Pain

Question 1

Nociceptive pain

Answer 1

When sensory nerves identify tissue damage

-visceral and somatic

Question 2

Visceral pain

Answer 2

Injury to internal organs

Question 3

Somatic pain

Answer 3

Injury to the skin, muscles, bones, or ligaments

Musculoskeletal

Question 4

Pathophysiological pain

Answer 4

Damage or malfunction of the nervous system

Question 5

Acetaminophen MOA

Answer 5

Thought to inhibit PG synthesis in CNS, resulting in decreased pain impulse generation

Question 6

REMS

Answer 6

Risk Evaluation and Mitigation Strategy

Question 7

COX1 or COX2 - which one protects gastric mucosa

Answer 7

COX1

Question 8

_________ is an irreversible COX1 inhibitor

Answer 8

Aspirin

Question 9

Ibuprofen max dose

Answer 9

OTC: 1.2g/day
Rx: 3.2g/day

Question 10

Naproxen max dose

Answer 10

1000mg/day (BID dosing)

Question 11

Highest COX2 selectivity NSAID

Answer 11

Celecoxib

Question 12

COX2 selective NSAIDs risks

Answer 12

Decrease GI risk, Increase MI/stroke risk

Question 13

COX2 selective NSAIDs

Answer 13

Celebrex
Diclofenac
Etodolac
Meloxicam
Nabumetone

Question 14

Opioid MOA

Answer 14

Mu receptor agonists in the CNS, which primarily produce pain relief, but also euphoria and resp depression

Question 15

Centrally-Acting Opioid Antagonists

Answer 15

Naloxone

Naltrexone

Question 16

Codeine age CI

Answer 16

Less than 18yrs

Question 17

Fentanyl patch dosing interval

Answer 17

q72hrs, can be q48hrs

Question 18

Fentanyl pre-requirement of pt

Answer 18

NOT opioid-naive

-must have been using morphine 60mg/day or equivalent x7 days

Question 19

Breakthrough pain dosing range

Answer 19

5-17% of total daily dose

Question 20

Morphine 60mg/day = ______ fentanyl patch

Answer 20

25mcg/hr

Question 21

Opioid equivalents PO

Answer 21

Morphine 30mg
Hydromorphone 7.5mg
Codeine 200mg

Question 22

Opioid Equivalents IV/IM

Answer 22

Morphine 10mg
Hydromorphone 1.5mg
Codeine 130mg

Question 23

Methadone dosing

Answer 23

If used for pain, dosed 2-3x/day

Question 24

Peripherally-acting mu-opioid receptor antagonists (PAMORAs)

Answer 24

Blocks opioid receptors in the gut to decrease constipation w/o affecting analgesia
-methylnatrexone (Relistor)
-naloxegol (Movantik) take in AM on an empty stomach
D/C all laxatives prior to use

Question 25

Mu receptor agonists and NE reuptake inhibitors

Answer 25

Tramadol - max 300/400mg day - inhibits reuptake of serotonin too Tapentadol (Nucynta) -decrease seizure threshold

Question 26

Buprenorphine is a ________ mu-opioid agonist

Answer 26

PARTIAL - agonist @ low doses (tx pain) - antagonist @ high doses (tx addiction)

Question 27

Buprenorphine/naloxone MOA for each

Answer 27

Buprenorphine suppresses withdrawal sx | Naloxone helps prevent misuse

Question 28

If prescribing buprenorphine for opioid dependency, need

Answer 28

Data waiver. The DEA will then issue a unique number starting with "X"

Question 29

How do TCAs and SNRIs work in neuropathic pain

Answer 29

Block NE uptake

Question 30

Antispasmodics (muscle relaxants) with analgesic effects

Answer 30

Baclofen Cyclobenzaprine (dry mouth) Tizanidine (decrease BP, dry mouth)

Question 31

Antispasmodics (muscle relaxants) that exert effects by sedation

Answer 31

Methocarbomol (decrease BP) | Carisoprodol (Soma) C-IV

Question 32

Triptans MOA

Answer 32

Selective agonists for the 5-HT1 receptor and cause vasoconstriction by inhibiting neuropeptide release

Question 33

Triptans SE

Answer 33

Tingling/numbness, CP/tightness, dizziness, dry mouth, drowsiness

Question 34

Triptan for children

Answer 34

Rizatriptan

Question 35

Longest half-life triptans (26hrs)

Answer 35

Frovatriptan | Naratriptan

Question 36

To prevent med-overuse (rebound HAs)

Answer 36

Limit acute tx to 2-3x/week at most (10-15 days a month)

Question 37

When to use prophylactic tx for migraines

Answer 37

If using acute tx greater than or equal to 2 days/wk, or greater than or equal to 3x/month

Question 38

Uric acid crystals are an end-product of _______ metabolism

Answer 38

Purine

Question 39

Foods to avoid for gout

Answer 39

Organ meats, alcohol, high-fructose corn syrup, fruit juices, shellfish, sardines

Question 40

Drugs than increase uric acid

Answer 40

ASA (low dose) Diuretics Niacin Calcineurin inhibitors

Question 41

Xanthine Oxidase inhibitors

Answer 41

Allopurinol Febuxostat -use with colchicine or an NSAID for first 3-6 months

Question 42

Allopurinol DI

Answer 42

Antacids decrease absorption And take after a meal to decrease N

Question 43

Uricosurics for gout

Answer 43

Inhibit uric acid resorption and increases excretion - lesinurad (Zurampic) HAVE TO USE WITH ALLOPURINOL OR FEBUXOSTAT - probenacid

Question 44

Tumor lysis syndrome

Answer 44

Complication of chemo - purines released into the blood = gout attack - tx allopurinol