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2022 Adv Pharm Faculty Landing Page > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Non-opioid classes of drugs used for pain management

A
  • Antidepressants
  • Anticonvulsants
  • Neuroleptic agents
  • Corticosteroids
  • Spasmolytics
  • Cannabinoids
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2
Q

Tricyclic indications for pain management

A

Neuropathic pain

Eg. Amitriptyline

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3
Q

Gabapentin

Drug class and pain management indications

A

Anticonvulsant: Inhibits GABA inhibition, binds to Na+,Ca+ channels in nerve cell

Used in chronic pain, fibromyalgia, post herpetic neuralgia, neuropathic pain

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4
Q

Pregabalin (Lyrica)

Class and pain management indications

A

Anticonvulsant: Inhibits GABA inhibition, binds to Na+,Ca+ channels in nerve cell

Uses include fibromyalgia, diabetic neuropathy, post herpetic neuralgia

Also associated with improved sleep and decreased anxiety

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5
Q

Spasmolytics

Examples and uses

A

Aka muscle relaxants

Methocarbamol (Robaxin), Cyclobenzaprine (Flexaril)

Use: adjunct to rest, PT for MS pain, spasm

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6
Q

Methocarbamol (Robaxin)

Adverse effects

A

Sedation

Bradycardia

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7
Q

Disease Modifying Anti-Rheumatic Drugs (DMARDS)

Classifications and examples

A
  1. Conventional
    • Methotrexate
    • Hydroxychloroquine
    • Leflunomide
    • Sulfasalazine
  2. Biologics (TNF ⍺ Antagonists)
    • infliximab (Remicade)
    • adalimumab (Humira)
    • certolizumab pegol (Cimzia)
    • golimumab (Simponi)
    • etanercept (Enbrel)
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8
Q

Methotrexate

Mechanism of Action and Indication

A
  • Inhibits cytokine production (TNF, interleukins)
  • Stimulates adenosine release (potent anti-inflammatory mediator)
  • Folic acid antagonist which DNA synthesis in cancer cells at higher doses

Use: Rheumatologic disease, 1st choice DMARD

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9
Q

Methotrexate

Adverse Effects and Contraindications

A
  • Nausea and vomiting
  • Folate deficiency
  • Oral ulcerations
  • Headaches
  • Fatigue (“methotrexate fog”)
  • Liver fibrosis

Contraindicated in pregnancy (think folate deficiency)

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10
Q

Hydroxychloroquine (Plaquenil)

Mechanism of Action

A

RA: blocks the stimulation of CD4 T cells, causes down regulation of the immune response

Malaria: increases levels of cytotoxic heme which accumulates in parasites

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11
Q

Hydroxychloroquine (Palquenil)

Adverse Effects

A
  • Prolonged QT
  • H/A
  • Rash
  • Diarrhea
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12
Q

TNF ⍺ Antagonist

Mechanism of Action and Indications

A

Suppresses the physiologic response of TNF ⍺ in the inflammatory response

Used in autoimmune diseases which trigger the excessive production of TNF ⍺ (RA, Crohnes Disease, psoriasis, psoriatic arthritis)

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13
Q

What does TNF ⍺ do?

A
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14
Q

TNF ⍺ Antagonist

Adverse Effects and Precautions

A

Injection site reactions (common), Infections, Neutropenia, Paradoxical immune disease, Malignancy, Neurologic complications, exacerbation of HF

Live attenuated vaccines contraindicated

Need to screen for latent or active TB

Don’t give to MS patients

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15
Q

Corticosteriods

Pain management mechanism of action

A
  • Inhibits arachidonic acid which is needed for cytokines
  • Suppresses the immune system, inflammation and allergic response
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16
Q

Corticosteriod

Adverse Effects (systemic)

A

Euphoria or depression, insomnia, Cushing’s Syndrome, GI upset, impaired healing, elevated glucose levels (think about DM)

17
Q

Corticosteriods

Adverse Effects (topicals)

A
  • Systemic effects
  • Atrophy (thin, transparent)
  • Skin bleaching
  • Striae
  • Telangiectasias
  • Purpura
  • Acneiform eruptions
  • Steroid rosacea
  • Glaucoma/cataracts
  • Growth suppression
  • Rebound flare
18
Q

What do Cyclo-oxygenase (COX) enzyme do?

A
19
Q

Celecoxib

A

Selective Cox-2 inhibitor

Decreased GI effects but associated with higher risk of MI

20
Q

NSAID indications

A
  • Mild to moderate pain
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Mild to moderate pain
  • Tendonitis
  • Synovitis
  • Primary dysmenorrhea
21
Q

NSAID adverse effects

A

NSAIDS significantly increased the risk of a second MI in patients with known CVD

Nephrotoxicity

GI upset

Fluid retention

Avoid in late pregnancy

22
Q

Opioid receptors

A

◦Mu

◦Located at supraspinal and spinal sites

◦Analgesia and respiratory depression

◦Mioisis, euphoria, reduced g.i. motility

◦Kappa

◦Dorsal horn of spinal cord and brain stem

◦Analgesia, miosis, sedation

◦Delta

◦Binding sites for endogenous peptides

◦Analgesia, dysphoria, delusions, hallucinations

23
Q

Major opioid effects

A
  • Analgesia
  • Respiratory depression
  • Euphoria
  • Sedation
  • Decreased GI motility (constipation)
  • Bradycardia
  • Nausea/vomiting
  • Miosis
  • Cough suppression
24
Q

Pearls for prescribing opioids

A

Usually schedule II controlled substance (no refills, 30 day supply)

Check PDMP (regulations vary by state) and DOCUMENT!

25
Q

Prescribing opioids for acute pain

A

No more than 7 days (per MA law), do NOT give extra just in case

Use lowest effective dose

Always use IR formulations

Use in combination with non-opioids

Set reasonable expectations for pain management

26
Q

Codeine

A

1/10 potency of morphine

Give for mild to moderate pain

Often given with Tylenol or cough suppressant

Nausea is common side effect

27
Q

Oxycodone

A

1.5x as potent as morphine

Give for moderate to severe pain

Can be given in combo with acetaminophen or NSAID or alone

Higher risk for abuse

28
Q

Hydrocodone

A

Give for moderate to severe pain

Only available in combo with acetaminophen or ibuprofen

29
Q

Fentanyl

A

50-100x more potent than morphine with rapid onset

Given for moderate to severe pain, pre and post op, and anesthesia adjunct

30
Q

Methadone

A

Not used first line for pain management

Requires special liscene for MAT

31
Q

Tramadol

A

Binds to mu receptors in the CNS inhibiting pain pathways, altering pain perception and response, inhibiting uptake of norepinephrine and serotonin

1/10th potency of morphine

Less respiratory depression compared to other opioids

Risk for serotonin syndrome

32
Q

MME goals

A

Goal for lowest MME possible, try to keep under 50MME/day

Use caution and justify use >90MME/day

2022 Adv Pharm Faculty Landing Page (22 decks)

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