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PHRM 845: Therapeutics III > Pain: Rogers > Flashcards

Pain: Rogers Flashcards

1
Q

What is Pain?

A
  • An unpleasant sensory and emotional experience associated with actual tissue damage
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2
Q

What are the assessments of pain?

A
  • Subjectively and Ojectively
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3
Q

What are the subjective assessments of pain?

A
  • PQRSTU
  • P: palliative and precipitating
  • Q: quality
  • R: region
  • S: severity
  • T: time
  • U: impact on yoU
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4
Q

What are the objective assessments of pain?

A
  • Behavioral and Physiological Changes
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5
Q

How do we classify pain?

A
  • Acute [<3 Months]
  • Chronic [>3 Months; Tissue and/or Nerve]
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6
Q

What are the goals of therapy for pain?

A
  • Correct the underlying cause
  • Minimize the pain
  • Improve QOL
  • Limit the side effects
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7
Q

What are some of the non-pharmacological treatments for pain?

A
  • Physical manipulation, Heat or Ice, Massage, Acupuncture, Exercise]
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8
Q

What is the treatment approach for pain?

A
  • Step 1: non-opioids +/- add on
  • Step 2: opioid + non-opioids +/- add on
  • Step 3: opioid + non-opioids +/- add on
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9
Q

What are some of the non-opiods that are used?

A
  • Acetaminophin and NSAIDS
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10
Q

What is aceteminophen used for?

A
  • Reduce fever and pain
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11
Q

What is the dosage forms for acetaminophen?

A
  • Tablet, capsule, chewable tablet, liquid, IV, Suppository
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12
Q

What is the dosing for acetaminophin?

A
  • Adults: 325-1000mg PO q4-6h PRN
  • Children: 10-15 mg PO q4h PRN
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13
Q

What are the side effects for acetaminophen?

A
  • Hepatotoxicity
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14
Q

What are the clinical pearls for acetaminophen?

A
  • GOLD STANDARD for osteoarthritis
  • MAX DOSE = 3-4 g
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15
Q

What are the side effects for NSAIDs?

A
  • GI Bleeding, Nephrotoxictity, fluid retention, increase cv events {BLACK BOXED WARNING]
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16
Q

What are NSAIDs used for?

A
  • Reduce pain, fever and inflammation
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17
Q

What are some of the clinical pearls for NSAIDs?

A
  • Caution in elderly
  • AVOID: cardiac history
  • AVOID: liver disease
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18
Q

What are the dosage forms for aspirin [bayer]?

A
  • Chewable tablet, tablet, EC tablet, Capsule, ER capsule, Suppository
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19
Q

What is the dosing for aspirin?

A
  • Adults: 325-1000 mg q4-6h PRN
  • Children: AVOID
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20
Q

What are the dosage forms for Ibuprofen?

A
  • Capsule, tablet, chewable tablet, suspension, IV
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21
Q

What is the dosing for ibuprofen?

A
  • Adults: 200-800 mg PO q6-8h PRN
  • Peds: 5-10 mg/kg PO q4-6h PRN
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22
Q

What are the dosage forms for Diclofenac?

A
  • Capsule, tablet, XR tablet, Packet, Gel, cream, patch, eye drops
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23
Q

What is the dosing for diclofenac?

A
  • Adult: 50 mg PO q8h or 2-4 G applied topically 4 times/day
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24
Q

What are the dosage forms for naproxen?

A
  • capsule, tablet, DR tablet, ER tablet, suspension
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25
Q

What is the dosing for naproxen?

A
  • Adult: 220-500 mg PO q6-12h
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26
Q

What are the dosage forms for Ketorolac?

A
  • Tablet, IV/IM, Nasal spray, Eye drops
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27
Q

What is the dosing for kertorolac?

A
  • Adults: 15-30 mg IV/IM q6h PRN or 10 mg PO q6h PRN
  • Peds: 0.5 mg/kg/dose IM/IV q6h PRN`
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28
Q

What is the clinical pearls for ketorolac?

A
  • MAX duration is 5 days: increases GI bleeding
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29
Q

What are the dosage forms for celecoxib?

A
  • Capsule, solutions
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30
Q

What is the dosing for celecoxib?

A
  • Adult: 200 mg PO BID
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31
Q

What is the clinical pearls for celecoxib?

A
  • COX 2 seletctive = less GI toxciity
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32
Q

What are some of the add on therapies that are use in pain?

A
  • Gabapentinods, SNRIs, TCAs, Muscle relaxents, Antiepilptics, Topical agents
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33
Q

What is the use of the Gabapentinoids [Gabapentin & Pregabalin]?

A
  • Fibromyalgia, Neuropathies, Post-op pain
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34
Q

What are the dosage forms for gabapentinoids [Gabapentin & Pregabalin]

A
  • tablets, capsule, ER tablet, liquid
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35
Q

What is the dosing for the gabapentinoids [Gabapentin & Pregabalin]?

A
  • Gabapentin: 100-300 mg PO TID
  • Pregabalin: 75 mg PO BID
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36
Q

What are the side effects of the gabapentinoids [Gabapentin & Pregabalin]?

A
  • Sedation, dizziness, Edema
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37
Q

What is the clinical pearls for the gabapentinoids [Gabapentin & Pregabalin]?

A
  • Renally adjusted
  • Used in combo
  • Pregabalin C-V and Gabapentin nothing
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38
Q

What is the uses for the SNRIs?

A
  • Fibromyalgia, Neuropathy
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39
Q

What are the dosage forms for SNRIs?

A
  • Capsule, Tablet, ER Capsule, ER Tablet
40
Q

What is the dosing for the SNRIs?

A
  • Venlafaxine: 37.5-75 mg PO daily
  • Duloxetine: 30 mg PO daily x 1 week, then increase to 60 mg PO daily
41
Q

What are the side effects for the SNRIs?

A
  • Nausea, Headache, hypertension, sedation, weakness
42
Q

What are the clinical pearls for SRNIs?

A
  • AVOID: duloxetine for CrCl < 30 mL/min
43
Q

What are the uses for TCAs?

A
  • Fibromyalgia, Neuropathy, Mirgraine Prophylaxis
44
Q

What are the dosage forms for TCAs?

A
  • Tablet [Amitripyline], Capsule & Solution [Nortiptyline]
45
Q

What is the dosing for the TCAs?

A
  • 10 mg PO qhs
46
Q

What are the side effects for the TCAs?

A
  • Anti cholinergic side effects, sedation
47
Q

What are the clincal pearls for TCAs?

A
  • LAST LINE
48
Q

What are the uses for the Muscle relaxents?-

A
  • Musculo-skeletal pain/spasms
49
Q

What are the dosage forms for Muscle Relaxents?

A
  • Tablet/Capsule [XR/IR], Suspension [Cyclobenzaprine & Baclofen], Solution [Methocarbamol & Baclofen]
50
Q

What is the dosing for the Muscle Relaxants?

A
  • Cyclobenzaprine 5 mg PO TID
  • Baclofen 5 mg PO TID
  • Carisprodol 250-350 mg PO TID
  • Methocarbamol 1.5 g PO 3-4x/day
  • Tizanidine 2-4 mg PO q6-12h
51
Q

What are the side effects of the Muscle relaxants?

A
  • Sedation, drowsiness, dizziness, dry mouth, vision changes
52
Q

What are the clinical pearls for the Muscle relaxants?

A
  • Short term use
  • Carisoprodol has abuse potential
53
Q

What is the use for carbamazepine?

A
  • Neuropathic pain
54
Q

What are the dosage forms for Carbamazepines?

A
  • Capsule, Tablet, ER Capsule/Tablet, Chewable Tablets, Supsension
55
Q

What is the dosing for Caramazepine?

A
  • 200 mg pO daily
56
Q

What are the clinical pearls for Carbamazepine?

A
  • HLA-B*1502
  • Autoinduction
57
Q

What are the dosage forms for Lidocaine?

A
  • Patch, Injection, Topical
58
Q

What is the dosing for lidocaine?

A
  • Apply 1 patch to affect area daily and remove 12 hours later
59
Q

What are the side effects for Lidocaine?

A
  • Hypotension, arrhythmia
60
Q

What are the clinical pearls for Lidocaine?

A
  • Tachyphylaxis
61
Q

What is the use for capsacian?

A
  • Muscle/joint pain, Neuroplathic Pain
62
Q

What are the dosage forms for Capsacian?

A
  • Cream, gel, liquid, lotion
  • Patch
63
Q

What is the side effects for capsacian?

A
  • skin iritation and pain
64
Q

What are the clincial pearls for capsacian?

A
  • DO NOT get into eyes
65
Q

What are some of the signs and symptoms for Opioid Overdose?

A
  • Sedation, Pinpoint Pupils, Decreased respiratory rate, bradycardia, hypotension, plae, clammy
66
Q

What are some of the signs and symptoms for opioids withdrawal?

A
  • Insomnia, Dilated pupils, Increase respiratory rate, tachycardia, hypertension, sweating
67
Q

What is the way that we can treat an opioids overdose?

A
  • NARCAN - Opioids Antagonist
68
Q

Who should receive Narcan?

A
  • History of overdose, substance use disorder, high opioids doses, concurrent benzo use
69
Q

What are the uses for Opioids?

A
  • Acute and Chronic pain
70
Q

What are the side effects for Opioids?

A
  • Antitusive, Constipation, Nausea & Vomiting, Itching, Orthostatic Hypotension, Urinary Retention, Sedation, RESPIRATORY DEPRESSION
71
Q

What is the dosage forms for Codeine?

A
  • Tablet, cough syrup
72
Q

What are the clinical pearls for Codeine?

A
  • Metabolized to morphine from 2D6 [PM = no effect; UM = overdose]
  • Schedule V, III, or II depends on dose
73
Q

What are the dosage forms for Tramadol?

A
  • capsule ER 24h, Tablet - IR & ER 24h, Solution
74
Q

What are the clinical pearls for Tramadol?

A
  • Lower seizure threholds
  • Serotonin Syndrome
  • BOXED WARNING: 3A4 inducer, inhibitor; 2D6 inhibitors
75
Q

What are the dosage forms for Morphine?

A
  • Capsule ER 24h, Tablet - IR & 12h ER, Solution, IM, IV, SubQ, Suppository,
76
Q

What are some of the clinical pearls for Morphine?

A
  • ITCHING
  • Renal Eliminated
  • BOXED WARNING: avoid alcohol while taking ER capsules
77
Q

What are the dosage forms for Hydromorphone?

A
  • IR & ER tablets, Solutions, Injections, Suppository
78
Q

What is the clinical pearls for Hydromorphone?

A
  • BOXED WARNING: oral [mg =/= ml] & IV [high potency 10mg/ml]
79
Q

What are the dosage forms for Norco/

A
  • Solution, ER capsule, ER tablets, Tablet [5, 7.5, 10]
80
Q

What are the clinical pearls for Norco?

A
  • Has Acetaminophen
  • BOXED WARNING: 3A4 inhibitor
81
Q

What are the dosage forms for Percocet?

A
  • Tablet, Capsule, Solution [2.5, 5, 7.5, 10]
82
Q

What are the clinical pearls for Percocet?

A
  • Has Acetaminophen
  • BOXED WARNING: 3A4 inhibitors
  • ER abuse deterrent
83
Q

What are the dosage forms for Fentanyl?

A
  • Buccal tablets, sublingual liquids, lozenges, injectable, patch [ONLY for opioids tolerant]
84
Q

What are the clinical pearls for Fentanyl?

A
  • BOXED WARNING: 3A4 inhibitor and inducer
  • Opioid tolerant is; Morphine 60 mg per day
85
Q

What is the use for Methadone?

A
  • LAST LINE for chronic pain, detox
86
Q

What are the dosage forms for Methadone?

A
  • Solution, Injection, tablet
87
Q

What are the clinical pearls for Methadone?

A
  • BOXED WARNING: QTc Prolongation
  • BOXED WARNING: 3A4 inhibitor and inducers
88
Q

What are the dosage forms for Meperidine?

A
  • Injectable, solution, tablet
89
Q

What are the clinical pearls for Meperidine?

A
  • AVOID: elderly, Renal impairment
  • BOXED WARNING: 3A4 inhibitor and inducer
  • BOXED WARNING: DO NOT use with 14 days of MOA-I
90
Q

What is important to know about Allergic Cross reactions?

A
  • If allergic to natural opiates [Morphine, Codeine] SHOULD NOT use semi synthetic opioids [Hydromorphone, Oxycodone, Oxymorphone, Hydrocodone, Buprenorphine]
  • If allergic to natural and semi synthetic CAN use synthetic opiates [fentanyl, methadone, meperedine]
91
Q

What is the way that we switch between opioids?

A
  • Calculate daily consumption
  • convert to oral morphine
  • Add morphine doses together
  • Reduce due to cross-tolerance [25-50%]
  • Split daily dose [4-6h]
92
Q

What is the Michigan Opioid Prescribing Engagement Network?

A
  • Looks to see how much pain control is needed for specific surgeries
  • Provides recommend dosing for acetaminophen and ibuprofen
93
Q

How does the CDC recommend prescribing opioids for chronic pain?

A
  • Opioids are NOT FIRST LINE
  • Establish goals
  • Risk vs benefits
  • Use IR opioids when starting
  • Lowest dose
  • Short duration for acute pain
  • Benefits vs harm
  • Strategies to reduce risk
  • PDMP
  • Urine drug test
  • AVOID concurrent opioids or benzo
  • opioids use disorder
94
Q

What is the recommendations for low back pain?

A
  • Self care
  • Non Pharm: Exercise, CBT, Rehab
  • Pharm: 1st [Tylenol or NSAIDs]; 2nd [SNRIs or TCAs]
95
Q

What is the recommendations for osteoarthritis?

A
  • Non Pharm: Exercise, weight loss, patient ed
  • Pharm: 1st [Tylenol or NSAIDs]; 2nd [Intra-articular Hyaluronic acid or Capsacin]
96
Q

What is the recommendations for Fibromyalgia?

A
  • Non Pharm: Exercise, CBT, Biofeedback
  • Pharm: Pregabalin, Duloxetine [or TCAs, Gabapentin, Venlafaxine]
97
Q

What is the recommendations for Neuropathic pain?

A
  • 1st: SNRIs or Gabapentin/Pregabalin
  • 2nd: Lidocaine or TCAs

PHRM 845: Therapeutics III (25 decks)

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