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Pain Flashcards

1
Q

Addiction

A

Stong desire/compulsion despite harm

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2
Q

Tolerance

A

Receptor level issue - more drug needed to stimulate receptor

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3
Q

3 classes of drugs that cause physical dependence, tolerance, and addiction

A

Benzos, Opioids, Barbiturates

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4
Q

Must always be added to pain regimen

A

Constipation prophylaxis (mush and push; docusate + senna/bisacodyl)

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5
Q

Biggest predictor of respiratory depression with pain meds

A

Sedation

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6
Q

Most AEs decrease over time, except…

A

Constipation

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7
Q

IV Acetaminophen

A

Ofirmev (addition to opioids can decrease overall opioid dose) - caution with this drug as there is a high risk of dosing errors

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8
Q

Antedote for APAP OD (glutathione substitute)

A

N-Acetylcystine (NAC) or Acetadote IV

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9
Q

Max dose of APAP per prescription

A

325 mg

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10
Q

Infant drops/childrens solution concentration

A

160 mg/5 mL

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11
Q

Max dose APA in children

A

10-15 mg/kg/dose (max 5 doses QD)

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12
Q

Max dose IBU in children

A

5-10 mg/kg/dose (max 40 mg QD)

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13
Q

Risk of GI bleed with Steroids and …

A

NSAIDs

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14
Q

Avoid aspirin in children

A

Reye’s Syndrome (other NSAIDs are okay to use)

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15
Q

AEs of ASA/Salicylates

A

GI bleed, renal impairment, increased BP, SJS/TEN (same with APAP), dyspepsia, heartburn

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16
Q

Avoid NSAIDs in patients with

A

MI history or HF

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17
Q

Stop NSAIDs at least ______ prior to elective surgery

A

1 week

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18
Q

Slsalate OD AE

A

Tinnitius

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19
Q

IBU brands

A

Advil, Motrin

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20
Q

IBU IV

A

Caldolor

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21
Q

All NSAIDs get dispensed with a…

A

MedGuide for GI bleed, CV risk, and preoperative bleeds (ex. CABG)

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22
Q

Naproxen brands

A

Aleve, Naprelan (Rx), Anaprox (Rx)

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23
Q

Vimovo generic

A

Naproxen + Esomeprazole (to protect the gut)

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24
Q

Diclofenac brands

A

Cataflam, Voltaren-XR, Zorvolex (nano formulation)

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25
Drugs for gut protection with NSAIDs
Misoprostol (pregnancy category X) and PPIs
26
Indomethacin AEs
CNS SEs (avoid in psych pts) and GI toxicity
27
Indomethacin (IR) is commonly used to treat which condition?
Gout
28
Indomethacin brand
Indocin
29
Piroxicam brand
Feldene
30
Piroxicam AEs
GI toxicity and SJS/TEN
31
Highest risk of SJS/TEN of all NSAIDs
Piroxicam
32
Ketorolac brand
Spris NS
33
Ketorolac initiation
Start with IV/IM/Nasal spray before oral
34
Max treatment duration of Ketorolac
5 days total due to severe GI bleeds, acute renal/liver failure, and anaphylactic shock
35
Sulindac
Safest NSAID to be used with Lithium
36
COX-2 selective NSAIDs (highest CV risk, lowest GI risk)
Celecoxib (Celebrex), Meloxicam (Mobic), Etodolac, Nabumetone
37
NSAID with highest COX-2 selectivity
Celebrex
38
NSAID contraindicated with sulfonamide allergy
Celebrex
39
If ASA is used for cardioprotection and IBU is used for pain...
Take ASA 1 hr before or 8 hours after IBU
40
Opioids agonize which receptor?
Mu
41
All ER formulations of opioids are...
REMS drugs
42
Morphine brands
MS Contin (cont- for controlled release), Avinza, Kadian, Oramorph SR, and Roxanol
43
Do not mix these opiods with alcohol as all of the drug will get dumped at once
Avinza (Morphine), Tapentadol (Nucynta), Oxymorphone (Opana)
44
Requires dose reduction of 50% when changing to this agent due to active metabolite that is renally cleared
Morphine
45
Relistor generic
Methylnaltrexone
46
Relistor only inidcated if
Failed DSS + stimulant laxative
47
Cross-allergenicity of morphine
oxymorphone, codeine, hydrocodone, hydromorphone, oxycodone
48
Cross-allergenicity of fentanyl
Meperidine
49
Cross-allergenicity of tramadol
Tapentadol
50
If morphine allergy use
Fentanyl, meperidine, methadone, tramadol, tapentadol
51
Opioid allergy symptoms
Decreased BP, rash, swelling of face/lips/tongue, difficulty breathing
52
Fentanyl patch brand
Duragesic
53
Fentanyl patch dosed in
mcg/hr
54
Actiq lollipop generic
Fentanyl (only for break through cancer pain - like all SL fentanyl formulations)
55
Not indicated for opioid naive
Fentanyl (must have been on 60 mg morphine x 7d)
56
Must hold fentanyl patch on for _____ seconds
30
57
SL fentanyl formulations are ______ drugs
REMS
58
3 patches that can be flushed
Fentanyl, Butrans, Daytrana
59
1st hydrocodone only drug
Zohydro ER (Q12h dosing)
60
2nd hydrocodone only drug
Hysingla ER (Q24h dosing)
61
Hydromorphone brand
Dilaudid, Dilaudid-HP (high potency), Exalgo (CI in opioid-naive)
62
Oxycodone brands
Oxeta, Roxicodone, Oxycontin (cont for controlled release), w/APAP (Endocet, Percocet, and Roxicet)
63
Hydrocodone and Oxycodone are substrates of
3A4
64
Oxymorphone brands
Opana, Opana ER
65
Take Opana w or w/o food
Without
66
Methadone brands
Dolophine, Methadose-liquid
67
Methadone is a ______ drug
REMS
68
Most proarrhythmic opioid
Methadone (QT prolongation)
69
Opioid with variable half lives
Methadone (15-60 hours)
70
Opioid that lowers testosterone most notably
Methadone
71
Serotonergic opioid
Methadone, Meperidine, Tramadol, Tapentadol
72
Meperidine brand
Demerol
73
Opioid only for acute pain management due to euphoric effects
Meperidine
74
Active metabolite of Meperidine
Normeperidine (renally cleared - can accumulate in elderly and with renal impairment)
75
Renal impairment can lead to increased risk of CNS toxicity, including seizures
Meperidine
76
Codeine can be metabolized differently in people with…..
CYP 2D6 polymorphisims (fast/slow metabolizers) - fast metabolizers get a buildup of morphine which can lead to respiratory depression
77
AEs with Codeine
GI
78
Combo Opioid agonists/Norepi Reuptake #s
Tramadol and Tapentadol (activating due to Norepi effects - leading to seizure risk)
79
Tramadol brands
Ultram, Conzip
80
Tramadol requires conversion by CYP2D6 and should be avoided with
CYP2D6 inhibitors
81
Tapentaol brands
Nucynta
82
Lower GI side effects than other opioids
Tramadol and Tapentadol
83
Antidote for opiod OD
Naloxone (mu receptor antagonist)
84
Signs of opioid OD
Somnolence, respiratory depression, cold/clammy skin, pinpoint pupils (miosis), coma/death
85
Evizo auto-injector
Naloxone for EMS
86
Naltrexone used for
Alcohol/opioid dependence
87
Buprenorphine transdermal
Butrans
88
Butrans indication
Mod-severe pain on patients who need ATC opioid
89
Buprenorphine
opioid agonist
90
Suboxone needs _____ DEA for prescribing
X (due to DATA waiver - drug addiction treatment act)
91
Butrans BBW
QT prolongation
92
Cyclobenzaprine brand
Fexmid
93
Antispasmodics with analgesic effects
Baclofen, Cyclobenzaprine, Tizanidine
94
Antispasmodics that work through sedation
Soma, Metaxalone (Skelaxin), Robaxin
95
Only muscle relaxant that is controlled
Soma (C-IV)
96
AEs of all muscle relaxants
Excessive sdation, dizziness, and confusion (AVOID OH)
97
Poor 2C19 metabolizers have higher/lower Soma concentrations
Higher
98
Neuropathic pain agents
Lyrica, Cymbalta, Gabapentin, Amitriptyline
99
Fibromyalgia Agents
Milnacipran, Lyrica, Cymbalta (SNRI)
100
Milnacipran brand
Savella
101
Milnacipran MOA
SNRI
102
AEs of Milnacipran
Nausea, headache, constipation, dizziness, insomnia, hot flashes
103
Lidocaine patches brand
Lidoderm
104
Patch duration
12 h on, 12 h off
105
ONLY patch you can cut into small pieces before taking backing off and applying
Lidoderm
106
Capsaicin brand
Zostrix (decreases substance P)
107
Diclofenac brand
Voltaren
108
Methyl salicylate (Icy Hot, BenGay, TheraGesic) can cause _________ burns
3rd degree

NAPLEX REVIEW (6 decks)

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