Pain Flashcards
Which of the following is an example of nociceptive pain?
a. ) Diabetic poly neuropathy (DPN)
b. ) Post herpetic neuralgia (PHN)
c. ) broken ankle
d. ) lower back pain
C
Symtoms of neuropathic pain include? (Select all) A.) Burning B.) Tingling C.) Stabbing/shooting D.) Dull throbbing
ALL
Fibromyalgia is which type of pain?
a. ) nociceptive
b. ) neuropathic
c. ) somatic
d. ) visceral
neuropathic pain (b)
Neuropathic pain usually involves the nerves; other examples include:
Diabetic neuropathy Chronic headaches Post herpetic neuralgia (PHN) Phantom limb Post Stroke
Neuropathic pain is a drug induced effect of which chemotherapy agent? A.) Vincristine B.) Lomustine C.) Bleomycin D.) Doxorubicin
A.)
Vinca alkaloids are known to cause peripheral neuropathy/pain along with taxans and platinum agents
Pain is considered chronic once it usually persists longer than how long? A.) 3 weeks B.) a month C.) 3 months D.) 2 months
3 months
Acetaminophen does not provide which of the following effects?
A.) Anti-inflammatory effects
B.) Antipyretic
C.) Analgesic
A.)
Acetaminophen does not provide anti-inflammatory effects. NSAIDs are used for their anti-inflammatory effects.
Generic of Vicodin, Norco, Lortab, Lorcet?
Acetaminophen + Hydrocodone
Generic of Percocet, Endocet?
know both brand names
APAP + Oxycodone
Generic of Ultracet?
APAP + Tramadol
IV APAP?
Ofirmev
Rectal APAP suppository brand name?
FeverAll
A 16 year old child is being admitted to the ICU for a biking accident, at what does should APAP be given along with his other medications? What is the maximum number of does/day?
10-15 mg/kg q4-6h (max 5 doses)
A teenager is presenting to the hospital with nausea/vommting after admitting to ingesting 50 tablets of 500mg acetaminophen tablets? Which drug should be administered? A.) Flumazenil B.) Calcium gluconate C.) Pyridoxine D.) N-acetylecysteine
D
N-Acetylcysteine (NAC)– should be given immediately.
Oral form (Cetylev) -usually not preferred due to the smell of rotten eggs IV form (Acetadote)
Which of the following describes the mechanism of action of Zanaflex?
A. Mu-opioid receptor agonist
B. Mu-opioid receptor antagonist
C. Periperally-acting mu-opioid receptor antagonist
D. Central alpha-2 agonist
E. Central alpha-2 antagonist
D
EJ has been using oxycodone immediate release for pain management (as-needed) for the past several months. She cannot swallow most pills and crushes her medications. The physician wishes to provide better pain control and will use a long-acting medication. Which of the following medications represent possible options? A. Robaxin B. Dilaudid D. Kadian E. Roxicodone
D.) Kadian (morphine )
Kadian is dosed Q12H or daily
Which of the following agents have a boxed warning to avoid any amount of alcohol as it could result in fatal respiratory depression due to increased absorption? (Select ALL that apply.) A. Norco B. Soma C. Zohydro D. Opana ER E. Nucynta ER
C, D, E
Increased risk of respiratory depression when taken with alcohol! BBW for all of these agents especially in ER formulations.
Kadian (morphine) Embeda (morphine/naltrexone) Zohydro (hydrocodone) Nucynta ER (tapentadol) Opana ER (oxymorphone)
An elderly gentleman has been taking tramadol 50 mg 5-8 times daily for 12 months for back and joint pain. The patient also used lorazepam 1 mg 4-5 times daily over the same time period. If the patient attempts to stop either of these medications, he will experience shakiness, agitation and tachycardia due to which of the following?
A. Pseudo-addiction
B. Opioid hyperalgesia
C. Physiological adaptation
D. Addiction, which is a common problem among opioid and benzodiazepine users
E. Tolerance
C.) Physiological adaptions (physical dependence)
Almost all patients using chronic opioids become physically dependent and have withdrawal symptoms once the drugs are stopped.
Symtoms include:
anxiety
tachycardia
shakiness
SOB
Choose the correct statement concerning the fentanyl patch.
A. Most patients can change the patch every 7 days..
B. Some patients require a new patch every 24 hours.
C. The patch can be used as needed for pain control.
D. Apply the patch to either the right or left thigh.
E. Applied on a flat surface such as the chest, back, flank, or upper arm.
E
A patient with rheumatoid arthritis uses daily ibuprofen therapy and requires occasional therapy with prednisone for acute flares. She is reporting abdominal pain, with burning. Upon examination, she is found to have GI ulceration which the physician feels is due to her use of these medications. She is not a candidate for celecoxib. Which medication would provide the strongest protection from NSAID-induced GI ulceration and bleeding? A. Famotidine B. Calcium acetate C. Rabeprazole D. Sucralfate E. Misoprostol
GI bleed =give PPI
Which of the following analgesic agents are considered serotonergic and should be used carefully in combination with other serotonergic drugs? (Select ALL that apply.) A. Meperidine B. Tramadol C. Codeine D. Methadone E. Hydromorphone
A, B, D
In addition tapentadol.
A patient has been using aspirin for pain relief. He takes aspirin multiple times daily. He also suffers from upset stomach and has been using bismuth subsalicylate (Pepto Bismol). Drug toxicity from these agents may present as:
A. Skin rash
B. Decreased night vision
C. Ringing in the ears in the absence of noise
D. Arthralgias
E. Heartburn and dyspepsia
C
Salicylate overdose can cause tinnitus (ringing of the ears).
A 69 year-old female patient asks her doctor for Demerol and states that nothing else works as well for her chronic pain. She has pain that is rated as 8 or 9 out of 10, on a daily basis. The patient has renal insufficiency, with a creatinine clearance estimated at 23 mL/min. Choose the correct statement.
A. The patient is not a candidate for opioid therapy.
B. The patient can receive the medication, but is limited to 300 mg daily.
C. The patient can receive the medication, but is limited to 200 mg daily.
D. The patient can receive the medication, but is limited to 100 mg daily.
E. The patient should not receive this medication for chronic pain control.
A
Meperidine (Demerol) is not appropriate for chronic pain control due to the short duration of action (it lasts about 3 hours) and due to the risk of neurotoxicity (including seizures) if the drug accumulates. This is of particular risk with renal insufficiency; it is not used with renal impairment.
A patient has a history of bipolar disorder with chronic episodes of major depression. In the past she was prescribed oxaprozin, an older NSAID, and developed a GI bleed. She is having her first episode of gout and the prescriber is recommending indomethacin. Allergies include amoxicillin (rash), sulfamethoxazole and carbamazepine. Which statements represent correct advice that could be provided to the prescriber? (Select ALL that apply.
A. Indomethacin has a high risk for GI toxicity, including ulceration and bleeding.
B. Indomethacin has a high risk for psychiatric side effects.
C. Indomethacin cannot be used due to the patient’s allergy profile.
D. The brand name of indomethacin is Mobic.
E. Indomethacin is highly selective for the COX-2 enzyme.
A, B
Select the correct mechanism of action for morphine?
A. Antagonist at the mu opioid receptor in the CNS.
B. Inhibits cyclooxygenase, which reduces prostaglandin formation and decreases pain and inflammation.
C. Serotonin/ norepinephrine reuptake inhibitor.
D. Agonist at the mu opioid receptor in the CNS.
E. Decreases substance P and reduces pain transmission from the nerve ending (localized effect).
D
