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NAPLEX review 2024 RXPrep Book > Pain/Related Conditions: Pain > Flashcards

Pain/Related Conditions: Pain Flashcards

1
Q

Most common medications for mild pain

A

tylenol
NSAIDs

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2
Q

Opioids are most appropriate for what kind of pain?

A

Moderate to severe

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3
Q

When should adjuvants be considered for pain?

A

at all severities of pain

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4
Q

Tylenol max daily dose

A

Maximum < 4,000 mg/day

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5
Q

Boxed warnings for Tylenol

A

severe hepatotoxicity with dosing > 4g/day or suing multiple Tylenol containing products

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6
Q

Tylenol pediatric (< 12 yrs old) dosing

A

10-15 mg/kg Q4-6H

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7
Q

Tylenol drug interactions

A

can be used with warfarin, but dosing > 2g/day can increase INR

avoid/limit alc use due to risk of hepatotoxicity

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8
Q

What do non-selective NSAIDs block

A

They block the synthesis of both COX enzymes (COX-1 & COX-2)

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9
Q

What do COX enzymes do

A

catalyze conversion of arachidonic acid to PGs and thromboxane A2 (TxA2)

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10
Q

COX-2 selective NSAIDs

A

block synthesis of COX-2 only, decreasing GI risk
COX-1 protects gastric mucosa

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11
Q

How does Aspirin block COX?

A

irreversible COX-1 and COX-2 inhibitor

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12
Q

Non-aspirin NSAID warnings

A

GI risk = inc risk of serious GI bleed and ulceration
CV risk = can increase risk of MI and stroke
No NSAIDs after CABG, antiplatelet therapy (aspirin) recommended

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13
Q

Side Effects of All NSAIDs

A

used cautiously or avoid in renal failure
can inc BP, avoid in uncontrolled HTN
don’t use 3rd trimester ( > 30 wks)
Nausea, taking with food can help
can cause photosensitivity

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14
Q

Ibuprofen daily maxs

A

OTC: 1200mg/day
RX: 3200mg/day
Peds 40mg/kg/day

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15
Q

Which IV NSAIDs can be used within 14 days of birth to close a patent ductus arteriosus

A

indomethacin
ibuprofen

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16
Q

Ibuprofen self-treatment OTC recommended limit

A

< 10 days

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17
Q

Indomethacin (Indocin) side effects

A

high risk of CNS side effects = avoid in psych conditions

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18
Q

Ketorolac boxed warnings

A

max combined duration of IV/IM and PO/Nasal is 5 days in adults

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19
Q

Ketorolac warnings

A

inc bleeding
acute renal failure
liver failure

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20
Q

When is Sulindac used

A

sometimes in reduced renal function, and in patients on lithium who require an NSAID

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21
Q

Piroxicam notes

A

high risk for GI toxicity and severe skin reactions, inc SJS/TEN

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22
Q

COX-2 selective drugs

A

Celecoxib (Celebrex)
Diclofenac (Voltaren)
Meloxicam (Mobic)
Etodolac
Nabumetone

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23
Q

Celecoxib Contraindications

A

sulfonamide allergy

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24
Q

Celecoxib notes

A

has highest COX-2 selectivity
avoid in pregnancy

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25
Q

Diclofenac Boxed warnings

A

avoid Arthrotec (diclofenac + misoprostol) in females of childbearing potential

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26
Q

Meloxicam, Etodolac, and Nabumetone COX selectivity

A

Has some COX-2 selectivity

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27
Q

Cardioprotection dosing of aspirin

A

81-162mg once daily

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28
Q

Aspirin warnings

A

Avoid with NSAID hypersensitivity
Avoid Aspirin in children and teenagers with viral infection due to Reye’s syndrome risk

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29
Q

Aspirin side effects

A

dyspepsia
heartburn
bleeding
nausea

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30
Q

Aspirin notes

A

PPI can be used to protect gut, weigh pro vs cons of long term PPIs
OD can cause tinnitus

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31
Q

Opioid boxed warnings

A

addiction, abuse and misuse can lead to OD and death
respiratory deprssion
inc risk with other CNS depressants
No alc ER morphine, hydrocodone, oxy
accidental ingestion can be fatal for child
crushing, dissolving or chewing LA can lead to OD
neonatal withdrawal when used during pregnancy

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32
Q

Physiological adaptation (physical dependence) definition

A

almost everyone who uses will experience physical withdrawal when med stopped, late dose or miss dose

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33
Q

Addiction defintion

A

strong desire or compulsion to take drug despite harm, drug-seeking behavior

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34
Q

Opiod use disorder definition

A

problematic pattern of opioid use that causes significant impairment or distress
have to have had unsuccessful trials to reduce or control opioid useT

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35
Q

tolerance definition

A

higher opioid dose needed to produce same lvl of analgesia

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36
Q

Opioid hyperalgesia definition

A

opioid dose inc to treat pain but pain gets worse instead of better

37
Q

Break-through-pain opioid definition

A

sharp spikes of severe pain that occur despite the use of ER opioid

often ER dispensed with BTP meds to be used in event it occurs

38
Q

All opioid sides effects

A

constipation
nausea
vomiting
somnolence
dizziness/lightheadedness
risk of respiratory depression
pruritus common

39
Q

Codeine boxed warnings

A

respiratory depression and death in children found to be ultra-rapid metabolizers CYP 2D6 polymorphism after tonsillectomy and/or adenoidectomy

40
Q

Codeine contraindications

A

dont use children < 12yrs old and < 18yrs following tonsillectomy/adenoidectomy

41
Q

Codeine side effects

A

has high degree of GI side effects including constipation

42
Q

Codeine notes

A

pro drug, gets metabolized to morphine

43
Q

Fentanyl boxed warnings

A

using w/ strong CYP3A4 inhibitors can inc effects and respiratory failure

44
Q

Fentanyl side effects

A

excessive sweating
dry mouth
asthenia
loss of appetite
application side redness/erythema

45
Q

Fentanyl notes

A

not used in opioid naive patients

pts on 60mg/day morphine equivalent or at least 7 days therapy can be converted to Fentanyl

46
Q

Fentanyl patch notes

A

only apply 1
apply to hairless skin
dont cover with heating pad
flush down toilet when done
can only cover with Bioclusive or Tegaderm

47
Q

Hydrocodone + Tylenol is….

A

Norco
vicodin

48
Q

Oxycodne + Tylenol is…

A

Percocet

49
Q

Hydrocodone boxed warnings

A

starting CYP3A4 inhibitions or stopping inducers can cause fatal OD

50
Q

Hydromorphone Boxed warnings

A

risk of med error with high potency injection 10mg/ml vs 2mg/ml

51
Q

Hydromorphone notes

A

start with low dose, high risk of OD due to potency

52
Q

Methadone boxed warnings

A

Life threatening QT prolongation and serious arrhythmias have occurred

53
Q

Methadone uses

A

txm fo pain and for detox and maintenance txm of opioid use disorder

54
Q

Methadone notes

A

variable half-life, hard to dose safely
can dec testosterone = sexual dysfunction

55
Q

Meperidine warnings

A

renal impairment and elderly at risk for CNS toxicity
avoid within 2 weeks of MAOi

56
Q

Meperidine notes

A

no longer recommended as analgesic
short half life

57
Q

Morphine side effects

A

pruritic
dry mouth

58
Q

Oxycodone Boxed warnings

A

initiation of CYP3A4 inhibitors or stopping inducers can lead to fatal OD

59
Q

Oxycodone side effects

A

pruritus
dry mouth

60
Q

Oxycodone notes

A

avoid high fat meals with higher doses unless re-formualted OxyContin

61
Q

Oxymorphone should be taken on a….

A

empty stomach

62
Q

IV to oral Morphine

A

10mg IV to 30mg oral

63
Q

IV to Oral Hydromorphone

A

1.5mg IV to 7.5mg oral

64
Q

Morphine to Hydromorphone

A

10mg = 1.5mg IV
30mg oral = 7.5mg oral

65
Q

Oxycodone to Hydromorphone oral

A

20mg oral = 7.5mg hydro oral

66
Q

Hydrocodone oral to oxycodone

A

30mg hydro = 20mg oxy

67
Q

How to convert dosing

A

add up total used in 24hrs
use conversions to convert to drug of choice
reduce dose by 25% unless exam doesnt ask to reduce***
divide into appropriate interval and dose

68
Q

Break through dosing is usually

A

10-15% of total daily baseline opioid dose

69
Q

Which formulations should be used for breakthrough pain?

A

use IR formulation

70
Q

Opioid-induced respiratory depression risks

A

hx of previous OD
substance use disorder
using larger doses ( > 50mg morphine)
use w/ benze, gabapentin, pregabalin
comorbid illness

71
Q

Peripherally-acting mu-opioid receptor antagonists (PAMORAs) MOA

A

block opioid receptors in the gut to reduce constipation without affecting analgesia

only effective when constipation is secondary to use of opioid

72
Q

PAMORAs

A

Methylnaltrexone
Naloxegol
Naldemedine

73
Q

PAMORAs Warnings

A

GI perforation

74
Q

PAMORAs side effects

A

abdominal pain
flatulence
diarrhea
nausea

75
Q

Tramadol boxed warnings

A

Respiratory depression and death in children following tonsillectomy and or adenoidectomy who are ultra-rapid metabolizers

76
Q

Tramadol warnings

A

Seizure risk
risk of serotonin syndrome
Hypoglycemia
CNS depression

77
Q

Tramadol Contraindications

A

children < 12 and < 18 after tonsillectomy/adenoidectomy surgery
MAOi concurrent or within 14 days

78
Q

Tramadol side effects

A

Dizziness
constipation
nausea
somnolence

79
Q

Tapentadol (Nucynta) warnings

A

can inc seizure risk, risk of serotonin syndrome

80
Q

Naltrexone shouldn’t be started until patient is opioid free for how long?

A

7- 10 days

81
Q

Buprenorphine MOA

A

partial mu-opioid agonist

agonist at low doses, antagonist at higher doses

low dose - pain, high dose = addiction txm

82
Q

Gabapentin side effects

A

Dizziness
somnolence
peripheral edema
weight gain
ocular effect

83
Q

Gabapentin CrCL < 60 dose reduction

A

reduce dose or inc interval

84
Q

Gabapentin used off-label for….

A

fibromyalgia
neuropathic pain
AUD

85
Q

Pregabalin side effects

A

same as Gaba

dizziness
somnolence
peripheral edema/weight gain
mild anxiolytic

86
Q

Pregabalin approved for use in…

A

fibromyalgia, PHN and neuropathic pain associated with diabetes and spinal cord injury

87
Q

Muscle relaxants

A

Baclofen = Lioresal
Cyclobenzaprine = Flexeril
Tizanidine = Zanaflex

88
Q

Muscle relaxant side effets

A

Dry mouth
excessive sedation, dizziness, confusion, muscle weakness

Tizanidine = Hypotension

89
Q
A

NAPLEX review 2024 RXPrep Book (78 decks)

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