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P2 E1 SG > Pain Mgmt 1 > Flashcards

Pain Mgmt 1 Flashcards

1
Q

Non-opiod Analgesics

  • What are the 2 Salicylates?
A
  • Acetylsalicylic Acid (ASA) (give low dose for CVD)
  • Choline & Mg Trisalicylate (doesn’t alter platelet function)
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2
Q

Non-opiod Analgesic - Acetaminophen

  • Elderly - no more than __ g / day
  • General population - no more than __ g / day
A
  • 2
  • 3
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3
Q

name the drug

  • Adult FDA approved nonopioid analgesic
  • Phenylacetic acids
  • Patch form?
  • Gel and Solution form?
A
  • Diclofenac epolamine (Flector patch)
  • Diclofenac sodium (solution / gel)
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4
Q

name the drug

  • Propionic Acids
  • Max daily dose of _____
A

Ibuprofen

  • 3200 mg
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5
Q

Which Propionic Acid

  • used for osteoarthritis?
  • used for acute pain?
A
  • Osteo = Naproxen
  • Acute = Naproxen sodium
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6
Q

name the drug

  • Pyrrolacetic Acids
A

Keorolac (parenteral)

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7
Q

name the drug

  • Cox-2 Selective
A

Celecoxib

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8
Q

name the drug

  • in cardiac pts where low dose ASA is indicated, give ASA first!!
  • Protects stomach lining, but not the kidneys
A

Cox-2 Selective

(Celecoxib)

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9
Q

Which drug?

  • ADE: Upper GI bleeding, Acute renal failure
  • Monitor: CBC, stool guaiac, serum creatinine
  • One of the leading causes of hospitalizations due to drug related ADE in the U.S.
A

NSAIDS

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10
Q

Which drug?

  • ADE: hepatotoxicity
  • Monitor:
    • Serum transaminases (ALT/AST)
    • Liver synthesis tests (PT/INR, albumin)
    • Serum concentration of this drug
A

Acetaminophen

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11
Q

Which 3 drugs?

  • Used in mild - mod pain
  • Care must be exercised to avoid overdose when combination products containing these agents are used
A
  • NSAIDs
  • Acetaminophen
  • Aspirin
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12
Q

NSAIDs / Acetaminophen / Aspirin

  • May use in conjunction w/ ___ agents to decrease doses of each
  • Regular alcohol use w/ _____ use may result in liver toxicity
  • W/ _____, underlying renal impairment, hypovolemia, and CHF may predispose to ________.
A
  • opioid
  • acetaminophen
  • NSAIDs / nephrotoxicity
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13
Q

What is a good reference tool for prescribing Opioids?

A

Arizona Department of Health Services website

(AZdhs.gov)

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14
Q

Which Opioid Analgesic?

  • Phenanthrenes
  • Naturally occuring
  • Lots of histamine release
A
  • Morphine
  • Codeine
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15
Q

Which Opioid Analgesic?

  • Phenanthrenes
  • Semi-synthetic
A
  • Hydromorphone (Dilaudid)
  • Oxymorhpone (Opana)
  • Levorphanol
  • Hydrocodone
  • Oxycodone (Oxycontin, Oxecta, Roxicodone)
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16
Q

Which drug?

  • Drug of choice in severe pain
  • May use immediate-release product with controlled release product to control breakthrough pain in cancer pain
A

Morphine

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17
Q

Which drug?

  • Use in severe pain
  • More potent than morphine; otherwise, no advantages
A

Hydromorphone (Dilaudid)

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18
Q

Which drug?

  • Use in severe pain
  • May use immediate-release product with controlled release product to control breakthrough pain in cancer pain
  • Extended-release reformulated to deter misuse
A

Oxymorphone (Opana)

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19
Q

Which drug?

  • Use in severe pain
  • Extended half-life useful in cancer patients
  • In chronic pain, wait 3 days between dosage adjustments
A

Levorphanol

(Phenanthrenes)

20
Q

Which drug?

•Use in mild to moderate pain and cough suppression

•Depends on CYP 450 2D6 for metabolism to morphine

•Weak analgesic; use with NSAIDs, aspirin, or acetaminophen, analgesic prodrug

•Should not be used in children

A

Codeine (Methylmorphine)

(Phenanthrenes)

21
Q

Which drug?

  • Use in moderate/severe pain
  • Most effective when used with NSAIDs, aspirin, or acetaminophen
  • Only available as combination product with other ingredients for pain
A

Hydrocodone

(Phenanthrenes)

22
Q

Which drug?

  • Use in moderate/severe pain
  • Most effective when used with NSAIDs, aspirin, or acetaminophen
  • May use immediate-release product with controlled release product to control breakthrough pain in cancer pain
  • CR reformulated to deter misuse
A

Oxycodone (OxyContin)

(Phenanthrenes)

23
Q

Name the drug

  • Phenylpiperidines
  • Synthetic
  • Which one has large histamine release?
  • Which one has transdermal, buccal, transmucosal, sublingual, nasal inhaled routes?
A
  • Meperidine (Demerol) - Lots of histamine
  • Fentanyl (Sublimaze, Duragesic, Actiq) - routes
24
Q

Which drug?

  • Use in severe pain
  • Oral not recommended

•Do not use in renal failure**

•May precipitate tremors, myoclonus, and seizures (active metabolite normeperidine)**

•Produces mydriasis not miosis**

•When used with monoamine oxidase inhibitors can induce hyperpyrexia and/or seizures or opioid overdose symptoms

A

Meperidine

25
Q

Which drug?

•Used in severe pain

•Do not use transdermal in acute pain**

  • With transmucosal, intranasal, sublingual dosing
  • start with lowest dose despite daily opioid intake
  • product-specific titration and maximum dose recommendations exist
  • breakthrough cancer pain in patients already receiving or tolerant to opioids
  • Transmucosal, intranasal, sublingual _____dosage forms are only available through a REMS program
A

Fentanyl

26
Q

Name the drug

  • Diphenylheptanes
  • Synthetic
A

Methadone

27
Q

Which drug?

  • Effective in severe chronic pain
  • Sedation can be major problem

•QT prolongation-major reason for lower use**

•Some chronic pain patients can be dosed every 12 hours

•Avoid dose titrations more frequently than every 2 weeks**

A

Methadone

28
Q

Which drug?

A

Methadone

29
Q

Agonist-Antagonist or Partial Agonist

  • Name the 2 drugs
  • Synthetic
  • no histamine release
A
  • Pentazocine (Talwin)
  • Buprenorphine (Butrans, Subutex) - Transdermal, Sublingual
30
Q

Which drug?

  • Third-line agent for moderate-to-severe pain
  • May precipitate withdrawal in opiate-dependent patients
  • Parenteral doses not recommended
A

Pentazocine

31
Q

Which drug?

  • Second-line agent for moderate-to-severe pain
  • May precipitate withdrawal in opiate-dependent patients
A

Butorphanol

32
Q

Which drug?

  • Second-line agent for moderate-to-severe pain
  • May precipitate withdrawal in opiate-dependent patients
A

Nalbuphine

33
Q

Which drug?** (KNOW)

•Second-line agent for moderate-to-severe pain

•May precipitate withdrawal in opiate-dependent patients

•Detailed manufacturer dosing conversion recommendations exist

•Naloxone may not be effective in reversing respiratory depression

•Must complete training to prescribe

A

Buprenorphine

34
Q

Name the drug

  • Opioid
  • Central Analgesic
  • Synthetic
  • No histamine release
A
  • Tramadol
  • Tapentadol
35
Q

Which drug?

•Maximum dose for nonextended-release, 400 mg/24 h,

•Decrease dose in patient with renal impairment and in the elderly

–> If more than 75 years old 300 mg/24 h

–> If creatinine clearance less than 30 mL/min 200 mg/24 h; maximum for extended-release, 300 mg/24 h

A

Tramadol

(central alagesic)

36
Q

Which drug?

  • First day of therapy may administer second dose after the first as soon as 1 hour after the first dose
  • Maximum dose first day 700 mg, maximum dose thereafter 600 mg (maximum dose for CR 500 mg)
  • REMS required
A

Tapentadol

(central analgesic)

37
Q

2 main ADEs of Opioids

A
  • Respiratory depression
    • monitor: RR or end tidal capnography
    • Pts at high risk: obstructive sleep apnea, COPD
  • Constipation
    • monitor: BM frequency & consistency
    • Constipation may be assessed using Bristol Scale
38
Q

What 2 ADE’s of Opioids will decrease over time?

A
  • Sedation
  • N / V
39
Q

Which ADE of opioids?

  • Monitor for: urticaria, pruritus, bronchospasm
A

Histamine release

40
Q

Which ADE of opioids?

  • Monitor for: biliary spasm, urinary retention
A

Increase in sphincter tone

41
Q

Which ADE of opioids?

  • Monitor: fatigue, depression, sexual dysfunction, amenorrhea
  • Problem w/ chronic use
A

Hypogonadism

42
Q

What are the 4 opioids to avoid/exercise caution?

A
  • Codeine (naturally occuring, Phenanthrene)
  • Meperidine (synethetic, Phenylpiperidine)
  • Agonist / Antagonist agents (Pentazocine, Buprenorphine)
  • Tramadol (synthetic, central analgesic)
43
Q

Which opioid to avoid/caution?

  • Do not use (esp. in children and breastfeeding)
  • Pro-drug: Must be converted to CYP 2D6 to morphine to produce analgesia
  • High degree of polymorphism of 2D6
  • Ultra-rapid metabolism = toxicity, poor metabolism = no analgesia
A

Codeine

44
Q

Which opioid to avoid/caution?

  • DO NOT USE
    Short duration, req freq dosing
  • Produces non-analgesic
  • toxic metabolite
  • accumulation results in seizures
  • risk of accumulation increased in renal insufficiency
A

Meperidine

45
Q

Which opioid to avoid/caution?

  • Caution
  • Can produce opioid withdrawal w/ chronic use
  • Higher rate of psychomimetic rxns compared to other opioids
A

Agonist / Antagonist agents

46
Q

Which opioid to avoid/caution?

  • Caution: esp. in elderly or renal dysfunction
  • Pro-drug: must be converted to CYP 2D6 to desmethyl (M1) to produce analgesia
  • High degree of polymorphism of 2D6
  • Ultra-rapid metabolism = toxicity, poor metabolism = no analgesia
  • Risk of seizures, serotonin syndrome, hypoglycemia
A

Tramadol

47
Q
A

P2 E1 SG (11 decks)

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