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Pain > Pain > Flashcards

Pain Flashcards

1
Q

What is Nociceptive pain?

A

Pain which results from injury to internal organs.

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2
Q

What is the difference between visceral and somatic pain?

A

Visceral pain is pain from internal organs

Somatic rain is pain referring to musculoskeletal pain

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3
Q

Which 2 types of pain are considered Neuropathic pain?

A

Fibromyalgia

Diabetic neuropathy

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4
Q

WRT the Pain Scale, what is considered Severe pain?

A

7 - 10

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5
Q

WRT the Pain Scale, what is considered Moderate pain?

A

4 - 6

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6
Q

WRT the Pain Scale, what is considered Mild pain?

A

1 - 3

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7
Q

Which drug classes should be used for Mild, Moderate , and Severe pain?

A

Mild: Non - Opioid ± adjuvant

Moderate - Severe: Opioid ± non-opioid or adjuvant

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8
Q

What is Acetaminophen’s MOA and its main effects?

A

MOA: (not fully known) Inhibition of PG syntheses

  • Reduces pain
  • Reduces Fever (its and antipyretic)

No anti-inflammation effects

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9
Q

What is the max dose for Acetaminophen?

A

4,000 mg/day

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10
Q

Acetaminophen BBW

A

Hepatotoxicity

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11
Q

Acetaminophen ADE

A

Severe skin rash (very rare): SJS, TEN

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12
Q

What is the dose of Acetaminophen for pediatrics (<12 years old)?

A

10 - 15 mg/kg/dose PO q4 - 6 hrs.

max 75 mg/kg/day

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13
Q

What is the reversal agent for Acetaminophen?

A

N-acetylcysteine

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14
Q

NSAIDS MOA

A

COX-1 and COX-2 inhibitor :

COX-1 and COX-2 are catalyst which convert arachidonic acid to PG and Thromboxane A2. Therefore all NSAIDS decrease formation of PG and decrease inflammation, pain and fever.

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15
Q

What is the benefit of selective COX-2 inhibitors?

A

Decreases GI risk

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16
Q

Which agent is a irreversible COX-1 inhibitor?

A

Aspirin

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17
Q

Which agents are Non-Selective COX-1 and COX-2 inhibitor NSAIDS?

A
  • Ibuprofen
  • Indomethacin
  • Naproxen
  • Ketorolac
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18
Q

Which agents are Selective COX-2 inhibitor NSAIDS?

A
  • Celecoxib
  • Diclofenac

Some COX-2 selectivity:

  • Meloxicam
  • Nabumetone
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19
Q

NSAIDS boxed warnings

A

GI risk (bleeding and ulceration)

CV risk (except for aspirin): can cause MI and Stroke

Coronary Artery Bypass Graft (CABG) surgery: NSAIDS are contraindicated, Aspirin is recommended

Premature closure of the ductus arteriosus: contraindicated in 3rd trimester of presence (>30 weeks)

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20
Q

NSAIDS ADE

A

Overuse can cause renal failure

Increase BP (contraindicated in uncontrolled HTN)

Premature closure of the ductus arteriosus: contraindicated in 3rd trimester of presence (>30 weeks)

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21
Q

What is the dose of Ibuprofen for pediatrics?

A

5 - 10 mg/kg/dose PO q6 - 8 hrs

max 40mg/kg/day

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22
Q

Which NSAIDS should be avoided in psych patients b/c it has a high risk for CNS side effects/

A

Indomethacin

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23
Q

Which NSAIDS is dosed BID?

A

Naproxen

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24
Q

What is the max day supply of Ketorolac?

A

5 days

not just for PO but for all dosage forms in combination

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25
Q

Ketotolac warning

A

Can cause:

  • Bleeding
  • Acute renal failure
  • Liver failure
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26
Q

Do Selective or Non-Selective NSAIDS have a higher CV risk?

A

Selective

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27
Q

Do Selective or Non-Selective NSAIDS have a higher GI risk?

A

Non-Selective

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28
Q

Which NSAIDS has a Sulfonamide allergy attached to it?

A

Celecoxib

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29
Q

Which NSAIDS has the highest COX-2 selectivity?

A

Celecoxib

30
Q

Which NSAIDS combo drug should be avoided in women of childbearing potential unless capable of comply with effective BC measures?

A

Diclofenac + Misoprostol = Arthrotec

Indication: RA, Osteoarthritis

31
Q

Salicylate NSAIDS BBW

A

Avoid using in children and teenagers with any viral infection due to risk of Reye’s syndrome

32
Q

Salicylate ADE

A

Dyspepsia
Heartburn
Bleeding

33
Q

Important drug-drug interactions with NSAIDS

A
  • Take aspirin 1 hour before or 8 hours after ibuprofen

- NSAIDS can increase Lithium and Methotrexate levels

34
Q

Opioid MOA

A

mu receptor agonists in the CNS

35
Q

True or False: REMS program exists for all opioid medications

A

True

36
Q

What schedule is Codine?

A

C-II

C-III when in combination with other meds

37
Q

Codine contraindications

A

< 12 years of age

< 18 years of age for treatment of tonsillectomy/adenoidectomy surgery, can cause death

38
Q

Codine AED

A

Constipation

39
Q

Fentanyl sig

A

Apply 1 patch q72hrs.

40
Q

Fentanyl contraindications

A

Not to be used in opioid-naive patients

Only for patient who have been using morphine 60mg/day or equivalent for at least 7 days

41
Q

How should you dispose a Fentanyl patch

A

In the toilet

42
Q

Which Opioid have d-d interactions with CYP3A4 inhibitors?

A

CYP3A4 inhibitors can cause fatal overdose

  • Hydrocodone
  • Fentanyl
  • Methadone
  • Oxycodone
43
Q

Which Opioid has a BBW for QT prolongation and senior arrhythmias?

A

Methadone (Dolophine)

44
Q

What are the steps to dose conversion between an Opioid agents?

A
  • Calculate total 24 hours dose requirement for current drug
  • Use ratio-conversion to calculate dose of new drug
  • Calculate 24 hours dose of new drug and reduce dose at least by 25%
  • Divide to attain appropriate interval or new drug
  • BTP 5 - 17% of daily dose
45
Q

True or False: Complaints of itching or rash are true allergies for Opioids.

A

False
not true allergy

True allergy reactions are:

  • Difficulty breathing
  • Severe drop in BP
  • Serious rash
  • Swelling of face, lips, tongue or larynx
46
Q

What are the 3 Opioid drug classes we can switch between in case of true opioid allergy?

A
  • Cod- : Codeine, Hydrocodone, Oxycodone
  • Morph- : Morphine, Hydromorphone, Oxymorphone
  • Norph- : Buprenorphine
47
Q

Opioid ADE

A

Constipations (will never improve)

48
Q

What drugs can be used to treat Opioid induced constipation? Class? Warning?

A

Class: PAMORAs

  • Methylnatrexone (Relistor)
  • Naloxegol (Movantik)

Both have warning of GI perforation

49
Q

What schedule is Tramadol?

A

C-IV

50
Q

Tramadol and Tapentadol MOA

A

mu-opioid receptor agonists
norepinephrine re-uptake inhibitors
serotonin re-uptake inhibitor (only tramadol)

51
Q

Tramadol and Tapentadol warning

A

Siezure risk

52
Q

What schedule is Tapentadol?

A

C-II

53
Q

What is considered a large dose of Opioid?

A

≥ 50mg of morphine or equivalent dose

54
Q

Buprenorphine MOA and Indication

A

MOA: Partial mu-opioid agonist

Indication: @ low dose for pain, @ high dose for addiction by suppressing withdrawal symptoms

55
Q

Naltrexone indication

A

Alcohol and opioid dependence

56
Q

Narcan SIG and Dose?

A

Nasal spray: 4 mg administered in 1 nostril

IV/IM/SC: 0.4 - 2 mg q2-3 min or IV infusion at 0.4 mg/hr

57
Q

What schedule is Buprenorphine?

A

C-III

58
Q

Gabapentin ADE

A
  • Somnolence
  • Ataxia
  • Peripheral edema
  • Weight gain
59
Q

What schedule is Lyrica?

A

C-V

60
Q

What is the max dose for Gabapentin?

A

3,600mg/day

61
Q

What is the max dose for Lyrica?

A

450mg/day

62
Q

Lyrica approved indications?

A

Fibromyalgia
PHN (Postherpetic Neuralgia)
Neuropatic pain

63
Q

What is the only FDA approved drug for the treatment of triennial neuralgia?

A

Carbamenzepine

64
Q

Name the 3 agents in the class for antispasmodics with analgesic effects

A

Baclofen (can cause sedation, dizziness, confusion)
Cyclobenzaprine (can cause dry mouth)
Tizanidine (can cause hypotension, dry mouth, weakness, QT prolongation)

65
Q

Name the 2 agents in the class for antispasmodics without analgesic effects

A

Carisoprodol

Methocarbamol

66
Q

What schedule is Carisoprodol in?

A

C-IV

67
Q

Which SNRI and TCA can be used to treat neuropathic pain?

A

Duloxetine

Amitriptyline

68
Q

How long can Lidocaine patch be applied for?

What is the number of max patch at once?

A

12 hours/day

Max of 3 patchs a a time

69
Q

Generic for

Bengay
Aspercreme

A

Bengay: Methyl sailcylate

Aspercremem: Trolamine

70
Q

True or False: Lidocaine patch may be cut.

A

True

71
Q

What is the MDD for Ibuprofen?

A

3.2 grams/day

Pain (3 decks)

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