDs, Salicylates agents
Aspirin (Acetylsalicylic acid) - Bayer, Bayer “Advanced” aspirin, Ascriptin, Bufferin, Ecotrin, Excedrin
Salsalate
Mg Salicylate
Choline Mg Trisalicylate
Diflunisal
Salicylate salts
Topical ?Salicylates
Risk that increases with NSAIDs use. Grp with highest risk?
GI bleeding
Elderly
Previous bleed
Chronic or high dose use
CI to Aspirin (NSAIDs, Salicylates use)? And Ibuprofen (NSAIDs, others)?
Avoid with NSAID hypersensitivity
Avoid Aspirin (not other NSAIDs) in children < 16 y/o with any viral inf
SE to Aspirin (NSAIDs, Salicylates) use? And Ibuprofen (NSAIDs, others)?
Dyspepsia
Heartburn (more common with Aspirin - EC or buffered pdt can reduce dx) - take NSAIDs, salicylate with food to reduce nausea
BP may increase (monitor)
GI irritation/bleeding, renal
Severe skin rash (SJS/TEN) - rare (stop drug, seek immediate medical help)
List agents under NSAIDs, others
Ibuprofen (Motrin, Advil)
Naproxen Na
Brand name of Ibuprofen (NSAIDs, others)?
Motrin
Advil
Brand name of Naproxen-Esomeprazole?
Vimovo
PPI used to protect gut from damage caused by NSAID
Howz all forms of Naproxen dosed?
All given BID
Advantage of Naproxen formulations?
Relatively lower cardiac risk
Agents under other non-selective NSAIDs?
Diclofenac (Cataflam, Voltaren XR)
Indomethacin (Indocin IR, CR)
Piroxicam (Feldene)
Ketorolac (Toradol)
Brand name of Diclofenac (non-selective NSAIDs)?
Cataflam
Voltaren XR
Brand name of Indomethacin (non-selective NSAIDs)?
Indocin
Brand name of Piroxicam (non-selective NSAIDs)?
Feldene
Brand name of Ketorolac (non-selective NSAIDs)?
Toradol
Sprix NS
SEs unique to indomethacin (Indocin)?
High risk for CNS SEs (avoid in psych conditions)
GI toxicity
SEs unique to Piroxicam (Feldene)?
High risk for GI toxicity and severe skin rxns (including SJS/TEN)
SEs unique to Ketotolac (Toradol)?
GI bleeding and perforation
Acute renal failure
Liver failure
Max duration of Ketorolac (Toradol) use?
Max 5 days in adults
COX-2 selective agents?
Celecoxib (Celebrex)
Meloxicam (Mobic)
Etodolac (Lodine)
Nabumetone (Relafen)
Brand name of Celecoxib (COX-2 selective agents)?
Celebrex
Brand name of Meloxicam (COX-2 selective agents)?
Mobic
Brand name of Etodolac (COX-2 selective agents)?
Lodine
Brand name of Nabumetone (COX-2 selective agents)?
Relafen
Which COX-2 selective agent has highest COX-2 selectivity and is CI with Sulfonamide allergy?
Celecoxib (Celebrex)
How do u mitigate upset stomach from NSAID use?
Take with food
Which meds shouldn’t NSAIDs be used with (to reduce ulcers and bleeding in stomach)?
Steroids
Anticoagulant
Antidepressant, including Fluoxetine Paroxetine Sertraline Citalopram Venlafaxine Others
When should NSAIDs be avoided?
If you’ve experienced breathing problems or allergic-type rxns after taking aspirin or other NSAIDs
Effect of NSAIDs on BP?
NSAIDs can raise BP
NSAIDs and photosensitivity?
Limit sun exposure; use broad spectrum sunscreen (blocks both UVA and UVB)
Which opioids are classified as pure opioid receptor agonists?
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Methadone
Morphine
Oxycodone
Oxymorphone