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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

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
Dilaudid dosing
Hydromorphone Oral 2-4 mg q4-6h prn IV 0.2-1 mg q2-3h prn
26
Lowest dose of fentanyl patch available
12.5 mcg
27
Ultiva
Fentanyl IV (remifentanil)
28
Fentanyl dosage forms
``` Patch Injection Lozenge (Actiq) Buccal/SL tablet (Fentora, Abstral) SL spray (Subsys) Nasal spray (Lazanda) Iontophoretic transdermal system (Ionsys) ```
29
Which analgesics can cause serotonergic syndrome?
Methadone Merperidine Tramadol Tapentadol
30
Why don't we use Demerol as an analgesic for longer than acute/single use?
Risk of seizures if accumulated Serotonergic CNS toxicity
31
Opioid side effects
N/V Dizziness Itching
32
Morphine dosing
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
Oxycodone metabolism
CYP 3A4
34
MOA tramadol, tapentadol
Mu opioid agonists and inhibitors of norepinephrine reuptake | Tramadol also inhibits reuptake of serotonin
35
Warnings w/ tramadol
Seizure risk Serotonin syndrome if given with other serotonergic drugs or with CYP2D6/3A4 inhibitors Avoid in breastfeeding mothers
36
Contraindications tramadol
Do not use in children < 12 years or children < 18 years undergoing tonsillectomy/adenoidectomy surgery
37
Morphine ratio PO to IV
PO 30 mg IV 10 mg (3 fold difference)
38
Dilaudid ratio PO to IV
PO 7.5 IV 1.5 (5 fold difference)
39
How to convert opioids
Calculate 24 hour total dose Reduce by 25% Divide by dosing interval BTP is 5-17% of 24 hour dose
40
True or false: all side effects of opioids lessen over time
False constipation does not All others do
41
Name the PAMORAs
Relistor (methylnaltrexone) Movantik (Naloxegol) Symproic (Nalmedine)
42
If patient has an allergy to codeine which opioids can they have?
Methadone Fentanyl Tramadol or tapentadol too? Meperidine is also OK but not recommended as an analegsic anymore
43
S/sx of opioid overdose
``` Extreme sleepiness Slow or shallow breathing Fingernails or lips turning blue or purple Extremely small pinpoint pupils Slow heartbeat Low blood pressure ```
44
Buprenorphine MOA, indications
Partial mu agonist Agonist at low doses, antagonist at higher doses Low doses = pain High doses = addiction
45
Schedule of buprenorphine
Schedule III
46
Dosage forms/brands of buprenorphine w/ dosing
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
Counseling butrans
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
Counseling belbuca
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
Antiepileptics used for pain
Gabapentin Pregabalin Carbamazepine
50
Carbemazepine brands
Tegretol Carbatrol Carnexiv
51
Muscle relaxants used for pain
Baclofen (lioresal) Cyclobenzaprine (Flexmid, flexeril) Tizanidine (zanaflex) Sedation ones: Carisoprodol (Soma) Metaxolon (Skelaxin) Methocarbamol (Robaxin)
52
Soma metabolism
CYP2C19; poor metabolizers will have higher carisoprodol concentrations Rapid metabolizers will have higher doses of the more toxic metabolite meprobamate
53
Antidepressants used for pain
Amitriptyline (Elavil) | Duloxetine (Cymbalta)
54
Lidocaine patches counseling
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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