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Block 3: MSK > Pharm > Flashcards

Pharm Flashcards

1
Q

Examples of Analgesics/ Antispasmodic

A
  • Opioids/Non-opioids
  • Muscle relaxants
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2
Q

Examples of Anti-inflammatory/
Immunosuppressant

A
  • NSAIDs
  • Corticosteroids
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3
Q

Examples of Dz Tx

A
  • bisphosphonates
  • gout
  • DMARDs
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4
Q

Pharmacologic therapy involves treating

A
  • symptoms to maintain function and
  • slowing underlying inflammation & tissue damage.
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5
Q

What is used for relief of symptoms?

A
  • Analgesics
  • Antispasmodic & Anti-spasticity agents
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6
Q

Antispasmodics are agents that specifically treat…

A

muscle spasms.

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7
Q

Drugs used for inflammation

A
  • Anti-inflammatory drugs
  • Gout specific drugs
  • DMARDs
    –> They decr inflammation & slow the bone damage assoc. w/ RA.
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8
Q

What is acute pain?

A

resolves w/n the expected period of healing & is self-limited.

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9
Q

What is chronic pain?

A

persists beyond the expected period of healing & is itself a disease state.

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10
Q

Chronic pain is defined as… (time)

A

pain extending beyond 3-6 months

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11
Q

What is nociceptive pain?

A

the normal response to any type of stimulus that results in tissue damage

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12
Q

What is visceral pain?

A

nociceptive pain that arises from the body’s organs (may be cramping, throbbing, vague)

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13
Q

What is somatic pain?

A

nociceptive pain that results from issues w/n the body’s bone, joints, muscles, skin, or CT (may be localized & stabbing, aching, throbbing)

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14
Q

What is neuropathic pain?

A

results from damage to or abnormal processing of the periph or central nervous system (CNS) (may be sharp, stabbing, burning, tingling, numb)

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15
Q

What is referred pain?

A

spreads beyond the initial injury site

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16
Q

When do we de-escalate pain management?

A
  • decreasing pain
  • postoperative pain
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17
Q

Which pain is mostly likely to cause chronic pain?

A

Neuropathic pain

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18
Q

What is used to treat moderate pain?

A
  • non-opioid analgesics
    +
  • opioids
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19
Q

What is a common sign of pain?

A

tachycardia

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20
Q

When do we escalate pain management?

A
  • increasing pain
  • cancer pain
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21
Q

What is used to treat mild pain?

A
  • Non-opioid analgesics (acetaminophen, NSAIDs)
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22
Q

What is used to treat severe pain?

A
  • non-opioid analgesics
    +
    opioids
    +
    adjuncts*
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23
Q

Are opioids first line or routine therapy for chronic pain?

A

NO

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24
Q

Don’t prescribe opioids & benzos for pain

A

okay

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25
Q

List goals of tx should contain pain relief & functional components

A
  • sleeping through most nights
  • returning to work
  • walking a set distance
  • participating more fully in family activities.
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26
Q

The pain experience involves…

A

emotions, attitudes, presence of psychiatric & anxiety conditions, hx of response to pain, living conditions etc

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27
Q

Chronic pain affects…

A
  • relationships
  • work
  • sleep
  • function
  • overall health
  • quality of life.
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28
Q

The opioid guideline does apply to pts w/ pain in these conditions…

A
  • Pain management related to SCD
  • Cancer-related pain tx
  • Palliative care
  • End-of-life care
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29
Q

Avoid concurrent benzodiazepine and opioid prescribing

A

Okay

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30
Q

Acetaminophen, paracetamol is an analgesic & antipyretic agent equivalent to…

A

aspirin

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31
Q

Acetaminophen possesses no significant ___ but is one of the most important drugs used in the tx of ___ when an ___ is not necessary.

A
  • anti-inflammatory effects
  • mild to moderate pain
  • anti-inflammatory effect
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32
Q

Acetaminophen dosage for acute pain & fever

A
  • 325–500 mg 4x daily
  • don’t exceed 4g/day
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33
Q

How long does it take for acetaminophen to reach peak concentrations?

A

30-60 min

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34
Q

Acetaminophen half-life

A

2-3 hrs
- relatively unaffected by renal function

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35
Q

Which pts should you have caution w/ when prescribing acetaminophen?

A

pts w/ liver dz

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36
Q

This placement of drugs into a schedule is based upon the substance’s…

A
  • medical use
  • potential for abuse
  • safety or dependence liability.
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37
Q

Sch 1 - Drugs, substances, or chemicals w/ no accepted medical use & a high potential for abuse.

A
  • heroin
  • LSD
  • marijuana (cannabis)
  • ecstasy
  • methaqualone
  • peyote
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38
Q

Describe Schedule II Drugs

A
  • Highly addictive
  • dangerous potential for abuse but can tx pain/addiction.
    (cocaine, meth, oxycodone, hydromorphone, fentanyl, Ritalin)
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39
Q

Describe Schedule III Drugs

A
  • mod-low potential for physical & psychological dependence.
  • some abuse potential

(steroids, < 90 mg of codeine per dosage unit (Tylenol w/ codeine)
ketamine, anabolic steroids, testosterone)

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40
Q

Describe Schedule IV Drugs

A

drugs w/ a low potential for abuse & low risk of dependence.
(Xanax, Valium, Ativan, Tramadol)

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41
Q

Describe Schedule V Drugs

A

drugs w/ lower potential for abuse than Sch IV & contain limited quantities of certain narcotics. Generally used for antidiarrheal, antitussive & analgesic purposes.
(Robitussin AC, Lomotil, Motofen, Lyrica, Parepectolin)

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42
Q

Is DEA registration Required?

A
  • Not req except for controlled substances.
  • Specific to the location you practice.
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43
Q

Is Licensure: State & Federal req?

A

State & Federal licensure req to prescribe controlled substances.

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44
Q

SC requirement for controlled substances

A

Obtain an annual registration from DHEC

45
Q

What is considered the prototypical opioid agonist?

A

morphine

46
Q

What is the major analgesic opioid receptor?

A

mu opioid receptor

47
Q

Mu opioid receptors have a high affinity for which endogenous opioid?

A

Endorphins

48
Q

Delta opioid receptors have a high affinity for which endogenous opioid?

A

Enkephalins

49
Q

Kappa opioid receptors have a high affinity for which endogenous opioid?

A

Dynorphins

50
Q

Define Tolerance

A

gradual loss of effectiveness w/ freq repeated therapeutic doses

51
Q

Define physical dependence.

A

a characteristic withdrawal or abstinence syndrome when drug is stopped, or an antagonist is administered.

52
Q

Clinical uses for opioids

A
  • Acute pain—ex. Trauma, kidney stone, postop
  • Chronic pain – multiple consider
    tolerance, dependence & diversion or misuse.
  • Acute Pulm Edema (LV HF)–
    reduced anxiety & reduced cardiac preload & afterload
  • Cough, Diarrhea, Shivering
  • Adjunct to anesthesia–sedative, anxiolytic & analgesic properties.
53
Q

Describe Sedative-hypnotics interactions w/ opioids

A

Incr CNS depression, particularly resp depression.

54
Q

Describe Antipsychotic agents
interactions w/ opioids

A
  • Incr sedation.
  • Variable effects on resp depression.
  • Accentuation of CV effects (antimuscarinic & α-blocking actions).
55
Q

Describe Monoamine oxidase inhibitors interactions w/ opioids

A
  • Relative contraindication to all opioid analgesics b/c of the high incidence of hyperpyrexic coma;
  • HTN has also been reported.
56
Q

Opioids: Modes of Administration

A
  • usual
  • PCA
  • Epidural
  • Transdermal patch
57
Q

BBW for Opioids

A
  • Medication Error Risk
  • Addiction, Abuse, and Misuse
  • Opioid Analgesic REMS
  • Respiratory Depression
  • Accidental Ingestion
  • Ultra-Rapid Metabolism of Codeine and Other Resp Depression Risk in Children
  • Neonatal Opioid Withdrawal Syndrome
  • CYP450 Interactions
  • Liver toxicity
  • Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
58
Q

The metabolite of codeine, codeine-N-oxide, is classified as

A

Schedule I

59
Q

In general, codeine is classified as

A

Schedule II (>90mg of codeine)

60
Q

Products containing <90 mg of codeine are generally classified as

A

Schedule III

61
Q

Some products w/ very low conc of codeine, such as Robitussin-AC & are classified as

A

Schedule V

62
Q

Describe Tylenol #4

A

300 mg acetaminophen & 60 mg codeine

63
Q

What 3 meds are strong agonists useful in treating severe pain.

A
  • Morphine
  • hydromorphone
  • oxymorphone
64
Q

How is morphine measured?

A

Morphine milligram equivalents
–> all other drugs are based off morphine

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95
Q

Facts about gold salts

A
  • once extensively used
  • are no longer recommended b/c of significant toxicities & questionable efficacy.
96
Q

How can JAK inhibitors be used?

A

as monotherapy or in combo w/ methotrexate

97
Q

What should pts do before started a JAK inhibitor?

A

screened & tx for latent TB prior to starting drugs

98
Q

Conventional synthetic DMARDs include

A
  • Hydroxychloroquine
  • Sulfasalazine
  • Methotrexate
  • Leflunomide
99
Q

Biologic DMARDs include

A

TNF inhibitors

100
Q

Targeted synthetic DMARDs include

A

Janus Kinase (JAK) Inhibitors

101
Q

Examples of TNF-blockers (inhibitors)

A
  • etanercept
  • infliximab
  • adalimumab
  • golimumab
  • certolizumab pegol.
102
Q

Infliximab &adalimumab are antibodies of the____ subclass that bind to membrane-bound TNF to ___.

A
  • IgG1
  • suppress cytokine release
103
Q

Abatacept

A

a recombinant protein, blocks T-cell co-stimulation

104
Q

Rituximab

A

a humanized mouse monoclonal antibody that depletes B cells,

105
Q

Tocilizumab

A

a monoclonal antibody that blocks the receptor for IL-6

106
Q

Most patients who require DMARD therapy are given what as monotherapy initially?

A

methotrexate

107
Q

NOTE

A

The most commonly used combo is methotrexate w/ one of the TNF inhibitors, which is more effective than methotrexate alone.

108
Q

NOTE

A

As a general rule, DMARDs have greater efficacy when administered in combination than when used individually.

Block 3: MSK (10 decks)

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