Pain Management (Pain Meds)

Question 1

Acetaminophen

Answer 1

1. Available as oral and rectal
2. Weak COX-1 and COX-2 inhibitor in peripheral tissues
3. Anti-pyretic

Question 2

Acetaminophen dosage

Answer 2

Adults: 325-1000mg q4-6
Max daily dose of 4mg/day
Onset 15-30 mins

Question 3

Acetaminophen SE

Answer 3

1. Large doses cause liver toxicity and can be lethal
2. Large doses can cause dizziness and disorientation.
3. Renal damage can occur even w/ normal dosages.

Question 4

Aspirin (ASA)

Answer 4

Salicylic acid.

1. Irreversibly inhibits COX and platelet aggregation.
2. Anti-pyretic
3. Anti-inflammatory effects reduce pain
4. Decrease thrombosis after CABG

Question 5

ASA SE

Answer 5

1. Gastric Upset, Ulcers
2. Hepa, Renal toxicity
3. Asthma and rashes
4. Salicylism
5. Overdoses are a medical emergency
   Toxic Levels: acidosis, resp. depression, cardiotoxicity.

Question 6

Salicylism

Answer 6

Vomiting, tinnitus, decreased hearing, vertigo.

Reversible by reducing dosage.

Question 7

NSAIDS

Answer 7

1. Mild to moderate somatic pain.
2. Anti-pyritic
3. Inhibits glycogenase (arachnidonic acid –> prostaglandins)
4. COX-1 and 2 inhibitors

Question 8

Prostaglandins

Answer 8

1. Activation of inflammatory response
2. Elicitation of pain and fever
3. contraction and relaxation of smooth muscle
4. inhibition of acid synthesis, increased mucous in stomach.
5. Increased blood flow to kidneys.

Question 9

NSAID SE

Answer 9

1. GI Upset, ulcers
2. Photosensitivity
3. Renal: HTN
4. Interfere w/ platelet aggregation for 2-4 days.
5. CI in pregnant and lactating women

Question 10

Ibuprofen

Answer 10

Advil, Motrin
200, 400 mg q4 or
600 mg q 6
Maximum 3200mg/day

Question 11

Naproxen

Answer 11

Aleve
250-500mg q 12
maximum 1000mg/day

Question 12

Prescription NSAIDS

Answer 12

Naproxen
Ketoprofen (orudis)
Indomethican
Ketorolac (Toradol) - 5 days max
Peroxicam (feldine)
Meloxicam (Mobic)
Ponstel

Question 13

COX-2 inhibitors

Answer 13

As effective as NSAIDS
Less GI toxicity
Celecoxib (Celebrex)
- onset 3 hrs - good for arthritis

Question 14

NSAID considerations

Answer 14

Risk for GI toxicity:
 - age>65
 - use of anticoagulant therapy
 - previous GI bleed
 - active PUD
 - use of glucocorticoids
Other:
 - take w/ food
 - BID instead of TID
 - Know renal status

Question 15

Opioids

Answer 15

Severe pain

1. exert effects through Mu1, 2 Delta and Kappa receptors. Block them.
2. Most profound effect through Mu receptors
   - Found in CNS - periaqueductal gray matter

Question 16

Opioids SE

Answer 16

1. N/V, constipation
2. hypotension, bradycardia
3. sedation, euphoria
4. resp. depression
5. dependence, tolerance, addiction

Question 17

Physical Dependence

Answer 17

Body will go into PHYSICAL withdrawals.

Tachy, anxiety etc.

Question 18

Addiction

Answer 18

Psychological dependence.

Extreme behavioral patterns.

Question 19

Morphine

Answer 19

IM, IV, oral, rectal, intrathecal.
Severe Pain
Long acting forms for chronic pain

Question 20

Morphine Dosage

Answer 20

IV: 2-5mg slow push
IM: 10-15mg
Oral varies

Question 21

Demerol (Meperidine)

Answer 21

IV and IM
Used for severe pain
SE similar to morphine
Dosage: 25-50mg slow IV slow push.

Question 22

Methadone

Answer 22

1. Primarily used in US to treat opioid dependence.
2. Extended duration of action and slow onset of action.
3. can be used to treat acute pain.

Question 23

Oxycodone

Answer 23

PO or IV
Used for severe pain
Oxycontin - long-acting

Question 24

Oxycodone/acetominophen

Answer 24

Percocet or Rixocet 5/325 or 10/325

Question 25

Oxycodone/Aspirin

Answer 25

Percodan

Question 26

Hydrocodone/Acetaminophen

Answer 26

Vicodin

Question 27

Hydrocodone/ASA

Answer 27

Lortab

Question 28

Codeine/Acetaminophen

Answer 28

Tylenol #3

Question 29

Naloxone (Narcan)

Answer 29

1. Injection indicated for resp. depression.
2. Compete for receptors of opioids
3. Used for overdoses

Question 30

Fentanyl

Answer 30

Very strong Mu opioid agonist
100x more potent than morphine
IV, transdermal, suckers, IN

Question 31

Tramadol

Answer 31

Binds w/ low affinity Mu Opioid receptors.
Low risk for dependence
Good for mild to moderate pain
SE: HA, dizziness, Somnolence