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SUMPHARM > PAIN- NSAIDs + > Flashcards

PAIN- NSAIDs + Flashcards

1
Q

What drug is mainstay for post op?

A

OPIATES

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2
Q

FOR malignant Pts what are Opiates good for?

A

improve QOL, fx, comfort, acceptance. DO NOT WITHOLD d/t fear of addiction

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3
Q

Should opiates be used for chronic pain?

A

rare,NEVER- evidence of serious SE

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4
Q

Mr. Durant c/o stiff throbbing ache, sore, squeezing, hurting pain in his calf. What type of pain is this?

A

Nociceptive- ACUTE use OPIOIDS

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5
Q

Mrs. Baynes c/o numbness, paresthesia, cold, fire, burning, foot asleep, shock like, shooting pain, comes and goes pain in L foot. What type of pain is this?

A

Neuropathic- AVOID OPIODS

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6
Q

How does the pathology of opioids and pain modulation work?

A

Opioid dull perception and transmission of pain

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7
Q

Opioids work on which primary receptors?

A

– mu-1: mostly analgesia

– mu-2: sedation, constipation, antidiuretic, respiratory depression, bradycardia, euphoria, physical dependence

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8
Q

When Opioids work on G protein receptor the DEC what?

A

DEC CAMP/Ca2+

DEC= release of neurotransmitters DA, Ach, NE, serotonin, sub P-pain

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9
Q

What is important to consider prior to pain management?

A

Type, Allergies, Prev pain use, Pain score, Renal, AGE

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10
Q

This elevates pain threshold; peripherally blocks pain

impulse generation, antipyresis, block Cox in CNS?

A

Acetaminophen (Ofirmev, Paracetamol, Tylenol®); APAP-Acetyl-P-AminoPhenol-

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11
Q

What are benefits of APAP?

A
  1. NOT ANTI-inflammatory.
  2. Less GIB.
  3. Less SE.
  4. Good with Opiates to DEC Pain, but Less DOSEa
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12
Q

What are warnings with APAP?

A

BBW OD metabolite Liver toxicity- hepatic necrosis
MAX 325mg.
1. Avoid use w/ ETOH
2. DI- warfarin
3. Often used in combo. Risk of OD on other med, ie codeine

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13
Q

If a Pt has allergy not responding to NSAID what else could be used?

A 
Another Catogory 
1. Salcytes- aspirin 
2. Propion Acids- profen 
3. Indole-indomethacin 
4. Acetic Ace- Diclofenac 
5. Napthylakanone- 
6. Oxicam, 
7- Pryanocaroxilc Acide 
8. Fenamates
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14
Q

What has a max ceiling effect of 3200, no added dose will inc effects, analgesic, and antipyretic?

A

Non Selective AIDs- Not as effective for pain as opioid,

Minor injuries

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15
Q

What are some myths about NSAIDS?

A

Delayed healing in tissue and bone fracture, NON UNION.

Ok to use early in TX pain, (but recall pts rarely sees MD Day 1 I prefe Tylenol 24-48hr)

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16
Q

If a Pt has PMH of GERD, PUD, what should be avoided and why?

A
  1. NSAIDs- inhibit COX 1-2, COX

2. DEC prostaglandins -GI protective, renal protective, platelet forming

17
Q

What RX only affect COX2?

A

Cox 2 inhibitor and Corticosteroids

18
Q

What is dose for Ibuprofen?

A

200-800mg TID/QID,
Max 3200mg/day (Advil, Motrin)
1-2hr onset

19
Q

What is dose for Naproxen?

A

250-500 BID/TID 1250 (Aleve)
MAX 1250mg
2-4hr onset

20
Q

What has the worst GI irritation

A

ASPIRIN

21
Q

What are COX 2 selects with less GIB?

A

-COXIB, -NAC.

22
Q

What COX 1 inhib is worse and not to give more than 5 days d/t GIB?

A

Ketoralac- strong but too much risk GIB
99% bound.
AVOID; 1. labor, peds 2. PUD 3. CABG, 4. Renal 5. minor pain 6. NSAIDS combo

23
Q

Avoid these Pt with Non selective d/t risk of GIB?

A 
>60 yrs
• History of GI problems 
• Current corticosteroid or anticoagulant use
• CV, DM
• Chronic use and high-dose NSAID
24
Q

What meds can be used with NSAIDs to MAYBE MINIMIZE dec GI?

A

proton pump inhibitors-omeprazole

Histamine 2 blockers- famotidine.

25
Q

Valorie should not use this d/t allergic reaction with her asthma?

A

ASA

26
Q

How long does it take for platelets to form again after toxicity of ASA?

A

7 days, ASA kills platelets.

Derosa ideal, take ASA every 5 dys, less GIB and less Stroke

27
Q

What are SE of ASA, which give reason to avoid ASA for pain control?

A

-**Painless GI bleeding
– Low doses- gout
– Reyes syndrome (Hepatic encephalopathy)- children
– Hyperthermia
– Hyperventilation
– Respiratory Alkalosis ** Don’t use with NON-selective NSAID- profen, proxen- compete binding on COX-platelets. USE APAP instead.
NOT seen in Celecoxib or Diclofenac.

28
Q

Which OTC med should be careful in high risk pt w/GI?

A

Excedrine- ASA+APAP+ Caffeine

29
Q

What is main reason for LOW DOSE ASA?

A

means 90% bound.
High dose less binding. Compete/Affect protein bound drugs warfarin, phenytoin.
Plasma levels inc. as dosage inc.

30
Q

What NSAID has higher SE treatment for gout, dose DEC as pain decreases?

A

Indomethacin

31
Q

**For Toradol (Ketorolac) who should have Lower Doses?

A
  1. > 65y
  2. Renal dfx
  3. Weight <50kg
32
Q

What are affects of prostaglandins?

A

Part of cell membrane

  1. protect renal
  2. platelet fx
  3. Protect gastric
  4. Inflammation
33
Q

What are benefits of COX2 inhibitors?

A
  1. Block inflammation
  2. Less SE than other NSAIDs
  3. Good for young healthy pop
34
Q

What and why were COX2s removed?

A
  1. INC. CVD CVA dz in wrong populations w/ comorbities.
  2. Steven Johnson Syndrome
  3. Sufa drug
  4. ASA could off set CV risk, but diminishes GI bleed protection w COXibs
35
Q

What is very effective in treating metatastic bone pain?

A

NSAID + OPiate.

  1. Rare
  2. APAP+ Opioid MC
  3. COMBOs- low dose, but INC effect
36
Q

Which drug is ideal if Pt has PUD?

A

COX 2 inhib Celecoxib/Celebrex or APAP

37
Q

Which NSAID is ideal for poor renal function?

A

APAP

38
Q

Which analgesic is ideal for post op?

A
  1. Opioid 2. NSAID, 3. APAP
39
Q

Which analgesics is ideal for CVD risk Pt?

A
  1. Naproxen safest NSAID

2. Celeocib least safe

SUMPHARM (26 decks)

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