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Phamacology Summer > Pain Management Part 2: Non-Opioids > Flashcards

Pain Management Part 2: Non-Opioids Flashcards

1
Q

NSAIDS

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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2
Q

First Generation NSAIDS

Second Generation NSAIDS

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

First
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac

Second
-Celecoxib

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3
Q

Herbals

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A
  • Feverfew

- Glucosamine + Chondroitin

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4
Q

SALICYLATES/IRREVERSIBLE

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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5
Q

REVERSIBLE

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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6
Q

REVERSIBLE

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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7
Q

USED TO TREAT
for MI/stroke reduction (prevention of clots)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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8
Q

USED TO TREAT
If you take ? w/ibuprofen, you lose the cardio protective benefit

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

ASA

-Aspirin

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9
Q

USED TO TREAT
PRN or frequent Aspirin dosing (every 4-6 hours)
 Rheumatoid Arthritis
 Osteoarthritis
 Joint pain, swelling, inflammation (arthritis, tendonitis, bursitis, etc.)
 Fever

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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10
Q

MECHANISM OF ACTION:
 Half life of aspirin is ~20 minutes

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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11
Q

MECHANISM OF ACTION: -Aspirin

 Half life of aspirin is ~ ? minutes

A

20

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12
Q

Adverse Reaction
Bleeding
 Inhibition of platelets (thromboxane A2)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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13
Q

Adverse Reaction
Gastric distress, heartburn, nausea

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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14
Q

Adverse Reaction
Gastric bleeding / ulceration

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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15
Q

Adverse Reaction
Renal impairment

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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16
Q

Adverse Reaction
Reye syndrome
(avoid in

A

12

-Aspirin

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17
Q

ASA=

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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18
Q

Acetyl salicylic acid=

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroitin

A

-Aspirin

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19
Q 
A sthma
S alicylism poisoning (N/V/D, breathing)
P remature closing of PDA/Platelet disaggregation/
Peptic Ulcer Disease
I ntestinal bleeding
R eye Syndrome/Ringing in the ears/Renal
Impairment/rapid breathing
I diosyncratic Reaction
N oise (Tinnitus)/Nephropathy

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin

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20
Q 
A sthma
S alicylism poisoning (N/V/D, breathing)
P remature closing of PDA/Platelet disaggregation/
Peptic Ulcer Disease
I ntestinal bleeding
R eye Syndrome/Ringing in the ears/Renal
Impairment/rapid breathing
I diosyncratic Reaction
N oise (Tinnitus)/Nephropathy

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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21
Q

Which affect aspirin?
DRUG-DRUG Interactions:

  • Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin.
  • Steroids can hurt GI tract (risk for ulcer/bleed)
  • Smoking/Alcohol can increase risk for bleeding
  • Other NSAIDs!
A

All

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22
Q

Administration

  • Take with food/liquids
  • Can use enteric coated tablets to protect the stomach

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin

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23
Q

Which affect aspirin & ibuprofen, ketorolac, naproxen, indomethacin, diclofenac, & Celecoxib
DRUG-DRUG Interactions:

  • Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin.
  • Steroids can hurt GI tract (risk for ulcer/bleed)
  • Smoking/Alcohol can increase risk for bleeding
  • Other NSAIDs!
A

All

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24
Q

Administration

  • Take with food/liquids
  • Can use enteric coated tablets to protect the stomach

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin

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25
Q 
Used to treat 
Joint pain, swelling, inflammation (arthritis, tendinitis, bursitis, etc.
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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26
Q

Fever
 Mild – moderate pain

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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27
Q

Remember these are DIFFERENT FROM ASPIRIN!

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

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28
Q

MECHANISM OF ACTION:
Reversibly inhibit both COX-I and COX-II pathways-
Stops prostaglandin production in both
Reduces pain, inflammation, fever

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,

diclofenac

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29
Q

ADVERSE EFFECTS:
 GI effects, bleeding
?- max of ? days usage!

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A 
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib
Ketorolac
5
30
Q

ADVERSE EFFECTS:
 Increased blood pressure (MI/Stroke)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

31
Q

Renal impairment (potential for AKI)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,

diclofenac

32
Q

Not to be used in heart failure (sodium/fluid retention)

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

33
Q 
Remember ? is the unique exception that protects from heart attack and stroke
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

aspirin

34
Q 
MI/Stroke Concerns
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

35
Q 
Not ideal in hx of MI or HTN
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-(ibuprofen, ketorolac, naproxen, indomethacin,

diclofenac

36
Q

Two Boxed Warnings:
Increased risk for thrombotic events (except?)
Increased risk for GI Bleeding, Ulcers

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

Except -ASA

37
Q

Drug intraction

  • Increased risk for bleeding- watch out with “blood thinners” like warfarin/heparin.
  • Steroids can hurt GI tract (risk for ulcer/bleed)
  • Smoking/Alcohol can increase risk for bleeding
  • Other NSAIDs!

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

38
Q

Fluid Retention Concerns due to sodiam accumenlation
 Avoid in heart failure patients

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi

A

-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

39
Q 
Take with food/liquids
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

40
Q 
Avoid salicylates in children (this includes Pepto-Bismol!)
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Aspirin

41
Q 
Boxed Warnings:
Cardiac Risk!
GI toxicity!
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Celecoxib

42
Q 
Boxed Warnings:
Cardiac Risk!
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Celecoxib

43
Q 
Boxed Warnings:
GI toxicity!
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Celecoxib

44
Q 
Selective blockade of cyclooxygenase 2 enzyme
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Celecoxib

45
Q 
Aviod - Sulfa-Allergy
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Celecoxib

46
Q 
USED TO TREAT:
Pain or Fever
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

47
Q 
ADVERSE EFFECTS:
 Extremely rare at therapeutic dosages
 NO gastric ulceration, renal impairment, bleeding compared to NSAIDS!
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

48
Q 
Liver toxicity / damage
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

49
Q 
 Do not exceed 1000 mg/dose
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

50
Q 
 No anti-inflammatory properties!
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

51
Q 
 Tylenol, acetaminophen, paracetamol, APAP
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

52
Q 
Patients may present ASYMPTOMATIC
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

53
Q 
Present with = Diaphoresis, N/V/D
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

54
Q 
ANTIDOTE:
 Acetylcysteine (Acetadote®)
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetaminophen (APAP))

55
Q 
Inhaled version (Mucomyst) to thin secretions
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetylcysteine

56
Q 
 Can see used in lung diseases like cystic fibrosis and emphysema 
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetylcysteine

57
Q 
 Protects Liver
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetylcysteine

58
Q 
 Oral Version (Cetylev)- Smells like rotten eggs 
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetylcysteine

59
Q 
 Intravenous Version (Acetadote)-this is what we use for overdose
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Acetylcysteine

60
Q 
Cardio-protective
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Aspirin

61
Q 
dangerous for hx of cardiac disease
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Celecoxib

62
Q 
Used to treat the pain of OA 
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Glucosamine + Chondroi

63
Q 
Adverse effects
 GI discomfort
 Drowsiness, headache, skin reactions (glucosamine)
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Glucosamine + Chondroi

64
Q 
 Drug interactions
 Enhances effects of warfarin
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Glucosamine + Chondroi

65
Q 
 Drug interactions
 May increase insulin resistance (glucosamine)
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Glucosamine + Chondroi

66
Q

 Anti-inflammatory properties

  • Feverfew
  • Glucosamine + Chondroi
A

-Feverfew

67
Q 
Used to treat migraine headaches, menstrual cramps,
inflammation, and fever
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Feverfew

68
Q 
May cause GI distress, altered taste, muscle stiffness
-Aspirin
-(ibuprofen, ketorolac, naproxen, indomethacin,
diclofenac
-Acetaminophen (APAP))
-Celecoxib
-Acetylcysteine
-Feverfew
-Glucosamine + Chondroi
A

-Feverfew

69
Q

May interact with aspirin and other NSAIDs, as well as
anticoagulants
-Feverfew
-Glucosamine + Chondroi

A

-Feverfew

70
Q

 If you see an Herbal that starts with G or F, usually the concern is bleeding
risk if added with an anticoagulant like Warfarin
T or F

A

T

Phamacology Summer (48 decks)

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