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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
Diclofenac Boxed warnings
avoid Arthrotec (diclofenac + misoprostol) in females of childbearing potential
26
Meloxicam, Etodolac, and Nabumetone COX selectivity
Has some COX-2 selectivity
27
Cardioprotection dosing of aspirin
81-162mg once daily
28
Aspirin warnings
Avoid with NSAID hypersensitivity Avoid Aspirin in children and teenagers with viral infection due to Reye's syndrome risk
29
Aspirin side effects
dyspepsia heartburn bleeding nausea
30
Aspirin notes
PPI can be used to protect gut, weigh pro vs cons of long term PPIs OD can cause tinnitus
31
Opioid boxed warnings
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
32
Physiological adaptation (physical dependence) definition
almost everyone who uses will experience physical withdrawal when med stopped, late dose or miss dose
33
Addiction defintion
strong desire or compulsion to take drug despite harm, drug-seeking behavior
34
Opiod use disorder definition
problematic pattern of opioid use that causes significant impairment or distress have to have had unsuccessful trials to reduce or control opioid useT
35
tolerance definition
higher opioid dose needed to produce same lvl of analgesia
36
Opioid hyperalgesia definition
opioid dose inc to treat pain but pain gets worse instead of better
37
Break-through-pain opioid definition
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
All opioid sides effects
constipation nausea vomiting somnolence dizziness/lightheadedness risk of respiratory depression pruritus common
39
Codeine boxed warnings
respiratory depression and death in children found to be ultra-rapid metabolizers CYP 2D6 polymorphism after tonsillectomy and/or adenoidectomy
40
Codeine contraindications
dont use children < 12yrs old and < 18yrs following tonsillectomy/adenoidectomy
41
Codeine side effects
has high degree of GI side effects including constipation
42
Codeine notes
pro drug, gets metabolized to morphine
43
Fentanyl boxed warnings
using w/ strong CYP3A4 inhibitors can inc effects and respiratory failure
44
Fentanyl side effects
excessive sweating dry mouth asthenia loss of appetite application side redness/erythema
45
Fentanyl notes
not used in opioid naive patients pts on 60mg/day morphine equivalent or at least 7 days therapy can be converted to Fentanyl
46
Fentanyl patch notes
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
Hydrocodone + Tylenol is....
Norco vicodin
48
Oxycodne + Tylenol is...
Percocet
49
Hydrocodone boxed warnings
starting CYP3A4 inhibitions or stopping inducers can cause fatal OD
50
Hydromorphone Boxed warnings
risk of med error with high potency injection 10mg/ml vs 2mg/ml
51
Hydromorphone notes
start with low dose, high risk of OD due to potency
52
Methadone boxed warnings
Life threatening QT prolongation and serious arrhythmias have occurred
53
Methadone uses
txm fo pain and for detox and maintenance txm of opioid use disorder
54
Methadone notes
variable half-life, hard to dose safely can dec testosterone = sexual dysfunction
55
Meperidine warnings
renal impairment and elderly at risk for CNS toxicity avoid within 2 weeks of MAOi
56
Meperidine notes
no longer recommended as analgesic short half life
57
Morphine side effects
pruritic dry mouth
58
Oxycodone Boxed warnings
initiation of CYP3A4 inhibitors or stopping inducers can lead to fatal OD
59
Oxycodone side effects
pruritus dry mouth
60
Oxycodone notes
avoid high fat meals with higher doses unless re-formualted OxyContin
61
Oxymorphone should be taken on a....
empty stomach
62
IV to oral Morphine
10mg IV to 30mg oral
63
IV to Oral Hydromorphone
1.5mg IV to 7.5mg oral
64
Morphine to Hydromorphone
10mg = 1.5mg IV 30mg oral = 7.5mg oral
65
Oxycodone to Hydromorphone oral
20mg oral = 7.5mg hydro oral
66
Hydrocodone oral to oxycodone
30mg hydro = 20mg oxy
67
How to convert dosing
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
Break through dosing is usually
10-15% of total daily baseline opioid dose
69
Which formulations should be used for breakthrough pain?
use IR formulation
70
Opioid-induced respiratory depression risks
hx of previous OD substance use disorder using larger doses ( > 50mg morphine) use w/ benze, gabapentin, pregabalin comorbid illness
71
Peripherally-acting mu-opioid receptor antagonists (PAMORAs) MOA
block opioid receptors in the gut to reduce constipation without affecting analgesia only effective when constipation is secondary to use of opioid
72
PAMORAs
Methylnaltrexone Naloxegol Naldemedine
73
PAMORAs Warnings
GI perforation
74
PAMORAs side effects
abdominal pain flatulence diarrhea nausea
75
Tramadol boxed warnings
Respiratory depression and death in children following tonsillectomy and or adenoidectomy who are ultra-rapid metabolizers
76
Tramadol warnings
Seizure risk risk of serotonin syndrome Hypoglycemia CNS depression
77
Tramadol Contraindications
children < 12 and < 18 after tonsillectomy/adenoidectomy surgery MAOi concurrent or within 14 days
78
Tramadol side effects
Dizziness constipation nausea somnolence
79
Tapentadol (Nucynta) warnings
can inc seizure risk, risk of serotonin syndrome
80
Naltrexone shouldn't be started until patient is opioid free for how long?
7- 10 days
81
Buprenorphine MOA
partial mu-opioid agonist agonist at low doses, antagonist at higher doses low dose - pain, high dose = addiction txm
82
Gabapentin side effects
Dizziness somnolence peripheral edema weight gain ocular effect
83
Gabapentin CrCL < 60 dose reduction
reduce dose or inc interval
84
Gabapentin used off-label for....
fibromyalgia neuropathic pain AUD
85
Pregabalin side effects
same as Gaba dizziness somnolence peripheral edema/weight gain mild anxiolytic
86
Pregabalin approved for use in...
fibromyalgia, PHN and neuropathic pain associated with diabetes and spinal cord injury
87
Muscle relaxants
Baclofen = Lioresal Cyclobenzaprine = Flexeril Tizanidine = Zanaflex
88
Muscle relaxant side effets
Dry mouth excessive sedation, dizziness, confusion, muscle weakness Tizanidine = Hypotension
89

NAPLEX review 2024 RXPrep Book (78 decks)

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