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2nd Semester Nursing > Pharm - Pain > Flashcards

Pharm - Pain Flashcards

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1
Q

Nociceptive pain is best treated with…

A

…opioids, NSAIDS or acetaminophen

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2
Q

Neuropathic pain is best treated with…

A

Anti-seizure meds or antidepressants

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3
Q

You would treat diabetic neuropathy with…

A

… antidepressants or antiepileptic

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4
Q

Treatment options for acute musculoskeletal pain (5)

A 
OTC NSAIDS
Rx NSAIDS
Skeletal muscle relaxants
Opioid analgesics
Topical analgesics
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5
Q

Acetaminophen: indications, warnings, max dose

A

First-line for musculoskeletal pain (mild)

Acute pain, joint pain (osteoarthritis), headaches, fever

Careful with hepatic impairment and alcohol abuse. Max 4g/day.
BBW: don’t take if you have 3+ alcoholic drinks per day

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6
Q

OTC NSAIDs: MOA, SEs, indications

A

Cox-blockers (cyclooxygenase) for mild to moderately severe pain.

Include aspirin, ibuprofen and naproxen.

SEs:
kidney/RENAL toxicity: inhibits prostaglandin synthesis
stomach: gastric ulcers
Bleeding: platelet inhibition
SEs are b/c they non-selectively block cox1 in addition to cox2

ASA also has metabolic acidosis (salicylate toxicity) as a worry. Shares this with pepto bismol. (Life-threatening)

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7
Q

Rx NSAIDs: which are most similar to the OTC ones?

A
  • Nabumetone
  • Indomethacin
  • Sulindac
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8
Q

Rx NSAIDS: which are the most potent?

A
  • Ketorolac (injection - in ED)

- Meloxicam (oral)

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9
Q

Cox-2 selective Rx NSAID

A

Celecoxib

Still causes kidney issues, not any more effective. Rarely used

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10
Q

Why do we avoid using NSAIDs long-term?

What disease state might require it anyway?

A

Heart failure and renal failure can occur

Rheumatoid arthritis or other inflammatory problems might need l/t NSAID therapy.

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11
Q

Topical NSAID: what and why?

What should you tell your patient?

A

Diclofenac gel

Good for joint pain (OA, RA)
No systemic side effects

Wash hands and don’t get it in your eyes

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12
Q

When would you use muscle relaxants for pain?

What should patients look out for?

A

When there’s a major neurologic injury or long-term treatment is needed. Will relieve muscle spasms.
(TBI, spinal cord injury, MS, severe back injury)

Likely to be sedating, especially at first.

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13
Q

Baclofen:
Class
MOA
Route

A

Muscle relaxant
Oral, IV, intrathecal pump
Good for l/t spastic conditions

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14
Q

When would you use BZDs for pain?

A

Treatment-resistant muscle spasticity

Relieves muscle spasms

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15
Q

Cyclobenzaprine- what do we know?

A

Muscle relaxant

For very short term use only: it’s super sedating

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16
Q

Tizanidine - what do we know?

A

Works as a muscle relaxant
Alpha-2 adrenergic agonist
Watch for low BP

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17
Q

Methocarbamol - what do we know?

A

Used for muscle spasms

Very sedating - it’s a general CNS depressant

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18
Q

Opioids:
MOA, effects
What does SUV CARR stand for?

A

Mu agonist
Decrease ability to sense pain
Cause general CNS depression

Sedation
U: euphoria
V: vasodilation
C: Constipation
A: analgesia
R: respiratory depression
R: reduced cough
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19
Q

Opioids: Which are the full/pure agonists and what should we know about them?

A 
MOFOM
Morphine
Oxycodone
Fentanyl
Oxymorphone
Methadone

Bind to opioid receptors with no antagonist activity, so there’s no ceiling effect (both on the high and on the pain relief)

20
Q

What do we know about opioid agonist-antagonists?

A

Butorphanol, nalbuphine, pentazocine

There’s a ceiling effect for analgesia and they can reverse the effects of the pure agonists

21
Q

What partial agonist do we know about and what class/kind of opioid is it similar to?

A

Buprenorphine

Similar to agonist-antagonists: there’s a ceiling effect for analgesia and it can reverse the effects of pure agonists.

22
Q

What do we know about opioid antagonists?

A

Naloxone!

Used to treat opioid OD/addiction.

23
Q

Codeine is usually used for…

A

… cough suppression

24
Q

Fentanyl is dangerous because…

A

… it’s 100x more potent than morphine

25
Q

Meperidine is unusual because…

A

… it can produce tremors, delirium and seizures

26
Q

Tramadol: MOA? Warnings?

A

Mu agonist AND inhibits serotonin and NE reuptake

Increases seizure risk

(Synthetic)

27
Q

What’s Methadone’s MOA? Half-life?

A

Mu agonist
NMDA-receptor antagonist
SNRI

30 hour half-life (long-acting)

28
Q

SEs of all opioids?

A 
CONSTIPATION
Slowed breathing rate
Nausea/vomiting (usually will resolve)
Sedation (usually resolves)
Confusion (usually resolves)
29
Q

Can you cut or crush long-acting opioids if needed?

A

No - no cutting, crushing or chewing

30
Q

Guidelines for Nursing administration of opioids

A
  • Assess respiratory status before administering
  • Schedule II
  • Don’t allow pts to walk without assistance until response is known (they’re vasodilators)
  • Measure I/Os for urinary retention or constipation

Watch for toxicity: pinpoint pupils, resp depression, coma

31
Q

What’s the technical term for pinpoint pupils?

A

Mitosis

32
Q

What s/s of opioid dependence appear after about 10 hours of last dose?

A

Yawning, runny noise, sweating

33
Q

What s/s of opioid dependence occur as withdrawal continues?

How long will they last if untreated? Is it lethal?

A

Sneezing violently
NVD, cramping
Muscle spasms, kicking, bone/muscle pain
Weakness

Lasts 7-10 days if not treated. Not Lethal.

34
Q

Remember to treat the condition, not just the pain. Recommendations for pain due to:

  • infection?
  • sprained ankle?
  • chronic condition?
A

Infection: antibiotics
Sprained ankle: RICE therapy
Chronic condition: physical therapy

35
Q

If a nerve is damaged at the dorsal root ganglion, is that peripheral nerve pain or central nerve pain?

A

Peripheral - central is only CNS and spinal cord

36
Q

What does neuropathic pain feel like?

A

Tingling, burning, numbness, pins/needles

Might be at a specific location

Can progress to the loss of all sensation and even impaired circulation.

37
Q

Which is more resistant to drug treatment: pain due to diabetic peripheral neuropathy and post-herpetic neuralgia? Or pain due to spinal cord injuries and HIV?

A

Spinal cord injury & HIV pain are most resistant to drug treatment.

38
Q

What are the 1st line agents for neuropathic pain?

A 
Antidepressants (TCAs and SNRIs) 
Antiepileptic agents (Gabapentin and pregabalin)
39
Q

What are the most common TCAs used for neuropathic pain (3)?
How long before you see the benefit?
What NTs do they affect?
What are the common SEs/warnings?

A

“AND”
Amitryptaline
Nortriptyline
Desipramine

6-8 weeks to see the benefit
Serotonin/norepinephrine

Often see anticholinergic SEs
Use caution with heart disease, glaucoma, suicide risk

40
Q

Which SNRIs are most commonly used in neuropathic pain?
What to watch out for?
How long until effect?
Scheduled?

A

Duloxetine (cymbalta), Venlafaxine (Effexor)

Watch for increased BP
Can take 4-6 weeks.

41
Q

Gabapentin and neuropathic pain: why does it work?

SEs to watch out for? Scheduled?

A

Decreases neuronal excitation

Watch for leg swelling (edema) and CNS depression

Not a scheduled drug

42
Q

Pregabalin and neuropathic pain: what else does it work for? Common SEs? Scheduled?

A

Neuropathic pain AND fibromyalgia

Leg swelling & CNS depression, like gabapentin
ALSO, Angioedema and peripheral edema increased risk

Schedule V

43
Q

Lidocaine gel/patches: uses, MOA?

A

Good for post-herpetic neuralgia (not diabetic peripheral neuropathy)

Nerve conduction blockade

Few adverse effects - good used in conjunction with other therapies

44
Q

Capsaicin: topical

What for? MOA? SE?

A

Post-herpetic neuralgia pain (not so much diabetic neuropathy)

Depletes/prevents accumulation of substance P

Can have localized burning

45
Q

Opioids or NSAIDs for neuropathic pain?

A

NSAIDs: really only if pain is d/t inflammation

Opioids: chronic pain is not good for opioid use. Ok for quick relief while working for other agents to work.

46
Q

Fibromyalgia: s/s

A

-Pain regulation disorder: widespread pain involving all 4 limbs and trunk. Pain inhibition is decreased and perceived pain is greater than normal.
Also…
-Fatigue
-Memory dysfunction
-Sleep is non-restorative
-11 out of 18 pain points… consecutive symptoms for more than 3 months.
Pain cannot be explained by any other disorder.

47
Q

What drugs are commonly used to treat Fibromyalgia (3)?

A

TCAs, SNRIs, Pregabalin/Gabapentin

Not opioids or tramadol unless absolutely last-line.

2nd Semester Nursing (18 decks)

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