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Pain > Pain1 > Flashcards

Pain1 Flashcards

1
Q

opioid withdrawal sx

A

anxiety, tachy, shaky, SOB, GI sx

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2
Q

pseudo-addiction

A

may run out too soon, worried about running out, but due to pain inadeq controlled

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3
Q

opioid hyperalgesia; dfn and tx?

A

chronic opioid use can worsen pain sensitivity; switch to diff opioid to mitigate tolerance or wean off op to oth analgesics

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4
Q

what is the most impt predictor of resp depr on IV opioids?

A

sedation

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5
Q

what is the usu cause of fatality with opioid OD?

A

resp depression

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6
Q

recommended dose of misoprostol to mitigate GI effects of NSAIDs

A

200 mcg QID

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7
Q

gastroprotective agents for GI effects of NSAIDs

A

misoprostol, PPI, H2 blockers

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8
Q

what is CV risk assoc NSAIDs?

A

htn, HF, MI, stroke, death

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9
Q

which COX selectivity of NSAIDs leads to higher CV risk?

A

COX2 selectivity

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10
Q

what do COX1 prostaglandins do?

A

increase gastrointestinal mucosal blood flow, mucus and bicarbonate production, and epithelial growth

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11
Q

what do COX2 prostaglandins do?

A

mediate inflammation, pain, and fever

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12
Q

agents better for neuropathic pain

A

antidepr [amitriptyline, duloxetine], and/or anticonvulsant [pregabalin]

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13
Q

agents better for severe pain due to injury, cancer

A

opioids

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14
Q

children dose APAP

A

10-15 mg/kg

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15
Q

APAP conc of infant drops or children’s susp

A

160 mg/5 ml

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16
Q

APAP cmb in Vicodin, Norco, Lortab

A

hydrocodone

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17
Q

APAP cmb in Percocet, Endocet

A

oxycodone

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18
Q

APAP cmb in Tylenol #2, 3, 4

A

codeine

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19
Q

APAP cmb in Ultracet

A

tramadol

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20
Q

hepatox assoc with what APAP dose?

A

> 4 g/day [2 g/day for heavy drinkers, pts with hepatitis]

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21
Q

what is DOC for pain in pregnancy?

A

APAP

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22
Q

which COX blockade incr bleeding?

A

COX 1

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23
Q

which COX blockade incr CV risk?

A

COX 2

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24
Q

which pts at greater risk of GI effects?

A

elderly, hx GI bleed, corticosteroids, SSRI/SNRI, chronic/HD use

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25
Q

how soon stop NSAID before surgery?

A

at least 1 wk

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26
Q

risks from chronic PPIs

A

decr bone density, incr infection

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27
Q

which NSAID rec take with food?

A

all

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28
Q

which NSAID cause more nausea?

A

salicylates: ASA and salsalate

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29
Q

what is max dose for Rx ibuprofen?

A

3.2 g/day [400-800 mg Q6-8H]

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30
Q

naproxen dosing for inflam, mild-mod pain

A

500-1000 mg/day in 2 div doses [all naprox is BID]

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31
Q

which NSAID high risk for CNS SE?

A

indomethacin; avoid in psych

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32
Q

which NSAID approved for gout?

A

indomethacin

33
Q

which NSAID has high risk for GI tox and severe skin rxns [SJS/TEN]?

A

piroxicam [last line, may need protective agents]

34
Q

what is the max tx duration for using ketorolac in adults? dosage form?

A

5 days, usu post-op [never pre-op]; start with inj switch to oral

35
Q

COX2 selective NSAIDs

A

celecoxib [highest], meloxicam, edotolac, nabumetone

36
Q

celecoxib is CI with what allergy?

A

sulfonamide

37
Q

use of NSAIDs concurrently?

A

only if cardioprotective ASA. but take ASA first and wait at least 1 hr to take others [might compete for platelet binding]

38
Q

what class agents interacts with NSAIDs to incr risk ulceration?

A

steroids

39
Q

what class agents interacts with NSAIDs to incr risk bleeding?

A

anticoagulants, antidepressants, antiplatelet agents

40
Q

how reduce tolerance for opioids at high doses?

A

rotate agents

41
Q

primary opioid receptor for pain relief?

A

mu

42
Q

what’s the only opioid SE that pt usu doesn’t dvp toler to?

A

constipation

43
Q

What is the antidote for tylenol & when is it to be started

A

N-acetylcystine; it is to be started immediately & within 8hs of ingestion

44
Q

with ATC opioids, what type of laxative to use?

A

typ need stim [senna, bisacodyl] or osmotic [MOM]

45
Q

What are the BBW for NSAIDS

A

GI bleeding (espcially non-selective agents), Cardiovascular events (MI, Stroke esp. COX-2 selective), do not use prioer ot CABG

46
Q

What are the common NSAID side effects

A

Nausea- take all with food, dyspnea & heart burn- eps. ASA, _ BP, Gi irritation, _ fluid retention

47
Q

Which NSAIDs cause photosensitivity more?

A

Propionic acid derived: ibuprophen & naproxen

48
Q

What are the contraindications for NSAID use?

A

avoid in pregnancy, children <16, renal insufficency, use prior to CABG, pregnancy, HF

49
Q

what are the options if a pt has a morphine-group allergy?

A

fentanyl, meperidine, methadone, tramadol, tapentadol

50
Q

what cross-reacts with fentanyl

A

meperidine

51
Q

what cross-reacts with morphine

A

oxymorphone, codeine, hydrocodone, hydromorphone, oxycodone, AND nalbuphine, buprenorphine, butorphanol, levorphanol

52
Q

what is the frequency of fentanyl patches application

A

Q3 days, sometimes q48h if pain reliefe is not long enough

53
Q

what agent is used for opioid overdose

A

naloxone

54
Q

signs of acute opioid over dose

A

sedation respiratory depression pinpoint pupils (miosis) cold/clammy skin

55
Q

Suboxone

A

buprenorphine + naloxone

56
Q

butrans

A

buprenorphine patch

57
Q

butrans patch is for what severity of pain

A

pt with mod-severe pain who needs ATC opioid

58
Q

buprenorphine is a C_

A

3

59
Q

buprenex

A

buprenorphine injection

60
Q

Buprenorphine side effects

A

QT prolongation

61
Q

what opioids cause QT prolongation

A

Methadone, Buprenorphine

62
Q

what agent is an opioid antagonist

A

naloxone

63
Q

What is the OTC dosing of ibuprofen?

A

200-400mg q4-6hs with max of 1.2g/d used for _10days

64
Q

What is the OTC dosing of Naproxen?

A

500mg, then 250 or 220(Na) q6-8h with max of 1.25mg of Naproxen base

65
Q

What is the typical dosing of celebrex?

A

OA: 100mg BID or 200mg qd RA: 100-200mg BID

66
Q

What are the anti-inflammatory doses of Ibuprofen & naproxen

A

Ibuprofen: 400-800mg q6-8hr with max 3.2g/d Naproxen: 500-1,00mg/day in 2 doses

67
Q

What is the combination in Treximet

A

Naproxen + sumatriptan

68
Q

What is Vimovo

A

Naproxen + esomeprazole

69
Q

of all the non-selecive NSAIDs which has the least cardio toxicity

A

Naproxen

70
Q

Brand name diclofenac

A

Cataflam & Voltaren

71
Q

Generic for Arthrotec

A

Diclofenac + misoprostil

72
Q

What is the significant MOA, advantage & side effect of Arthrotec

A

Arthrotec has misoprostil which works by replacing the prostaglandins not produced b/c of diclofenac. This means less GI irritation; however there is increased diarrhea, cramping and uterin contractions due to the misoprostil

73
Q

In what pt population is indomethacin not to be used

A

Avoid in pts with psychiatric issues due to the increase risk of CNS effects this medication has

74
Q

What is the special SE of Indocin

A

indocin infuced HA

75
Q

What is the indication of Feldene/piroxicam

A

inflammation refractory to other NSAID failure

76
Q

Generic for Feldene

A

Piroxicam

77
Q

What are the DE of ketorolac

A

Major bleeding, perforations, acute renal & liver failure, anaphylaxis

78
Q

In what pt population would Sulindac/Clinoril be used

A

pts with reduced renal failure that require NSAID use

Pain (2 decks)

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