Pain Management Flashcards
generic name and class
tylenol
generic: acetaminophen
class: analgesic/antipyretic
drug to treat mild-moderate pain
indication
acetaminophen
pain,headache,fever
MOA
acetaminophen
centrally acting analgesic (blocks COX) and antipyretic with minimal anti-inflammatory properties
major contraindications
acetaminophen
- hypersensitivity
- active acute hepatic dysfunction
- don’t use with other acetaminophen-containing products
BBW
acetaminophen
hepatotoxicity
rare but serious ADRs
acetaminophen
SJS and elevated liver function tests
key counseling points
acetaminophen
- heed max dose limits
- avoid alcohol
- measure dose accurately, esp. for children
generic name and class
motrin/advil
generic: ibuprofen
class: NSAIDs
drug to treat mild/moderate pain and reduce inflammation
indication
ibuprofen
OTC: pain, headache, fever
Rx: osteoarthritis, RA
MOA
ibuprofen
nonselective inhibitor of COX-1 and COX-2, and reversibly alters platelet function and prolongs bleeding time
major contraindications
ibuprofen
- hypersensitivity
- Aspirin Triad: asthma, urticaria, or allergic-type reaction following aspirin or other NSAID administration
- CABG surgery
- treatment of perioperative pain
BBW
ibuprofen
- cardiovascular events
- GI toxicity
- CABG
common ADRs
ibuprofen
- (>10%) None known
- Less Common (1-10%) GI distress, edema, itching, rash, dizziness, tinnitus, ototoxicity
rare but serious ADRs
ibuprofen
Stevens-Johnson syndrome, GI bleeding, thrombosis, elevated liver
functions, acute renal failure, congestive heart failure, aplastic anemia
key counseling points
ibuprofen
- Take with food/milk
- Avoid in HF
- Older patients increased risk of GI
and renal issues - Increased risk of CV events (fatal MI and stroke)
generic name and class
aspirin
generic: ASA, acetyl salicylic acid
class: NSAIDs
indication
aspirin
mild to moderate pain, fever, MI and stroke prophylaxis
MOA
aspirin
inhibits COX enzyme
major contraindications
aspirin
- Hypersensitivity,
- aspirin triad (asthma, rhinitis, nasal polyps)
- inherited or acquired bleeding disorders
- children <18 y of age with viral infections
common ADRs
aspirin
- abdominal pain
- diarrhea
- headache
- indigestion
rare but serious ADRs
aspirin
- Angioedema
- GI hemorrhage
- GI ulcer
- Reye syndrome
- Stevens-Johnson syndrome
key counseling points
aspirin
- Avoid additional aspirin, NSAIDs, or aspirin-containing products
- Avoid ≥ 3 alcoholic drinks/d
- not recommended for children <18 y of age with a viral illness
other NSAIDs in top 300
generic - brand
- naproxen - naprosyn, aleve
- diclofenac - cambia, voltaren, zipsor, zorvolex
- etodolac - etodolac
- indomethacin - indocin, tivorbex
- meloxicam - mobic
- nabumetone - relafen
generic name and class
celebrex
generic: celecoxib
class: COX-2 inhibitor
Drugs to treat mild-moderate pain AND reduce inflammation
indication
celecoxib
Osteoarthritis; Rheumatoid arthritis; Ankylosing spondylitis; Acute pain, primary dysmenorrhea
MOA
celecoxib
inhibition of the COX-2 enzyme isoform
major contraindications
celecoxib
Asthma, urticaria, or allergic-type reaction following aspirin or other NSAID administration; CABG surgery, treatment of perioperative pain, hypersensitivity to sulfonamides
BBW
celecoxib
GI toxicity, cardiotoxicity and CABG
common ADRs
celecoxib
hypertension, headaches, GI distress, diarrhea
rare but serious ADRs
Stevens-Johnson syndrome, GI ulcers and bleeding, thrombosis, elevated liver functions, acute renal failure
key counseling points
celecoxib
Celecoxib has less risk of GI effects than other NSAIDs, but increased cardiovascular toxicity
generic name and class
MS contin, avinza, kadian
generic: morphine
class: opioid analgesic
drugs to treat moderate-severe pain
indication
morphine
acute and chronic pain
MOA
morphine
Pure mu agonist
major contraindications
morphine
Hypersensitivity to opioids, acute or severe asthma, paralytic ileus, respiratory depression, GI obstruction; concurrent use or use within 14 days of MAOI
BBW
morphine
Ethanol; addiction, abuse and misuse, REMS, respiratory depression, neonatal opioid withdrawal, accidental ingestion, concurrent use with benzodiazepines, medication errors
common ADRs
morphine
Constipation, nausea, vomiting, hypotension, dizziness, sedation,
diaphoresis, headaches, depression, xerostomia
rare but serious ADRs
morphine
Cardiac arrest, physical dependence, respiratory depression, serotonin
syndrome, adrenal insufficiency, decreased sex hormones
key counseling points
morphine
Tolerance and physical dependence may occur; avoid abrupt discontinuation. Fatal respiratory depression has occurred. Highly
concentrated oral solutions are available. Check doses carefully when
using highly concentrated oral solutions. Avoid concomitant use with
benzodiazepines.
other opiod analgesic top 300
generic - brand
- buprenorphine/naloxone - suboxone, zubsolv
- codeine/acetaminophen - tylenol with codeine
- fentanyl transdermal - duragesic, ionsys
- hydrocodone - vicodin, lortab, zohydro ER, hysingla ER
- methadone - dolophine, methadose
- oxycodone - oxycontin, percocet
- tramadol - ultram
generic name and class
flexeril
generic: cyclobenzaprine
class: skeletal muscle relaxant
Drugs to reduce pain from muscle contractions/spasms
indication
cyclobenzaprine
skeletal muscle spasm
MOA
cyclobenzaprine
Unclear, relieves muscle spasms through a central action, possibly at the brain stem level. (Structurally similar to TCA antidepressants, has anti-Ach effects)
major contraindications
cyclobenzaprine
Hypersensitivity to cyclobenzaprine, concomitant MAOI use, heart failure, acute coronary phase of AMI, heart block, hyperthyroidism
common ADRs
cyclobenzaprine
xerostomia, headache, dizziness, drowsiness
rare but serious ADRs
cyclobenzaprine
Cardiac dysrhythmia, cholestasis, hepatitis, jaundice, anaphylaxis,
immune hypersensitivity reaction, slowed or difficult breathing when
used in combination with opioids
key counseling points
cyclobenzaprine
Risk of falls in older patients. used for only short periods (up to 2-3 wk). Should avoid concomitant use with opioids. Should be used with
caution in patients with glaucoma, increased IOP, urinary retention,
etc, as cyclobenzaprine has anticholinergic-like effects. Avoid use in
elderly; may be more sensitive to effects.
other skeletal muscle relaxants in top 300
generic - brand
- baclofen - lioresal, ozobax
- carisoprodol - soma, vabadom
- methocarbamol - robaxin
- tizanidine - zanaflex
generic name and class
lidoderm
generic: lidocaine or benzocaine
class: local anesthetics
Drugs to reduce mild-moderate topical pain
indication
lidocaine
Postherpetic neuralgia and localized pain
MOA
lidocaine
stabilize neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses. Analgesia vs. complete sensory block.
major contraindications
lidocaine
hypersensitivity
common ADRs
lidocaine
Skin irritation (Systemic adverse reactions after appropriate application
of topical or transdermal lidocaine are unlikely because of the small amount of lidocaine absorbed)
rare but serious ADRs
lidocaine
Methemoglobinemia (benzocaine containing oral products in children)
key counseling points
lidocaine
No >12h in 24h period. Apply to intact skin, without covering with occlusive dressing or tight clothes. Patches may be cut to size. Fold patches on themselves when disposing to avoid accidental ingestion by children/pets.
lidocaint topical patch 5% (Rx) and 4% (OTC)
