Pain Flashcards
1
Q
CII
A
- DEA and Missouri BNDD needed for prescribe controlled substances, including discontinuation
- CII: no refill, no call into pharmacy or clarified over phone
3 hydrocodone and hydrocodone containing products are CII
2
Q
dysesthesia
A
impairment of sensitivity especially to touch
3
Q
WHO weak vs strong opioids
A
Weak: Codeine, Dihydrocodeine, dextropropoxyphene, tramadol
Strong: morphine, methadone, fentanyl, hydromorphone, pethidine, oxycodone, buprenorphine, dextromoramide
4
Q
Full agonists
A
- morphine
- fentanyl
- hydromorphone
- codeine
- methadone
- tramadol
- pethidine
5
Q
partial agonist
A
- buprenorphine
- pentazocine
- butorphanol
6
Q
agonists-antagonists
A
- nalbuphine
2. nalorphine
7
Q
Full antagonists
A
- naloxone
- naltrexone
- methylnaltrexone
- alvimopan (ADL 8-2698)
8
Q
codeine phosphate
A
- natural but w/o analgesic effect itself
- Metabolized in liver: glucuronidation, N- & O-demethylation (P450 2D6)
- codeine—->O-demethylation—>morphine (2-10%)–>analgesia
- 9% Caucasians w/o analgesia
- ultrarapid metabolizers: up to 29% some Middle Eastern & North African–>brestfeed–>toxicity; 0.5% some Asian
9
Q
codeine phosphate (cont.)
A
- PO: 30-120 mg Q 4hrs —> duration of action 4-6 hrs
- If 60 mg PO: NNT of 12 for at least 50% pain relief
- Improving non-opioid analgesics
- major adverse: constipation
10
Q
dextropropoxyphene
A
- synthetic: structurally related to methadone
- high but saturable 1st-pass
- In liver: demethylation–>norpropoxyphene–>analgesic
- PO: 50-100mg q6-8hrs
- confusion, hallucination, convulsion, prolonged QT–>torsades de points, cardiac arrest–>withdrawal or discouragement
11
Q
dihydrocodeine
A
- semisynthetic
- analgesia: independent of metabolization to dihydromorphine
- analgesic efficacy similar to codeine, inferior to ibuprofen (200mg) or diclofenac (50 mg)
- advantage: slow-release preparation for q12 hrs
12
Q
tramadol
A
- opioid agonist + monoaminergic
- PO: bioavailability 80-90%
- Effective, fewer side effects, efficacy on NP
- P450 2D6–>O-desmethyltramadol (M-1)–>opioid-like analgesia
- recommended dose limits: 600mg/day due to regulation, but unsupported by data
- MC side effects: N/V
13
Q
morphine PO vs epidural vs i.t.
A
PO—>epidural: 2-5%
PO—>i.t. 0.5-1%
