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naplex review > Pain > Flashcards

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
Q

Drugs for gut protection with NSAIDs

A

Misoprostol (pregnancy category X) and PPIs

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26
Q

Indomethacin AEs

A

CNS SEs (avoid in psych pts) and GI toxicity

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27
Q

Indomethacin (IR) is commonly used to treat which condition?

A

Gout

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28
Q

Indomethacin brand

A

Indocin

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29
Q

Piroxicam brand

A

Feldene

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30
Q

Piroxicam AEs

A

GI toxicity and SJS/TEN

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31
Q

Highest risk of SJS/TEN of all NSAIDs

A

Piroxicam

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32
Q

Ketorolac brand

A

Spris NS

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33
Q

Ketorolac initiation

A

Start with IV/IM/Nasal spray before oral

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34
Q

Max treatment duration of Ketorolac

A

5 days total due to severe GI bleeds, acute renal/liver failure, and anaphylactic shock

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35
Q

Sulindac

A

Safest NSAID to be used with Lithium

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36
Q

COX-2 selective NSAIDs (highest CV risk, lowest GI risk)

A

Celecoxib (Celebrex), Meloxicam (Mobic), Etodolac, Nabumetone

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37
Q

NSAID with highest COX-2 selectivity

A

Celebrex

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38
Q

NSAID contraindicated with sulfonamide allergy

A

Celebrex

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39
Q

If ASA is used for cardioprotection and IBU is used for pain…

A

Take ASA 1 hr before or 8 hours after IBU

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40
Q

Opioids agonize which receptor?

A

Mu

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41
Q

All ER formulations of opioids are…

A

REMS drugs

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42
Q

Morphine brands

A

MS Contin (cont- for controlled release), Avinza, Kadian, Oramorph SR, and Roxanol

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43
Q

Do not mix these opiods with alcohol as all of the drug will get dumped at once

A

Avinza (Morphine), Tapentadol (Nucynta), Oxymorphone (Opana)

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44
Q

Requires dose reduction of 50% when changing to this agent due to active metabolite that is renally cleared

A

Morphine

45
Q

Relistor generic

A

Methylnaltrexone

46
Q

Relistor only inidcated if

A

Failed DSS + stimulant laxative

47
Q

Cross-allergenicity of morphine

A

oxymorphone, codeine, hydrocodone, hydromorphone, oxycodone

48
Q

Cross-allergenicity of fentanyl

A

Meperidine

49
Q

Cross-allergenicity of tramadol

A

Tapentadol

50
Q

If morphine allergy use

A

Fentanyl, meperidine, methadone, tramadol, tapentadol

51
Q

Opioid allergy symptoms

A

Decreased BP, rash, swelling of face/lips/tongue, difficulty breathing

52
Q

Fentanyl patch brand

A

Duragesic

53
Q

Fentanyl patch dosed in

A

mcg/hr

54
Q

Actiq lollipop generic

A

Fentanyl (only for break through cancer pain - like all SL fentanyl formulations)

55
Q

Not indicated for opioid naive

A

Fentanyl (must have been on 60 mg morphine x 7d)

56
Q

Must hold fentanyl patch on for _____ seconds

A

30

57
Q

SL fentanyl formulations are ______ drugs

A

REMS

58
Q

3 patches that can be flushed

A

Fentanyl, Butrans, Daytrana

59
Q

1st hydrocodone only drug

A

Zohydro ER (Q12h dosing)

60
Q

2nd hydrocodone only drug

A

Hysingla ER (Q24h dosing)

61
Q

Hydromorphone brand

A

Dilaudid, Dilaudid-HP (high potency), Exalgo (CI in opioid-naive)

62
Q

Oxycodone brands

A

Oxeta, Roxicodone, Oxycontin (cont for controlled release), w/APAP (Endocet, Percocet, and Roxicet)

63
Q

Hydrocodone and Oxycodone are substrates of

A

3A4

64
Q

Oxymorphone brands

A

Opana, Opana ER

65
Q

Take Opana w or w/o food

A

Without

66
Q

Methadone brands

A

Dolophine, Methadose-liquid

67
Q

Methadone is a ______ drug

A

REMS

68
Q

Most proarrhythmic opioid

A

Methadone (QT prolongation)

69
Q

Opioid with variable half lives

A

Methadone (15-60 hours)

70
Q

Opioid that lowers testosterone most notably

A

Methadone

71
Q

Serotonergic opioid

A

Methadone, Meperidine, Tramadol, Tapentadol

72
Q

Meperidine brand

A

Demerol

73
Q

Opioid only for acute pain management due to euphoric effects

A

Meperidine

74
Q

Active metabolite of Meperidine

A

Normeperidine (renally cleared - can accumulate in elderly and with renal impairment)

75
Q

Renal impairment can lead to increased risk of CNS toxicity, including seizures

A

Meperidine

76
Q

Codeine can be metabolized differently in people with…..

A

CYP 2D6 polymorphisims (fast/slow metabolizers) - fast metabolizers get a buildup of morphine which can lead to respiratory depression

77
Q

AEs with Codeine

A

GI

78
Q

Combo Opioid agonists/Norepi Reuptake #s

A

Tramadol and Tapentadol (activating due to Norepi effects - leading to seizure risk)

79
Q

Tramadol brands

A

Ultram, Conzip

80
Q

Tramadol requires conversion by CYP2D6 and should be avoided with

A

CYP2D6 inhibitors

81
Q

Tapentaol brands

A

Nucynta

82
Q

Lower GI side effects than other opioids

A

Tramadol and Tapentadol

83
Q

Antidote for opiod OD

A

Naloxone (mu receptor antagonist)

84
Q

Signs of opioid OD

A

Somnolence, respiratory depression, cold/clammy skin, pinpoint pupils (miosis), coma/death

85
Q

Evizo auto-injector

A

Naloxone for EMS

86
Q

Naltrexone used for

A

Alcohol/opioid dependence

87
Q

Buprenorphine transdermal

A

Butrans

88
Q

Butrans indication

A

Mod-severe pain on patients who need ATC opioid

89
Q

Buprenorphine

A

opioid agonist

90
Q

Suboxone needs _____ DEA for prescribing

A

X (due to DATA waiver - drug addiction treatment act)

91
Q

Butrans BBW

A

QT prolongation

92
Q

Cyclobenzaprine brand

A

Fexmid

93
Q

Antispasmodics with analgesic effects

A

Baclofen, Cyclobenzaprine, Tizanidine

94
Q

Antispasmodics that work through sedation

A

Soma, Metaxalone (Skelaxin), Robaxin

95
Q

Only muscle relaxant that is controlled

A

Soma (C-IV)

96
Q

AEs of all muscle relaxants

A

Excessive sdation, dizziness, and confusion (AVOID OH)

97
Q

Poor 2C19 metabolizers have higher/lower Soma concentrations

A

Higher

98
Q

Neuropathic pain agents

A

Lyrica, Cymbalta, Gabapentin, Amitriptyline

99
Q

Fibromyalgia Agents

A

Milnacipran, Lyrica, Cymbalta (SNRI)

100
Q

Milnacipran brand

A

Savella

101
Q

Milnacipran MOA

A

SNRI

102
Q

AEs of Milnacipran

A

Nausea, headache, constipation, dizziness, insomnia, hot flashes

103
Q

Lidocaine patches brand

A

Lidoderm

104
Q

Patch duration

A

12 h on, 12 h off

105
Q

ONLY patch you can cut into small pieces before taking backing off and applying

A

Lidoderm

106
Q

Capsaicin brand

A

Zostrix (decreases substance P)

107
Q

Diclofenac brand

A

Voltaren

108
Q

Methyl salicylate (Icy Hot, BenGay, TheraGesic) can cause _________ burns

A

3rd degree

naplex review (6 decks)

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