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Quarter 4 finals > Pharm- Antihistamines and Pain > Flashcards

Pharm- Antihistamines and Pain Flashcards

1
Q

1st generation ORAL Antihistamines

A

Benadryl (diphenhydramine)

Dramamine (dimehydrinate)

Phenergan (Promethazine)

Antivert (Meclizine)

Hydroxyzine (Atarax, Vistaril)

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2
Q

1st generation that is VERY sedating, good to use if pt’s sx are keeping them up at night (like so itchy)

A

Hydroxyzine

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3
Q

2nd generation ORAL Anthistamine (less SE overall, not as sedating)

A

Claritin (Loratadine)

Zyrtec (Cetirizine)

Allegra (Fexofenadine)

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4
Q

out of the 2nd generation, which one is the most sedating?

A

Zyrtec (Cetirizine)

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5
Q

Nasal and Ocular Antihistamines

A

Azelastine

Azelastine + Fluticasone

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6
Q

Antihistamine SE

A

just like Anticholinergic

Red as beet
Dry as bone
Blind as bat
Mad as hatter
Hot as hare
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7
Q

1st line for Allergic Rhinitis:

Inhaled Nasal Steroid

A

Flonase (Fluticasone) nasal spray

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8
Q

Approved Antihistamines for jobs where worker CANNOT be sleepy

A

Claritin (Loratadine)

Allegra (Fexofenadine)

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9
Q

If pilot takes a non-approved Anti-histamine, how long until they can fly?

A

5 times the drugs 1/2 life

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10
Q

Flomax (Tamsulosin) is

A

a-blocker

Used to tx BPH

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11
Q

What meds should NOT be used along with Flomax (Tamsulosin), an a-blocker

A

Sudafed
Benadryl (Diphenhydramine)

Bc ALL OF THESE can cause Urinary Retention

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12
Q

What are the classes you should avoid due to BPH

A

Decongestants
1st Gen Antihistamines

reason: can trigger urinary retention

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13
Q

What about a person with GLAUCOMA that has seasonal allergies?

A

Decongestant
Antihistamine
Steroids

ALL can increase IOP, so
Speak with pt’s eye doctor

Can follow IOP closely, consider immunotherapy

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14
Q

Scabies treatment

A

Permethrin cream

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15
Q

If someone has itchy sx, what can help them sleep?

A

Hydroxyzine (atarax)

Benadryl (diphenhydramine)

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16
Q

Chronic urticaria, sometimes linked to Auto-Immune condition

A

Tx with Non-sedating Antihistamine (2nd gen)

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17
Q

Poison Ivy tx

A

Steroid cream

Non-sedating Antihistamine (2nd gen)

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18
Q

Steroid cream for poison ivy

A

Triamcinolone (Kenalog) cream

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19
Q

What is Augmentin?

A

Amoxicillin/Clavulanic acid

has Penicillin in it, cannot give Augmentin to someone with PCN allergy

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20
Q

If person has hives,

Has tried Steroid and Anti-histamine and STILL NOT IMPROVING

A

can add H-2 blocker as adjunct

not 1st line

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21
Q

3 meds to immediately get on hand to treat Anaphylaxis

A

Benadryl
Epi
Steroid

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22
Q

Definition of Anaphylaxis

A

Affects >1 body part at same time

Skin/mucosa: 90%
Respiratory: 70%
GI: 45%
Cardiac: 45%

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23
Q

An example of what to give someone experiencing Anaphylaxis

A

Benadryl
EPI
Steroid: Dexamethasone aka “Decadron”
H-2 blocker as adjunct: Famotidine (pepcid)

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24
Q

Consider these ppl HIGH RISK when Rxing ANTIHISTAMINES and be very careful

A

BPH
Glaucoma
Very young/very old
High risk jobs

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25
Q

Short acting Opioids

A 
Ultram (tramadol)
Nucynta
Norco
Percocet
Opana
Diluadid
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26
Q

Short acting Opioids used in CA pain only

A

Actiq, Subsys, Abstral
AKA FENTANYL

much shorter half life

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27
Q

Norco is

A

Hydrocodone + Tylenol

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28
Q

Percocet is

A

Oxycodone + Tylenol

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29
Q

Long acting opioids will have “ER at the end; extended release” in Generic name,

Or Brand name is:

A

Oxycontin

Dilaudid

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30
Q

Methadone

A

Not as common

Very potent, cheap
Good for: Neuropathic pain

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31
Q

Generic name examples of Long acting pain med

A 
Oxycodone ER
Oxymorphone ER
Morphine Sulfate ER
Hydromorphone ER
Fentanyl patch
32
Q

Pseudo- addiction

A

Undertreated pain resulting in red flag behaviors

but pt is really in pain

33
Q

Nociceptive pain

“typical pain”

A

Injury to tissues
peripheral pain receptors

Laceration
Fracture
Post op surgery
Tumor/CA
Internal organ injury
34
Q

Options to tx Nociceptive pain

A 
NSAIDs
Tylenol
Steroids
Opioids
PCA-pt controlled analgesics
Physical Therapy
TENs unit
Muscle relaxant
35
Q

Neuropathic pain

A

Dysfx of Nerves, Spinal cord, or Brain

36
Q

Examples of Etiology of Neuropathic pain

A 
Post herpes
Radiculopathy
Trigeminal neuralgia
Diabetic neuropathy
Phantom lib
CVA, Traumatic spinal cord injury
37
Q

Meds that help with Neuropathic pain

A 
Neurontin (gabapentin)
Lyrica (pregabalin)
TCA
Duloxetine (cymbalta)
Tramadol
Nucynta
Lidoderm patch

ESI (epidural steroid injeciton)

38
Q

Firefighter with back pain

A 
NSAIDs
Muscle relax
Trigger point injection in office
Medrol dose pack
Ice/heat
Consider short course of Opioids

F/u in 1-2 weeks

39
Q

If no improvement of back pain

A

Consider PT, imaging, repeat Trigger point injection if it helped

TENs unit

40
Q

Older gardener lady with RA, on Percocet 10/325 every 6 hours but the 1/2 life of this is only 3-4 hours… she is a compliant pt… what can we do?

A

Consider switching to Long Acting Opioid:

Oxycontin ER q12 hrs

41
Q

If switching from Short to Long acting Opioid, what do we need to consider?

A

Reduce daily dose by 50-75% when converting

Consider low dose opioid for breakthrough pain while converting

Breakthrough med no more than 25% of daily acting long dose

42
Q

What can we add topical for joint pain?

A

Topical compound cream, i.e.:

Lidocaine
Ibuprofen
Diclofenac

43
Q

Meds for Diabetic Neuropathy and

Fibromyalgia

A

Gabapentin (neurontin)
Pregabalin (lyrica)
Cymbalta (duloxetine)

44
Q

Pt Controlled Analgesia a good option for

A

intractable CA pain

45
Q

Considerations when using PCA (patient controlled analgesia)

A

Order continuous Pulse ox
Narcan orders
Monitor Mental status, Respiratory status

Doc/PA see pt again within 12 hours

Once dose stable, see every 12-24 hrs

46
Q

PO to IV morphine conversion is typically 3:1

soo if pt is on IV and wants to go to Oral

A

have to multiple dose x 3

20mg IV qd x3 = 60 mg Morphine qd

47
Q

Fentanyl patch

A

NOT GREAT for acute pain

Better for long term, takes 12 hours to reach therap levels

48
Q

Fentanyl additional considerations

A

less effective in super skinny pts (cachectic)

exposure to heat increases potency- increased absorption- can be fatal!

49
Q

Methadone

Cheap, potent, good for NEUROPATHIC pain

A

CAUTION:

QT prolongation (tDP risk)
many drug interactions
50
Q

Tramadol/Nucynta

good for NEUROPATHIC pain

A

CAUTION:

pts on Antidepressants–> Seretonin syndrome

51
Q

Drug of choice in ESRD (end stage Renal dz)

person has bad Kidney

A

Fentanyl

Methadone

52
Q

If pt has Hepatic dz (bad liver)

A

Avoid Opioids

53
Q

Increased Intracranial pressure

A

NO opioids

54
Q

Considerations for Rx of Opioids

A

Write out in LONG hand the # of pills

55
Q

Wong-Baker FACES pain rating scale

A

3YO and older

look at faces and match pain scale

56
Q

Behavioral observation Pain scale

A

Scores:

  • facial expression
  • able to be consoled
  • level of interaction
  • limb/trunk motor responses
  • verbal responses
57
Q

FLACC pain score

A 
Face
Legs
Activity
Cry
Consolability
58
Q

Opioid analgesics commonly used in kids

A 
Morphine
Hydromorphone
Oxycodone
Hydrocodone
Fentanyl
Methadone
59
Q

When to refer

A

Current interventions not working
Chronic pain
PCA-pt controlled analgesia
Life-limiting condition

60
Q

If parent gave something at home that was working, and pt hasn’t had the most recent dose

A

give that SAME med in office

if it was working, use it again

61
Q

Testicular torsion

A

No cremasteric reflex-testicle does not rise when thigh is stroked

62
Q

Steps to tx testicular torsion

A

Manual detorsion
Surgical detorsion
Pain med
Nausea med

63
Q

Appendicitis

A

Opioids are indicated as pre-op

need to be IV bc this pt is now NPO

64
Q

12 YO w burn to hand, abdomen, and left leg

15% total

A

need to refer her bc >10% AND involving her HAND

following ABA referral criteria

65
Q

What do we want to avoid in peds opioids

A

NO Codeine or Tramadol in 12 or younger

66
Q

<12 yo

A

NO Codeine or Tramadol

67
Q

Ginkgo biloba should not be used with ____ in elderly

A

Warfarin

*inc risk of bleeding

68
Q

St. John’s Wort should not be used with _____

A

SSRI

*inc risk of Serotonin Syndrome

69
Q

Age related changes to consider with aging

A

Inc body fat relative to muscle
Natural decline in Kidney fx
Declining Liver fx

(rapid weight loss can lead to increased absorption of med)

70
Q

BEERS criteria

A

Avoid using Opioids with BENZOS or GABApentinoinds

71
Q

Opioids with Benzos can lead to

A

severe ADE- adverse drug events like Respiratory depression, death

72
Q

Avoid use of SNRI

A

pt with hx of Falls or Fractures

73
Q

STOPP criteria (Screening Tool of Older Person’s Prescriptions)

A

Consider drug intxns

Duplications of drugs within a class

74
Q

Older pt with joint pain, already on Diazepam

“pam” is a Benzo!!

A

DON’T want to add Opioid

bc Opioid + Benzo is a no-no

75
Q

Opioid naive 70 YO pt with compression fracture, severe low back pain

A

Can give short acting opioid, 3 day follow up

Quarter 4 finals (11 decks)

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