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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
Q

Theraputic use includes gouty arthritis and osteoarthritis of the hip

A

Indomethacin

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26
Q

This drug is rapidly and almost completely absorbed, metabolized by the liver, and cleared in bile and urine

A

Indomethacin

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27
Q

Side effects of this NSAID are “worse” than others… Dizziness, N/V/D, anorexia, HA, dizziness, vertigo, mental confusion, hepatic & pancreatic effects

A

Indomethacin

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28
Q

This drug decreases the effects of ACEI, furosemide, thiazides, and beta blockers

A

Indomethacin

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29
Q

Interacts with digoxin, lithium, MTX, and enhances the nephrotoxicity of cyclosporines

A

Etodolac

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30
Q

This drug is approved for RA, OA, and ankylosing spondilitis. An opthalmic preparation is available

A

Diclofenac

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31
Q

Prodrug used for treatment of RA and OA

A

Nabumatone

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32
Q

This drug is COX-2 selective at low-moderate doses and nonselective at high doses

A

Meloxicam

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33
Q

2 drugs: have a high incidence of GI ADRs, once daily dosing, and interfere with renal excretion of lithium

A

Meloxicam and Piroxicam

34
Q

This NSAID has limited use due to serious side effects of agranulocytosis and aplastic anemia

A

Phenylbutazone

35
Q

This NSAID has GI side effects along with fluid retention, insomnia, blurred vision, euphoria, and nervousness

A

Phenylbutazone

36
Q

This NSAID displaces warfarin, oral hypoglycemics, and sulfonamides from their protein binding sites

A

Phenylbutazone

37
Q

This drug is a pyrrolizine carboxylic acid derivative

38
Q

This NSAID is the only available injectable (IM, IV). It is also available PO, and opthalmic solution

39
Q

You should only administer this drug for a max of 5 days (3 is better) due to potential GI bleeding

40
Q

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

A

Celecoxib (BB WARNING)
Rolecoxib (not on market)
Valdecoxib (not on market)

41
Q

This drug has analgesic and antipyretic effects, but has weak anti-inflammatory and no anti-platelet effects

A

Acetaminophen

42
Q

This drug is rapidly absorbed from the GI, undergoes 1st pass metabolism, and is excreted in the urine

A

Acetaminophen

43
Q

This drug gets hydroxylated to N-acetyl-benzoquinoneimine, which reacts with glutathione to form non-toxic substances (UNLESS its an OD)

A

Acetaminophen

44
Q

When left without glutathione, NAB binds sulfhydryl groups elsewhere causing what?

A

Hepatic necrosis and renal tubular necrosis

45
Q

Use this drug to counteract acetaminophen OD (creates sulfhydryl groups to bind)

A

N-acetylcysteine

46
Q

Name 3 endogenous peptide neurotransmitters

A

endorphins, enkephalins, dynorphins (opiates mimic these)

47
Q

Name three types of pure agonist opiods

A

Phenanthrenes (morphine like)
Phenylpiperidine (meperidine like)
Diphenylheptane (methadone like)

48
Q

This opiod agonist has high affinity for u receptors. Actions include analgesia, euphoria, respiratory depression, cough suppression, miosis

49
Q

This opiod agonist effects include: emesis, relief of diarrhea and dysentery, decrease motility of smooth muscle, increases GI and anal sphincter tone. Causes constipation

50
Q

HIgh doses of this drug can cause bradycardia and/or hypotension and can increase CSF pressure (contraindicated in pts with severe brain injury)

51
Q

This drug triggers histamine release causing urticaria, sweating and vasodilation, and bronchoconstriction

52
Q

This drug

  • inhibits the release of GNRH and CRH.
  • decreases LH, FSH, ACH, b-endorphin, testosterone, and cortisol
  • increases prolactin, GH, and ADH
53
Q

Name three theraputic uses for morphine

A

analgesia
diarrhea
cough

54
Q

This drug demonstrates an extensive first pass effect

55
Q

BE CAREFUL if giving to a pt with a head injury, asthma, COPD, BPH or urethral stricture, olds, neonates, BP maintenance problems

56
Q

This drug interacts with ETOH, antipsychotics, benzos, and Cimetidine

57
Q

This drug binds primarily to kappa receptors

A

Meperidine

58
Q

This drug demonstrates antimuscarinic activity and causes mydriasis

A

Meperidine

59
Q

This drug is hydrolyzed and metabolized in the liver. Its active metabolite is then hydrolyzed further

A

Meperidine (active metabolite- normeperidine)

60
Q

ADR for this drug is SEIZURES (esp in pts with renal failure, hx seizures, long term use)

A

Meperidine

61
Q

YOU CAN NOT TAKE THIS DRUG if you have taken an MAOI within the last 14-21 days

A

Meperidine

62
Q

This drug should be cautiously given to olds or pts with renal/hepatic failure. Drug interactions with MAOIs, barbs, Chlorpromazine, and Phenytoin

A

Meperidine

63
Q

Monitor signs and symptoms of jerking and twitching AND pain scores

A

Meperidine

64
Q

DO NOT USE THIS MED FOR CHRONIC PAIN MANAGEMENT

A

Meperidine

65
Q

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.

66
Q

You can use this for long acting chronic pain control

67
Q

This drug dose needs to be slowly escalated. It has a long DOA and VARIABLE KINETICS

68
Q

This drug is highly protein bound, has urinary elimination, and has a wide range of dose equivalents

69
Q

Monitor signs of withdrawal on pts with this drug (lacrimation, rhinorrhea, diaphoresis, yawning, restlessness, insomnia, dilated pupils

70
Q

This drug is more potent than morphine and is available IV or transdermal

71
Q

This drug does not cause release of histamine, so it may be preferred when CV stability is an issue

72
Q

P450 inhibitors increase the effects of these 2 drugs. Inducers decrease effects of them.

A

Methadone and Fentanyl

73
Q

This is a mild-moderate opiate agonist that is a prodrug. It gets metabolized to morphine

74
Q

Two mild-moderate opiate agonists used for management of diarrhea

A

Diphenoxylate, Loperamide

75
Q

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

A

Buprenorphine

76
Q

This drug has similar ADRs to morphine but can antagonize the respiratory depression caused by morphine.

A

Buprenorphine

77
Q

This opiod partial agonist/antagonist is an agonist of the kappa receptor

A

Butorphanol

78
Q

This opiod partial agonist/antagonist is a mild u and kappa agonist and has effects at sigma receptor causing dysphoria

A

Pentazocine

79
Q

This is an opiod antagonist. Has high binding affinity for u receptor and is a competitive antagonist of kappa and delta

80
Q

This opiod antagonist has a long DOA (48 hours) used for opiod dependent maintenance programs

A

Naltrexone

81
Q

This opioid is a weak u agonist. Works by norepi/serotonin CNS reuptake inhibition. Useful if a pt is allergic to other opiates

Pharmacy (22 decks)

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