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Pain Management Flashcards

1
Q

What is the pain algorithm for acute mild/moderate pain?

A
  1. NSAIDs or APAP

2. Opiods

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2
Q

What is the pain algorithm for acute severe pain?

A
  1. Opiods

2. Add NSAIDs or APAP

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3
Q

Pain algorithm chronic visceral

A
  1. Opiods for severe

2. Add adjuvants (TCA or AED)

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4
Q

Pain algorithm chronic inflammatory

A
  1. APAP or NSAIDs

2. Long acting opiod

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5
Q

Pain algorithm chronic neuropathic, central acting

A

Clonidine or Baclofen

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6
Q

Plain algotrithm chronic neuropathic, peripheral acting

A
  • TCA or AED
  • Lidocaine
  • SSRI or SNRI
  • Long acting opiod
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7
Q

Pain algorithm chronic functional

A
  1. TCA or Tramadol

2. SSRI or SNRI

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8
Q

NSAIDs inhibit what enzyme

A

cyclooxygenase

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9
Q

Three major clinical actions of NSAIDs

A

analgesia
anti-inflammatory
antipyretic

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10
Q

PGE analog used to treat NSAID induced GI damage

A

Misoprostol

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11
Q

Adverse effects include GI bleeds, tinnitus, edema, hyperkalemia

A

NSAIDs

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12
Q

Contraindications include GI bleeds, hypersensitivity, surgery 1 week prior. Caution in patients with asthma, renal impairment, and thrombocytopenia

A

NSAIDs

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13
Q

Aspirin gets its anti-coagulant effect how?

A

it inhibits thromboxane A2 production in platelets leading to ineffective platelets for clotting

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14
Q

Used prophylactically to decrease incidence of TIAs, MI, unstable angina

A

Aspirin

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15
Q

With chronic use, can prevent colon cancer

A

Aspirin

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16
Q

Adverse effects include salicylism and hypersensitivity (urticaria, bronchoconstriction, angioedema)

A

Aspirin

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17
Q

Respiratory effect of aspirin at high dose

A

hyperventilation->respiratory alkalosis

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18
Q

Respiratory effect of aspirin at toxic dose

A

central respiratory paralysis->respiratory acidosis

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19
Q

Adverse effects include Reye’s syndrome (given with viral infections can lead to cerebral edema and hepatitis)

A

Aspirin

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20
Q

Dont give this drug if:
someone is on heparin or warfarin
someone has gout (probenecid & sulfinpyrazone)

A

Aspirin

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21
Q

What drug could decrease rate of Aspirin absorption?

A

antacids

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22
Q

What drug inhibits the anti platelet effect of Aspirin?

A

Ibuprofen

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23
Q

This drug is a derivative of salicylic acid, does not cause salicylate intoxication, is more potent than Aspirin, does not have antipyretic activity, and does not cross the BBB

A

Diflunisal

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24
Q

This class has less GI side effects than Aspirin. Side effects include dyspepsia (bleeding), HA, tinnitus, and dizziness

A

Propionic acids

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25
Theraputic use includes gouty arthritis and osteoarthritis of the hip
Indomethacin
26
This drug is rapidly and almost completely absorbed, metabolized by the liver, and cleared in bile and urine
Indomethacin
27
Side effects of this NSAID are "worse" than others... Dizziness, N/V/D, anorexia, HA, dizziness, vertigo, mental confusion, hepatic & pancreatic effects
Indomethacin
28
This drug decreases the effects of ACEI, furosemide, thiazides, and beta blockers
Indomethacin
29
Interacts with digoxin, lithium, MTX, and enhances the nephrotoxicity of cyclosporines
Etodolac
30
This drug is approved for RA, OA, and ankylosing spondilitis. An opthalmic preparation is available
Diclofenac
31
Prodrug used for treatment of RA and OA
Nabumatone
32
This drug is COX-2 selective at low-moderate doses and nonselective at high doses
Meloxicam
33
2 drugs: have a high incidence of GI ADRs, once daily dosing, and interfere with renal excretion of lithium
Meloxicam and Piroxicam
34
This NSAID has limited use due to serious side effects of agranulocytosis and aplastic anemia
Phenylbutazone
35
This NSAID has GI side effects along with fluid retention, insomnia, blurred vision, euphoria, and nervousness
Phenylbutazone
36
This NSAID displaces warfarin, oral hypoglycemics, and sulfonamides from their protein binding sites
Phenylbutazone
37
This drug is a pyrrolizine carboxylic acid derivative
Ketorolac
38
This NSAID is the only available injectable (IM, IV). It is also available PO, and opthalmic solution
Ketorolac
39
You should only administer this drug for a max of 5 days (3 is better) due to potential GI bleeding
Ketorolac
40
These 3 drugs inhibit COX 2 only. Use cautiously in patients with CHF or renal disease. May need to add Aspirin as these lack antiplatelet effects
Celecoxib (BB WARNING) Rolecoxib (not on market) Valdecoxib (not on market)
41
This drug has analgesic and antipyretic effects, but has weak anti-inflammatory and no anti-platelet effects
Acetaminophen
42
This drug is rapidly absorbed from the GI, undergoes 1st pass metabolism, and is excreted in the urine
Acetaminophen
43
This drug gets hydroxylated to N-acetyl-benzoquinoneimine, which reacts with glutathione to form non-toxic substances (UNLESS its an OD)
Acetaminophen
44
When left without glutathione, NAB binds sulfhydryl groups elsewhere causing what?
Hepatic necrosis and renal tubular necrosis
45
Use this drug to counteract acetaminophen OD (creates sulfhydryl groups to bind)
N-acetylcysteine
46
Name 3 endogenous peptide neurotransmitters
endorphins, enkephalins, dynorphins (opiates mimic these)
47
Name three types of pure agonist opiods
Phenanthrenes (morphine like) Phenylpiperidine (meperidine like) Diphenylheptane (methadone like)
48
This opiod agonist has high affinity for u receptors. Actions include analgesia, euphoria, respiratory depression, cough suppression, miosis
Morphine
49
This opiod agonist effects include: emesis, relief of diarrhea and dysentery, decrease motility of smooth muscle, increases GI and anal sphincter tone. Causes constipation
Morphine
50
HIgh doses of this drug can cause bradycardia and/or hypotension and can increase CSF pressure (contraindicated in pts with severe brain injury)
Morphine
51
This drug triggers histamine release causing urticaria, sweating and vasodilation, and bronchoconstriction
Morphine
52
This drug - inhibits the release of GNRH and CRH. - decreases LH, FSH, ACH, b-endorphin, testosterone, and cortisol - increases prolactin, GH, and ADH
Morphine
53
Name three theraputic uses for morphine
analgesia diarrhea cough
54
This drug demonstrates an extensive first pass effect
Morphine
55
BE CAREFUL if giving to a pt with a head injury, asthma, COPD, BPH or urethral stricture, olds, neonates, BP maintenance problems
Morphine
56
This drug interacts with ETOH, antipsychotics, benzos, and Cimetidine
Morphine
57
This drug binds primarily to kappa receptors
Meperidine
58
This drug demonstrates antimuscarinic activity and causes mydriasis
Meperidine
59
This drug is hydrolyzed and metabolized in the liver. Its active metabolite is then hydrolyzed further
Meperidine (active metabolite- normeperidine)
60
ADR for this drug is SEIZURES (esp in pts with renal failure, hx seizures, long term use)
Meperidine
61
YOU CAN NOT TAKE THIS DRUG if you have taken an MAOI within the last 14-21 days
Meperidine
62
This drug should be cautiously given to olds or pts with renal/hepatic failure. Drug interactions with MAOIs, barbs, Chlorpromazine, and Phenytoin
Meperidine
63
Monitor signs and symptoms of jerking and twitching AND pain scores
Meperidine
64
DO NOT USE THIS MED FOR CHRONIC PAIN MANAGEMENT
Meperidine
65
This drug is a synthetic opiod with greatest action at u receptors. It can be used as a substitute for morphine and heroine for controlled withdrawal.
Methadone
66
You can use this for long acting chronic pain control
Methadone
67
This drug dose needs to be slowly escalated. It has a long DOA and VARIABLE KINETICS
Methadone
68
This drug is highly protein bound, has urinary elimination, and has a wide range of dose equivalents
Methadone
69
Monitor signs of withdrawal on pts with this drug (lacrimation, rhinorrhea, diaphoresis, yawning, restlessness, insomnia, dilated pupils
Methadone
70
This drug is more potent than morphine and is available IV or transdermal
Fentanyl
71
This drug does not cause release of histamine, so it may be preferred when CV stability is an issue
Fentanyl
72
P450 inhibitors increase the effects of these 2 drugs. Inducers decrease effects of them.
Methadone and Fentanyl
73
This is a mild-moderate opiate agonist that is a prodrug. It gets metabolized to morphine
Codeine
74
Two mild-moderate opiate agonists used for management of diarrhea
Diphenoxylate, Loperamide
75
This partial opiod agonist/antagonist is 20x more potent than morphine in producing analgesia. It is a partial u agonist that has slower developing effects
Buprenorphine
76
This drug has similar ADRs to morphine but can antagonize the respiratory depression caused by morphine.
Buprenorphine
77
This opiod partial agonist/antagonist is an agonist of the kappa receptor
Butorphanol
78
This opiod partial agonist/antagonist is a mild u and kappa agonist and has effects at sigma receptor causing dysphoria
Pentazocine
79
This is an opiod antagonist. Has high binding affinity for u receptor and is a competitive antagonist of kappa and delta
Naloxone
80
This opiod antagonist has a long DOA (48 hours) used for opiod dependent maintenance programs
Naltrexone
81
This opioid is a weak u agonist. Works by norepi/serotonin CNS reuptake inhibition. Useful if a pt is allergic to other opiates
Tramadol

Pharmacy (22 decks)

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