Pain / Opioid / Alcohol

Question 1

Which pain meds affect serotonin?

Answer 1

Tramadol
Tapentadol
Fentanyl
Methadone
Meperidine

Question 2

Which extended release pain med can you crush?

Answer 2

NONE DUMBASS

Question 3

How do you describe someone who is opioid tolerant?

Answer 3

> 60mg/day MME for >1 week

Question 4

How do you convert opioids?

What is the morphine and hydromorphine conversations?

Answer 4

Reduce the new opioid dose by 25-50%

Morphine IV/IM 10mg = 30mg PO

Hydromorphone 1.5mg IV/IM = 7.5mg PO

Question 5

Morphine

Brand names
PK / PD

Answer 5

MSIR, Ms Contin CR, Kadian Er, Arymo ER

Metabolized in liver and active metabolites excreted by kidneys

Hydrophillic so slow onset and long duration

Question 6

Hydromorphone

Great option for…

Answer 6

Patients with renal impairment

Question 7

Hydrocodone

Brands
Pgx

Answer 7

Zohydro ER

Hysingla ER

3A4 substrate (so inhibitors will increase hydrocodone)H

Question 8

Hydrocodone combination brand names

Answer 8

Vicodine 5/300 or 7.5/300
Norco
Lorcet
Vicoprofen 7.5/200
Aoadaz (benzhydrocodone + APAP)

Question 9

Oxycodone

Brand names

Answer 9

Roxicodone
Oxaydo IR
oxycontin ER
Xtampza ER

Question 10

Oxycodone combinations

Answer 10

Percocet
Endocet
Xartemis
Percodan (oxy + aspirin)

Question 11

Meperidine

Brand
Contraindications
Caution
ROA
Max dose

Answer 11

Demerol

MAOI’s, renal insufficiency

Seizures

IV/IM/SC/PO

600mg/day and keep under 2 days

Question 12

Fentanyl

Renal adjustment?
Brand names / ROA

Answer 12

Safe for renal impairment

Sublimaze - IV/IM
Lazanda nasal spray
Actiq - lozenges
Fentora - buccal tablets
Duragesic patches

Question 13

Fentanyl patch counseling

Strengths

Answer 13

Apply every 72 hours

Do NOT cut

Flush down toilet when done

12,25,37,50,62.5,75,87.5,100 mcg/HOUR

Question 14

Sulfentanil

Brand
Dose/ROA
Indication
BBW

Answer 14

Dsuvia

30mcg sublingual or IV

Acute pain and surgical analgesia

REMS programed and only dispensed in a certified health care setting

Question 15

Methadone

Brand
MOA
Warning

Answer 15

Dolophine, methadose

NMDAR antagonist and NE/5HT reuptake inhibitor

QT prolongation, delayed life-threatening sedation/respiratory depression

Question 16

Codeine is a prodrug converted into … via..

Answer 16

Morphine

CYP2D6

Question 17

Buprenorphine

MOA
Brand/ROA

Answer 17

Partial opioid agonist and partrial antagonist

Butrans patch
Belbuca buccal fil
Sublocade monthly SUBQ
Probuphine subdermal implant
Brixade ER SUBQ

Question 18

BBW for tylenol + codeine

Answer 18

Do not use in kids after tonsillectomy

Question 19

Butrans patch counseling

ADE

Dose

Answer 19

5/10/20 mcg/ HOUR changed once a week for chronic pain >18y.o

QT prolongation

Question 20

Buprenorphine/naloxone

Control class
Brand names/ROA

Answer 20

C3

Suboxone SL tab
Zubsolv SL tab
Bunavil buccal film

Question 21

Fioricet vs fiorinal with codeine?

Indication

Answer 21

Fioriceet has APAP

Fiorinal has aspirin

Used for tension headaches

Question 22

Tramadol

Control class
Brand names
ADE

Answer 22

C5

Ultram
Conzip ER
Sumapryn Fusepaq
EnovaRx cream
Ultracet (tramadol + APAP)

Seizures, can increase INR, can increase suicide risk

Question 23

Tapentadol

Brand
Control class
ADE
Avoid…

Answer 23

Nucynta

C2

Seizures, serotonin syndrome

Avoid alcohol

Question 24

What 3 pain meds do you avoid in renal impairment?

Answer 24

Morphine
Oxycodone
Meperidine

Question 25

What are your options for opioid use disorder in DSM5?

Answer 25

Methadone Buprenorphine Alpha 2 agonists - clonidine and lofexidine Naltrexone

Question 26

Naltrexone Brand /ROA/dose Indication

Answer 26

Vivitrol 380mg IM monthly Treat and prevent opioid relpase

Question 27

Naloxone Brands/ ROA Indication

Answer 27

IM/SC 0.4mg Narcan nasal spray 4mg Kloxxado nasal dpray 8mg Opioid overdose

Question 28

Nalmefene Brand Indication ROA

Answer 28

Opvee Opioid overdose Nasal spray

Question 29

Options for opioid-induced constipation + brand names

Answer 29

Methylnaltrexone (relistor) Naloxegel (Movantik) Naldemedine (symproic) Lubiprostone (amitza)

Question 30

Which antidepressants are recommended for neuropathic pain? What about antiepiletpic meds? Any topical therapies?

Answer 30

TXA - nortriptyline, amitriptyline SNRI - duloxetine, venlafaxine Gabapentin and pregabalin Lidocaine 5% patch Capsaicin (Qutenza) 8% patch

Question 31

What 2 meds are FDA-approved for post herpetic nerualgia? What is an OTC option?

Answer 31

Gabapentin and pregabalin lidocaine patches 4% or capsaicin cream

Question 32

What makes up a banana bag?

Answer 32

Thiamine 100mg Folic acid 1mg MVI 1 ampule Magensium 3 grams

Question 33

How do you manage alcohol withdrawl? What do you give if they have a seizure due to the withdrawl?

Answer 33

Give benzo's Diazepam or lorazepam Benzo's . don't give phenytoin

Question 34

What are three options for preventing alcohol relapse + brand name?

Answer 34

Naltrexone - Vivitrol Acamprosate - campral : an analoge of GABA Disulfiram - antabuse

Question 35

What is the antidote for methanol and ethylene glycol poisioning?

Answer 35

Fomepizole (inhibtis alcohol DH to prevent formation of formaldehyde)