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NAPLEX - OUR cards > Pain > Flashcards

Pain Flashcards

1
Q

Brand name for rectal APAP

A

FeverAll

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2
Q

Brand name for injectable APAP

A

Ofirmev

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3
Q

Antidote for APAP overdose

A

N-acetylcysteine

Restores intracellular glutathione

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4
Q

Boxed warnings for NSAIDs

A

GI risk
CV risk
CABG - use is contraindicated for treatment of perioperative pain in setting of CABG surgery

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5
Q

NSAIDs and pregnancy

A

Avoid in third trimester

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6
Q

Enteric coated, buffered aspirin brands

A

Bufferin

Ecotrin

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7
Q

Extended release aspirin

A

Duriaza

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8
Q

Side effects salicylates

A 
Tinnitus (salicylate overdose)
Nausea
Bleeding
Heartburn
Renal impairment
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9
Q

Which NSAID has a high risk for psych conditions

A

Indomethacin
Can induce psychosis
Apparently has structural similarities to serotonin and this might be why

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10
Q

Nasal dosing ketorolac

A

Age < 65 use one spray in each nostril q6-8h
Age > 65 use one spray in ONE nostril q6-8h
LIMIT 5 DAYS

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11
Q

Sprix

A

Ketorolac

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12
Q

Why don’t we use piroxicam a lot

A

High risk for GI toxicity and severe skin reactions (SJS/TEN)
May need to add PPI or misoprostol to protect gut
Use when other NSAIDs have failed

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13
Q

Contraindications to celebrex?

A

Sulfonamide allergy

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14
Q

Arthrotec

A

Diclofenac + misoprostol

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15
Q

How to take aspirin and ibuprofen if prescribed together?

A

Take aspirin one hour before or 8 hours after ibuprofen

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16
Q

Max dose diclofenac gel

A

32 g/day total
Use 2 g on hands, wrists, or elbows (do not exceed 8 g/day in these areas)
Use 4 g on feet, ankles, or knees (do not exceed 16 g/day in these areas)

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17
Q

Pain relievers with REMS programs

A

Long acting and ER opioids

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18
Q

Opioids you absolutely cannot take with alcohol (underlined in the book)

A

Kadian (morphine ER)
Embeda (morphine/naltrexone)
Zohydro (hydrocodone ER)
Nycynta ER (tapentadol)

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19
Q

Metabolism of codeine

A

Codeine goes through CYP2D6 to morphine
Children that are ultra-rapid metabolizers have overdosed on codeine used for minor procedures or in infants of breastfeeding mothers who were ultra-rapid metabolizers

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20
Q

Fentanyl metabolism

A

CYP3A4

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21
Q

Who is a candidate for fentanyl patch?

A

Chronic pain only

Patients who have been using at least morphine 60 mg/day for at least 7 days can be converted to a fentanyl patch

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22
Q

Ionsys

A

Fentanyl iontophoretic transdermal system
Hospital use only for short term post op pain

think Ion System

23
Q

Hydrocodone metabolism

A

CYP3A4

24
Q

Which NSAID has a duration limit?

A

Toradol (ketorolac) - 5 days

Due to inc risk of acute renal failure and liver failure I’m assuming

25
Q

Dilaudid dosing

A

Hydromorphone
Oral 2-4 mg q4-6h prn
IV 0.2-1 mg q2-3h prn

26
Q

Lowest dose of fentanyl patch available

A

12.5 mcg

27
Q

Ultiva

A

Fentanyl IV (remifentanil)

28
Q

Fentanyl dosage forms

A 
Patch
Injection
Lozenge (Actiq)
Buccal/SL tablet (Fentora, Abstral)
SL spray (Subsys)
Nasal spray (Lazanda)
Iontophoretic transdermal system (Ionsys)
29
Q

Which analgesics can cause serotonergic syndrome?

A

Methadone
Merperidine
Tramadol
Tapentadol

30
Q

Why don’t we use Demerol as an analgesic for longer than acute/single use?

A

Risk of seizures if accumulated
Serotonergic
CNS toxicity

31
Q

Opioid side effects

A

N/V
Dizziness
Itching

32
Q

Morphine dosing

A

IR (tab or soln): 10-30 mg q4h PRN
ER 15-200 mg q8-12h
IV (ioioid naive): 2.5-5 mg q3-4h PRN

33
Q

Oxycodone metabolism

A

CYP 3A4

34
Q

MOA tramadol, tapentadol

A

Mu opioid agonists and inhibitors of norepinephrine reuptake

Tramadol also inhibits reuptake of serotonin

35
Q

Warnings w/ tramadol

A

Seizure risk
Serotonin syndrome if given with other serotonergic drugs or with CYP2D6/3A4 inhibitors
Avoid in breastfeeding mothers

36
Q

Contraindications tramadol

A

Do not use in children < 12 years or children < 18 years undergoing tonsillectomy/adenoidectomy surgery

37
Q

Morphine ratio PO to IV

A

PO 30 mg IV 10 mg (3 fold difference)

38
Q

Dilaudid ratio PO to IV

A

PO 7.5 IV 1.5 (5 fold difference)

39
Q

How to convert opioids

A

Calculate 24 hour total dose
Reduce by 25%
Divide by dosing interval
BTP is 5-17% of 24 hour dose

40
Q

True or false: all side effects of opioids lessen over time

A

False
constipation does not
All others do

41
Q

Name the PAMORAs

A

Relistor (methylnaltrexone)
Movantik (Naloxegol)
Symproic (Nalmedine)

42
Q

If patient has an allergy to codeine which opioids can they have?

A

Methadone
Fentanyl
Tramadol or tapentadol too?
Meperidine is also OK but not recommended as an analegsic anymore

43
Q

S/sx of opioid overdose

A 
Extreme sleepiness
Slow or shallow breathing
Fingernails or lips turning blue or purple
Extremely small pinpoint pupils
Slow heartbeat
Low blood pressure
44
Q

Buprenorphine MOA, indications

A

Partial mu agonist
Agonist at low doses, antagonist at higher doses
Low doses = pain
High doses = addiction

45
Q

Schedule of buprenorphine

A

Schedule III

46
Q

Dosage forms/brands of buprenorphine w/ dosing

A

Butrans: patch 5 mcg/hr once weekly
Bulbuca: buccal film 75 mcg q12-24h
Suboxone: film with naloxone Daily
Zubsolv: SL tab with naloxone Daily

47
Q

Counseling butrans

A

Place on upper outer arm, upper chest, side of chest, or upper back
Change weekly
Do not use the same site for at least 3 weeks

48
Q

Counseling belbuca

A

One side is yellow, one side is white. Yellow is drug
White side placed on fingertip and inserted between gum and cheek on the cheek
Do not eat or drink for 30 minutes after placement

49
Q

Antiepileptics used for pain

A

Gabapentin
Pregabalin
Carbamazepine

50
Q

Carbemazepine brands

A

Tegretol
Carbatrol
Carnexiv

51
Q

Muscle relaxants used for pain

A

Baclofen (lioresal)
Cyclobenzaprine (Flexmid, flexeril)
Tizanidine (zanaflex)

Sedation ones:
Carisoprodol (Soma)
Metaxolon (Skelaxin)
Methocarbamol (Robaxin)

52
Q

Soma metabolism

A

CYP2C19; poor metabolizers will have higher carisoprodol concentrations
Rapid metabolizers will have higher doses of the more toxic metabolite meprobamate

53
Q

Antidepressants used for pain

A

Amitriptyline (Elavil)

Duloxetine (Cymbalta)

54
Q

Lidocaine patches counseling

A

Can cut into smaller pieces before removing backing
Do not apply more than 3 Lidoderm patches at once
Wear up to 12 hrs/day

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