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NAPLEX > Pain > Flashcards

Pain Flashcards

1
Q

Chronic pain

A

Pain that last more than 3 months.

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2
Q

Pain scales

A

Assess severity of pain.
A Joint committee standard.
Pain is the “5th Vital sign”

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3
Q

Analgesic Regimen for pain

A

Start low and stop at the lowest dose needed to control pain. Using meds with multiple MOA is ideal

Pain scale of 1-3: Non-opioid. +/- 2 agents

Pain scale of 4-6: Opioid for mild pain. +/- non-opioid or opioid.

Pain scale of 7-10: Opioid for severe pain. +/- non opioid or opioid.

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4
Q

Apap

Brand, BBW, Peds dosing, antidote (4)

A

Brand: INJ; ofirmev, Supp; FeverAll

BBW: do not exceed 4g/day

Peds: 10-15mg/kg q 4 to 6 h

antidote: NAC, Mucomyst, Acetadote, Cetylev (Use Rumack-Matthew Nomogram)

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5
Q

NSAIDS

BBW (3), SE (3), C/I, Med guides?

A

Med guide is required for all RX NSAIDs

BBW: GI Bleeding Risk, Cardiovascular risk (MI or Stoke), and CABG (only aspirin is recommended)

SE: reduce renal clearance, increase BP, nausea (take with food)

Contraindication: third trimester

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6
Q

ASA

Brand, Avoid, EC, Notes

A

Brand: Bufferin, Ecotrin

Avoid ASA in children and teens with viral infections due to reyes syndrome

EC: is used to decrease nausea.

Durlaza and yosprala are not used when immediate effect is needed (MI) due to low aspirin

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7
Q

Non-ASA salicylates

A

Salsalate, Mag salicylate, Difunisal,

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8
Q 
Ibuprofen
brand (3), peds dose
A

Brand: Motrin, Advil, caldolor

peds dose: 5-10mg/kg q 6 - 8 h max 40mg/kg/day

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9
Q

Indomethicin

Brand, SE

A

Indocin

High risk for CNS SE

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10
Q 
Naproxen
Branded Combo (2), dosing
A

Treximet (+sumatriptan), Vimovo (+Esomeprazole)

Can be dosed bid

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11
Q

NSAIDs (Rare counseling point)

A

Photosensitivity

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12
Q

*Ketorolac

Brand (2), BBW, Warnigs

A

Brand: Sprix, Toradol
BBW: Use no more than 5 days regardless of dosage forms*

Warnings: Renal (Volume depletion)* and Liver failure

decrease dose in 65 yo or more or less than 50kg or increase SCr.*

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13
Q

Piroxicam; Brand?

A

Feldene

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14
Q

Sulindac

A

CLinoril

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15
Q

Celecoxib

brand, C/I, selectivity?

A

Celebrex
C/I: Sulfonamide allergy
HIGH COX 2 Inhibition

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16
Q

Diclofenac

Brand((3), BB,

A

Volaren, Dyloject, Antrotec(+Misoprostol)

BBW: Avoid in women childbearing potential

Misoprostol is used to replace gut-protective prostaglanins and can terminate pregnancy

Do not use more than 32 grams and use dosing card. 2g for hands wrist elbows

4g for feet ankles or knees

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17
Q

Meloxicam

A

Mobic

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18
Q

Nabumetone

A

Relefan

MOA: NSAID

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19
Q

Etodolac

A

Lodine

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20
Q

Opioid Hyperanalgesia

A

When an increase dose occurs and makes the pain worse. Try different opioid.

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21
Q

Centrally acting opioid antagonist

A

Naloxone is used to reverse respiratory depressin

Naltrexone is used in combo to prevent rhe use of another opioid inapporiately.

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22
Q

Opioids concerns

A

REMS for all ER and LA meds including methadone

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23
Q

Opiod BBW

A

BBW: Addiction leading to death
Respiratory depression
avoid use with BZD and alcohol

24
Q

Codeine

Brand, BBW, CS categorization

A

Brand: Tylenol #2,3,4

BBW: 2D6 Ultra metabolizers avoid due to respiratory depression

CII: Codeine (itself)
CIII: capsule/tablet combination products
CIV: Oral solutions

25
Q

Fentanyl

BBW, Brand, Notes, disposal, Similar

A

Duragesic, Sublimaze, Onsolis (buccual)

BBW: avoid 3A4 inhibitors

Start on pt using more than 60 morphine equiv per day for 7 days

Disposal: in toilet

Alfentanil (Alfenta) , Remifentanil (Ultiva) Sufentanil (Sufenta)

26
Q

Hydrocodone IR

Brand (4), warning

A

Brand: Norco, Lorcet, Lortab, vicodin

Warning: poor 2d6 metabolizers

27
Q

Hydrocodone ER

A

Vantrela ER

BBW: 3a4 inhibitors

28
Q

Hydromorphone

A

Dilaudid

BBW: use in opiod tolerant pt (High risk for OD)

29
Q

Methadone

Brand, BBW, Notes (3)

A

Dolophine, Methadose
BBW: QT prolong

Notes: Variable half-life, serotonergic agents and major 3A4 substrate

30
Q

Morphine

A

MS Contin, Kadian, Roxanol, Arymo ER
If renally impaired start at lower dose.

SE: Dizziness CNS Effects, N/V pruritis

31
Q

Oxycodone

IR, ER, BBW,

A

IR: Roxicodone, RoxyBOnd
ER: Xtampza, Endocet, percocet, Roxicet, (all 3 with apap)

BBW: 3A4 inhibitor or stoping inducer can cause fetal OD

32
Q

Oxymorphone

A

Opana

Take on empty stomach

33
Q

Tramadol

Brand, MOA

A

Ultram, Conzip (Ultracet +apap)

MOA: Centrally acting analgesic

34
Q

Tapentadol

Brand, MOA, C/I

A

Nuncyta
C/I avoid MAOi
MOA: Centrally acting analgesia

35
Q

Fentanyl Counseling points

A

Do not heat patch
apply to hairness skin or short hair and press for 30 secs

dispose in toilet
keep away from animals or children

36
Q

Opioid management

A

If medications is effective but runs out to fast increase frequenct and NOT strength

If ineffectivie increase dose

37
Q

Opiod conversion

A

Calc 24 hr dose, use ration,

then reduce dose by 25% (if the exam dose not specifiy to reduce then do not reduce)

38
Q

Fentanyl

A

Convert to mcg then divide by 24 to get the mcg/her dosing

39
Q

OIC

A

Methylnaltrexone (Relistor), Naloxegel (Movantik), Lupiprostone (Amitzia), Naldemedine (Symproic)

40
Q

Opioid allergy

A

Drugs in the same chemical class has COD or MORPH in the name.

Buprenorphine is still apart of the MORPH class. + heroin

41
Q

Patient needs Naloxone if:

A 
Hx of previous OD,
more than 50mg morphine equiv
substanse abuse
concurrent use of BZD
respiratory illness or psych
42
Q

Naloxone

Brand (2) notes

A

Narcan, Evzio

may repeat dosing,
will cause acute pain, tachy

43
Q

Buprenorphine

A

Brand: Butrans, Belbucca, suboxone, Zubsolv (+naloxone)

Prescribers need an X in their DEA to prescribe it

44
Q

Neurological pain

A

Diabetes, spinal chord injury, fibromyalgia, Postherpatic pain.

45
Q

Gabapentin

A

Neurontin, Fanatrex, Gralise (PHN), Horizant (PHN + RLS)

46
Q

Pregabalin

A

Lyrica

47
Q

Baclofen

A

Lioresal

MOA: Antispasmodic with anagesic effects

48
Q

Cyclobenzaprine

A

Fexmid, Amrix, Flexeril

MOA: Antispasmodic with anagesic effects

49
Q

Tizanidine

A

Zanaflex
MOA: Alpha 2 agonist for muscle spasm
SE: Hypotension, dry mouthm weakness

50
Q

Carisoprodol

A

Soma
poor 2c19 will have higher conc
MOA: Antispasmodic effect with sedation

51
Q

MEthocarbomal

A

Robaxin-750

MOA: Antispasmodic effect with sedation

52
Q

Metexalone

A

Skelaxin

MOA: Antispasmodic effect with sedation

53
Q

Milnacipran

Brand, MOA, BBW

A

Savella
MOA: SNRI
BBW psychatric events

54
Q

Amitriptyline

A

Elavil

55
Q

Duloxetine

A

Cymbalta

56
Q

lidocaine 5% patch

A

Lidoderm

Can cut patch.

Do not use more than 3 at one time

57
Q

Casaicin 0.025% and 0.075%

A

Zostrix and Qutenza 8% (given in health care office due to burning. pretreat with lidocaine)

NAPLEX (13 decks)

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