Pain & Comfort

Question 1

How do NSAIDS work?

Answer 1

Inactivate cyclooxygenases (COX 1 & COX 2) enzymes needed for prostaglandin formation resulting in anti-inflammatory, analgesic and antipyretic effects.

ALL CAUSE NEPHROTOXICITY

Question 2

COX 1 Enzymes

Answer 2

Inhibit undesirable effects (side effects)- include GI distress, renal tract, platelet function, and macrophage differentiation.

Question 3

COX 2 Enzymes

Answer 3

Inhibit desirable effects (therapeutic outcome) - reduces inflammation and fever (antipyretic)

Question 4

Misoprostol

Answer 4

Medication used to protect stomach from getting ulcers while taking NSAIDS.

DO NOT GIVE TO PREGNANT WOMEN

Question 5

Salicylates

Answer 5

Asprin (ASA)

CAN CAUSE REYES SYNDROME IN KIDS/TEENS- very serious neurologic complication causing brain swelling/death.

Toxicity- acute or chronic (salicylism)- tinnitus, hyperventilation, seizures

ALSO USED TO PREVENT BLOOD CLOTS

Question 6

Other NSAIDS (Cox 1 & Cox 2 Inhibitors)

Answer 6

Ibuprofen, naproxen, ketoprofen, meloxicam

KNOW KETOROLAC (TORADOL)

Question 7

Ibuprofen Maximum Daily Allowance

Answer 7

2400mg

Question 8

Selective Cox -2 Inhibitors

Answer 8

CELECOXIB- KNOW THIS MED- “Coxib” family

originally created for Arthritis, less GI problems, BUT risk for thromboembolism

Question 9

Acetaminophen (APAP)

Answer 9

Used for mild pain and FEVER

DOES NOT HAVE ANTI-INFLAMMATORY EFFECT

causes HEPATOXICITY

Question 10

Acetaminophen Daily Allowance

Answer 10

4000mg

Question 11

What is the antidote for Acetaminophen?

Answer 11

Acetylcysteine

Question 12

Osteoarthritis (OA)

Answer 12

Degenerative joint disease (DJD)- joint inflammation

Question 13

Treatment of OA

Answer 13

NSAIDS- diclofenac, nabumetone

COX 2 slective medications- celecoxib, meloxicam (low dose is COX 1, high dose is COX 1 & COX 2)

Question 14

Herbal Treatment for OA

Answer 14

Glucosamine- watch with diabetes patients, and made from oyster and crab shells so watch for shellfish allergies

SAMe (S-adenosyl-L-methionine)- also antidepressant so watch for SEROTONIN SYNDROME

Flexium- combination of glucosamine and SAMe- EXPENSIVE BUT BEST RESULTS

Question 15

GOUT

Answer 15

Metobolic disorder of purine metabolism- can be hereditary or occur in conditions that increase uric acid (bone cancer, thiazide diuretics).

ALSO DIET RELATED

Question 16

Medication for ACUTE episodes of GOUT

Answer 16

NSAIDS, Steroids

COLCHICINE- DRUG OF CHOICE

Question 17

Medication for CHRONIC GOUT

Answer 17

Vitamin C 1000mg/day- uricosuric acid

ALLOPURINOL- TAKEN DAILY TO PREVENT

Probenecid- 2nd line (if other 2 aren’t working) BLACK BOX WARNING- Crcl < 30ml/min

Question 18

What is the definition of Opioid?

Answer 18

A drug that binds to opiate receptors in the brain and produces morphine like action

Question 19

What are the 3 mechanisms of action of opiate medication?

Answer 19

Agonist (most opiates)- binds with and produces actions at the opiate receptors (mu, delta, kappa- mostly mu)

Partial Agonist- binds with pain receptors and produces a weaker action than agonist

Antagonist- binds with pain receptors but DOES NOT REDUCE PAIN. (competes with and reverses effects of the agonist medications)

Question 20

Narcotic or Opioid Agonist

Answer 20

Mimic the action of endorphins on opiate receptors in the brain

Morphine- prodrug- all come from this

-Codeine
-Meperidine (Demerol)- metabolites make drug effects last longer
-hydromorphone (Dilaudid)- synthetic version of morphine *used often in hospital
-oxycodone- most abused
1. Percocet- w/ acetaminophen
2. Percodan- w/ aspirin
3. Oxycontin- sustained release
4. Fentanyl- 100x more potent than
morphine. (transmucosal lollipop-
Actiq- used for kids)
-methadone- moderate pan and treatment of narcotic withdrawal.

Question 21

Morphine

Answer 21

Prototype drug for all other narcotic analgesics

-Roxanol- liquid morphine
-Duramorph- epidural after C-section

DO NOT COMBINE WITH OTHER DOWNERS

Question 22

Fentanyl

Answer 22

Strongest opiate available (100x stronger than morphine)- used for CHRONIC severe pain such as cancer

Patch- teach patients do not cut in half and do not dispose in trash

Question 23

Hydromorphone

Answer 23

Trade name is Dilaudid (synthetic morphine)

Question 24

Oxycodone

Answer 24

Oxycontin- significant abuse- created a tamper resistant formulation

Combo with Acetaminophen- Percocet

Combo with aspirin- Percodan

Question 25

Hydrocodone

Answer 25

Trade names- Vicodin, hycodan, Lortab

Question 26

Meperidine

Answer 26

No longer drug of choice- leads to accumulation of normeperidine (renally toxic metabolite)- NOT LONGER THAN 48hrs

Question 27

Codeine

Answer 27

Alone is CII and combo is CIII

Good cough suppressant- must be 18 years of age

Question 28

Methadone

Answer 28

Used for opiate addiction withdrawal or pain relief

Half-life is longer than duration of action- high risk of death for OD

Question 29

TRAMADOL- MUST KNOW

Answer 29

Can cause SEROTONIN SYNDROME When combined with SSRI’s or other serotonin-active drugs, Symptoms are high temp, high blood pressure, agitation, increased reflexes, tremor, sweating, seizures, dilated pupils, and diarrhea

Contraindications
severe renal or hepatic dysfunction , older adults, people with seizures

Question 30

MORHPINE ADMINISTRATION

Answer 30

**FIRST draw up dose from vial dispensed to you.

SECOND, dilute with 5ml (sterile water or normal saline)

RATE OF ADMINISTRATION IS 2.5-15mg OVER 5 MINUTES!!!!!!!

Question 31

Narcotic Antagonist

Answer 31

Compete with opiate receptors leading to reversal of the effects of opiates

Question 32

Opiate Antedote

Answer 32

NALOXONE- IV, IM, SQ, PO, OTC…

CAN BE INHALED- common used

Question 33

Addiction Treatment

Answer 33

buprenorphine- implantable x 6 mos.

buprenorphine + naloxone (Suboxone)

naltrexone- antagonist; try and use and opiates do not work. Must be opiate free at least 1 week.