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Pain Flashcards

(71 cards)

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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
Ketotolac warning
Can cause: - Bleeding - Acute renal failure - Liver failure
26
Do Selective or Non-Selective NSAIDS have a higher CV risk?
Selective
27
Do Selective or Non-Selective NSAIDS have a higher GI risk?
Non-Selective
28
Which NSAIDS has a Sulfonamide allergy attached to it?
Celecoxib
29
Which NSAIDS has the highest COX-2 selectivity?
Celecoxib
30
Which NSAIDS combo drug should be avoided in women of childbearing potential unless capable of comply with effective BC measures?
Diclofenac + Misoprostol = Arthrotec Indication: RA, Osteoarthritis
31
Salicylate NSAIDS BBW
Avoid using in children and teenagers with any viral infection due to risk of Reye's syndrome
32
Salicylate ADE
Dyspepsia Heartburn Bleeding
33
Important drug-drug interactions with NSAIDS
- Take aspirin 1 hour before or 8 hours after ibuprofen | - NSAIDS can increase Lithium and Methotrexate levels
34
Opioid MOA
mu receptor agonists in the CNS
35
True or False: REMS program exists for all opioid medications
True
36
What schedule is Codine?
C-II | C-III when in combination with other meds
37
Codine contraindications
< 12 years of age | < 18 years of age for treatment of tonsillectomy/adenoidectomy surgery, can cause death
38
Codine AED
Constipation
39
Fentanyl sig
Apply 1 patch q72hrs.
40
Fentanyl contraindications
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
How should you dispose a Fentanyl patch
In the toilet
42
Which Opioid have d-d interactions with CYP3A4 inhibitors?
CYP3A4 inhibitors can cause fatal overdose - Hydrocodone - Fentanyl - Methadone - Oxycodone
43
Which Opioid has a BBW for QT prolongation and senior arrhythmias?
Methadone (Dolophine)
44
What are the steps to dose conversion between an Opioid agents?
- 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
True or False: Complaints of itching or rash are true allergies for Opioids.
False not true allergy True allergy reactions are: - Difficulty breathing - Severe drop in BP - Serious rash - Swelling of face, lips, tongue or larynx
46
What are the 3 Opioid drug classes we can switch between in case of true opioid allergy?
- Cod- : Codeine, Hydrocodone, Oxycodone - Morph- : Morphine, Hydromorphone, Oxymorphone - Norph- : Buprenorphine
47
Opioid ADE
Constipations (will never improve)
48
What drugs can be used to treat Opioid induced constipation? Class? Warning?
Class: PAMORAs - Methylnatrexone (Relistor) - Naloxegol (Movantik) Both have warning of GI perforation
49
What schedule is Tramadol?
C-IV
50
Tramadol and Tapentadol MOA
mu-opioid receptor agonists norepinephrine re-uptake inhibitors serotonin re-uptake inhibitor (only tramadol)
51
Tramadol and Tapentadol warning
Siezure risk
52
What schedule is Tapentadol?
C-II
53
What is considered a large dose of Opioid?
≥ 50mg of morphine or equivalent dose
54
Buprenorphine MOA and Indication
MOA: Partial mu-opioid agonist Indication: @ low dose for pain, @ high dose for addiction by suppressing withdrawal symptoms
55
Naltrexone indication
Alcohol and opioid dependence
56
Narcan SIG and Dose?
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
What schedule is Buprenorphine?
C-III
58
Gabapentin ADE
- Somnolence - Ataxia - Peripheral edema - Weight gain
59
What schedule is Lyrica?
C-V
60
What is the max dose for Gabapentin?
3,600mg/day
61
What is the max dose for Lyrica?
450mg/day
62
Lyrica approved indications?
Fibromyalgia PHN (Postherpetic Neuralgia) Neuropatic pain
63
What is the only FDA approved drug for the treatment of triennial neuralgia?
Carbamenzepine
64
Name the 3 agents in the class for antispasmodics with analgesic effects
Baclofen (can cause sedation, dizziness, confusion) Cyclobenzaprine (can cause dry mouth) Tizanidine (can cause hypotension, dry mouth, weakness, QT prolongation)
65
Name the 2 agents in the class for antispasmodics without analgesic effects
Carisoprodol | Methocarbamol
66
What schedule is Carisoprodol in?
C-IV
67
Which SNRI and TCA can be used to treat neuropathic pain?
Duloxetine | Amitriptyline
68
How long can Lidocaine patch be applied for? What is the number of max patch at once?
12 hours/day Max of 3 patchs a a time
69
Generic for Bengay Aspercreme
Bengay: Methyl sailcylate Aspercremem: Trolamine
70
True or False: Lidocaine patch may be cut.
True
71
What is the MDD for Ibuprofen?
3.2 grams/day

Pain (3 decks)

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