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Narcotics: Pain Mgmt and Addiction > Pain mgmt non opioid focused pharm lecture > Flashcards

Pain mgmt non opioid focused pharm lecture Flashcards

1
Q

acetaminophen MOA

A

not well understood

  • blocks prostaglandin release
  • raises pain threshold
  • not anti-inflammatory
  • analgesic, antipyretic
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2
Q

regular strength APAP dose

A

325-650 mg

q4-6 hours prn pain

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3
Q

extra strength APAP dose

A

1000 mg

q6 hr prn pain

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4
Q

Max daily dose APAP

A

4g otherwise OD! (adults)

kids 5 doses of 50-75 mg/kg max

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5
Q

3 main things to education pts about with tylenol

A
  • liver warning
  • alcoholic bev not recommended (esp. 3+ drinks)
  • watch out combo products
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6
Q

alcoholics and APAP

A

dose lower assume already have some liver damage

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7
Q

APAP is metabolixed to

A

NAPQI (n-acetyle etc..)

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8
Q

how does viral illness impact APAP metablosims

A

increased risk toxicity if dehydrated

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9
Q

early sx APAP OD

A

N/V
AMS
metabolic acidosis
increased PT/INR (liver damage)

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10
Q

stage 1 APAP toxicity

A

asymptomatic
LFT normal
N/V, diaphoretic, pallor, malaise etc

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11
Q

stage 2 APAP tox

A

AST over 1000
RUQ pain
increased PT, bilirubin, sCr, BUN
proteinuria, hematuria, casts

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12
Q

stage 3 APAP tox

A

-max liver injury 72-96 hr post ingestion
-coma
-high ammonia level
-fatal 3-5 days post APAP OD
multiorgan failure

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13
Q

stage 4 APAP OD

A

recovery hepatic regeneration days to wks

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14
Q

APAP OD suspect first step?

A
  • rumack matthew nomogram
  • for acute OD in pt over 12
  • estimate level of toxicity
  • use w/in 4-24 hrs
  • above line need NAC
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15
Q

NAC must be given w/in ___hrs of APAP OD

A

8

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16
Q

NAC adminstered

A

IV or oral

less ADR with oral

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17
Q

NSAIDS block __ enzymes

A

COX enzymes

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18
Q

COX enzymes do what

A

create prostaglandins

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19
Q

what do prostaglandins do

A
  • released creating pain, inflammation, and pyretic properties
  • induce uterine contractions with labor
  • maintain renal blood flow (chronic NSAID use RF for renal ischemia AKI)
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20
Q

why no NSAID third trimester of pregnancy?

A
  • can cause premature closure PDA

- impact placenta detachment

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21
Q

what is best pain reliever for post marathon pain?

A

APAP
- NSAID will block inflammatory response of muscle repair process, and will compromise blood flow to kidneys risk of renal ischemia

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22
Q

t/f enteric coated NSIADS should not be taken with milk or antacids

A

true

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23
Q

T/F nsaids take with food

A

yes decrease GI ADR

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24
Q

those that are on chronic NSAID what think about?

A
  • GI Risk ulcers, dyspepsia, bleeds

- rx: PPIs to reduce risk

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25
Q

ASA/omeprazole

brand and indication?

A

brand: Yosprala

indicated for ppl who need ASA for CV risk but at risk for ulcers

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26
Q

G6PD what drugs avoid?

A 
APAP 
NSAIDS 
FQ 
Sulfas 
dimenhydramine

can lead to hemolysis in pt who RBC already shorter lifespan

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27
Q

misoprostol brand

A

cytotec

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28
Q

misoprostol is a ___

A

synthetic prostaglandin E1 analog

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29
Q

misoprostol functions

A
  • inhibits gastric acid secretion
  • protects GI mucosa
  • reduce incidence gastric and duodenal ulcers
  • abortifacient
  • teratogenic
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30
Q

how does misoprostol lead to abortion ?

A

induces labor
or
uterine rupture after 8 wk pregnant

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31
Q

if rx misoprostol what needs to be documented?

A
  • advised pt risk abortion if pregnant
  • do not share with others
  • negative pregnancy test 2 wks prior to start
  • pt capable comply with contraceptive measures
  • pt got oral and written warnings of hazards
  • pt will start misoprostol only on second or third day of next period
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32
Q

t/f celecoxib (celebrex) found to increase risk of CV events

A

yes

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33
Q

t/f diclofenac increase risk CV events

A

true 36%!!!

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34
Q

if have pt with high bp ask..?

A

are you taking NSAIDS?

all NSAIDS can increase BP

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35
Q

NSAID renal risk

A

AKI
hyperkalemia

Need to dose adjust for renal insufficiency

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36
Q

NSAIDS and ASA interaction

A

ibuprofen blocks antiplatelet effects of ASA

  • take 30 min after ASA or 8 hrs before
37
Q

List 5 classes of NSAIDS

A
  • salicylate
  • propionic acids
  • carboxylic acids
  • enolic acids
  • cox 2 inhibitors
38
Q

ex salicylates

A

ASA (acetylsalicylic acid)

39
Q

max daily dose of ASA

A

4 g

40
Q

tx ASA overdose

A

sodium bicarbonate

41
Q

regular ASA dose

A

81 mg tab

4-8 tabs q 4 hrs max

42
Q

3 propionic acids NSAIDS

A
  • ibuprofen (advil, motrin)
  • ketoprofen (orudis)
  • naproxen (aleve, naprosyn, naprelan, anaprox)
43
Q

advil

A

ibuprofen

44
Q

motrin

A

ibuprofen

45
Q

asprin

A

ASA

46
Q

orudis

A

ketoprofen

47
Q

aleve

A

naproxen

48
Q

naprosyn

A

naproxen

49
Q

anaprox

A

naproxen

50
Q

naprelan

A

naproxen

51
Q

max does naproxen

A

1500 mg daily

52
Q

ibuprofen max dose

A

3200 mg daily

OTC max 2400mg daily

53
Q

naproxen gout regimen

A

750 mg naproxen first

then 250 mg q8hrs until attack subsides

54
Q

t/f naproxen sodium has cross reactivtivity with ASA allergy

A

true! ! !

55
Q

6 carboxylic acids

A
  • ketorolac
  • etodolac
  • diclofenac
  • sulindac
  • indomethacin
  • nabumetone
56
Q

toradol

A

ketorolac

57
Q

acular

A

ketorolac

58
Q

acuvail

A

ketorolac

59
Q

sprix

A

ketorolac

60
Q

lodine

A

etodolac

61
Q

voltaren

A

diclofenac

62
Q

flector

A

diclofenac

63
Q

zipsor

A

diclofenac

64
Q

pennsaid

A

diclofenac

65
Q

clinoril

A

sulindac

66
Q

indocin

A

indomethacin

67
Q

relafen

A

nabumetone

68
Q

why diclofenac should not be your first NSAID pick?

A
  • increase cardiac risk
  • more liver tox than most other nsaids
  • more GI tox
69
Q

indocin commonly used for

A

first line gout acute flares

close PDA in neonates

used to be used premature labor

70
Q

indomethacin acute gout regimen

A

50 mg TID daily unitl pain improves then taper off

71
Q

enolic acid NSAIDS

A

meloxicam (mobic)

piroxicam (feldene)

72
Q

mobic

A

meloxicam

73
Q

feldene

A

piroxicam

74
Q

t/f meloxicam renal dose adjust?

A

yes

75
Q

maximum daily dose of meloxicam

A

15 mg

76
Q

indications meloxicam

A
  • OA or RA pain relief
77
Q

indications of feldene (generic?)

A

generic piroxicam

tx for acute and chronic RA and OA

78
Q

t/f piroxicam dose adjust in hepatic impairment

A

true

79
Q

piroxicam monitoring

A
  • occult blood loss
  • Hgb Hct
  • periodic renal and hepatic function ptests
  • periodic eye exams with chronic use
80
Q

piroxicam max daily dose

A

20 mg

81
Q

cox 2 inhibitors

A

celecoxib (celebrex)

82
Q

celebrex is brand for

A

celecoxib

83
Q

indications celecoxib

A
  • prevention of familial adenomatous polyposis
84
Q

celecoxib dosing primary dysmenorrhea or acute pain

A
  • 400 mg initial
  • additional 200mg if needed on day 1

maintanence dose 200mg BID prn

85
Q

osteoarthritis celecoxib dose

A

100 mg / day or divided into 50 mg BID

86
Q

RA celebrex dose

A

100-200 mg BID

87
Q

t/f celebrex not recommended in pts with advanced renal disease

A

true

88
Q

how dose adjust celebrex for hepatic impairment

A

decrease dose by 50% in pts with moderate hepatic impairment child pugh class II

Narcotics: Pain Mgmt and Addiction (8 decks)

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