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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
how soon stop NSAID before surgery?
at least 1 wk
26
risks from chronic PPIs
decr bone density, incr infection
27
which NSAID rec take with food?
all
28
which NSAID cause more nausea?
salicylates: ASA and salsalate
29
what is max dose for Rx ibuprofen?
3.2 g/day [400-800 mg Q6-8H]
30
naproxen dosing for inflam, mild-mod pain
500-1000 mg/day in 2 div doses [all naprox is BID]
31
which NSAID high risk for CNS SE?
indomethacin; avoid in psych
32
which NSAID approved for gout?
indomethacin
33
which NSAID has high risk for GI tox and severe skin rxns [SJS/TEN]?
piroxicam [last line, may need protective agents]
34
what is the max tx duration for using ketorolac in adults? dosage form?
5 days, usu post-op [never pre-op]; start with inj switch to oral
35
COX2 selective NSAIDs
celecoxib [highest], meloxicam, edotolac, nabumetone
36
celecoxib is CI with what allergy?
sulfonamide
37
use of NSAIDs concurrently?
only if cardioprotective ASA. but take ASA first and wait at least 1 hr to take others [might compete for platelet binding]
38
what class agents interacts with NSAIDs to incr risk ulceration?
steroids
39
what class agents interacts with NSAIDs to incr risk bleeding?
anticoagulants, antidepressants, antiplatelet agents
40
how reduce tolerance for opioids at high doses?
rotate agents
41
primary opioid receptor for pain relief?
mu
42
what's the only opioid SE that pt usu doesn't dvp toler to?
constipation
43
What is the antidote for tylenol & when is it to be started
N-acetylcystine; it is to be started immediately & within 8hs of ingestion
44
with ATC opioids, what type of laxative to use?
typ need stim [senna, bisacodyl] or osmotic [MOM]
45
What are the BBW for NSAIDS
GI bleeding (espcially non-selective agents), Cardiovascular events (MI, Stroke esp. COX-2 selective), do not use prioer ot CABG
46
What are the common NSAID side effects
Nausea- take all with food, dyspnea & heart burn- eps. ASA, _ BP, Gi irritation, _ fluid retention
47
Which NSAIDs cause photosensitivity more?
Propionic acid derived: ibuprophen & naproxen
48
What are the contraindications for NSAID use?
avoid in pregnancy, children <16, renal insufficency, use prior to CABG, pregnancy, HF
49
what are the options if a pt has a morphine-group allergy?
fentanyl, meperidine, methadone, tramadol, tapentadol
50
what cross-reacts with fentanyl
meperidine
51
what cross-reacts with morphine
oxymorphone, codeine, hydrocodone, hydromorphone, oxycodone, AND nalbuphine, buprenorphine, butorphanol, levorphanol
52
what is the frequency of fentanyl patches application
Q3 days, sometimes q48h if pain reliefe is not long enough
53
what agent is used for opioid overdose
naloxone
54
signs of acute opioid over dose
sedation respiratory depression pinpoint pupils (miosis) cold/clammy skin
55
Suboxone
buprenorphine + naloxone
56
butrans
buprenorphine patch
57
butrans patch is for what severity of pain
pt with mod-severe pain who needs ATC opioid
58
buprenorphine is a C_
3
59
buprenex
buprenorphine injection
60
Buprenorphine side effects
QT prolongation
61
what opioids cause QT prolongation
Methadone, Buprenorphine
62
what agent is an opioid antagonist
naloxone
63
What is the OTC dosing of ibuprofen?
200-400mg q4-6hs with max of 1.2g/d used for _10days
64
What is the OTC dosing of Naproxen?
500mg, then 250 or 220(Na) q6-8h with max of 1.25mg of Naproxen base
65
What is the typical dosing of celebrex?
OA: 100mg BID or 200mg qd RA: 100-200mg BID
66
What are the anti-inflammatory doses of Ibuprofen & naproxen
Ibuprofen: 400-800mg q6-8hr with max 3.2g/d Naproxen: 500-1,00mg/day in 2 doses
67
What is the combination in Treximet
Naproxen + sumatriptan
68
What is Vimovo
Naproxen + esomeprazole
69
of all the non-selecive NSAIDs which has the least cardio toxicity
Naproxen
70
Brand name diclofenac
Cataflam & Voltaren
71
Generic for Arthrotec
Diclofenac + misoprostil
72
What is the significant MOA, advantage & side effect of Arthrotec
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
In what pt population is indomethacin not to be used
Avoid in pts with psychiatric issues due to the increase risk of CNS effects this medication has
74
What is the special SE of Indocin
indocin infuced HA
75
What is the indication of Feldene/piroxicam
inflammation refractory to other NSAID failure
76
Generic for Feldene
Piroxicam
77
What are the DE of ketorolac
Major bleeding, perforations, acute renal & liver failure, anaphylaxis
78
In what pt population would Sulindac/Clinoril be used
pts with reduced renal failure that require NSAID use

Pain (2 decks)

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