Pharm2 7 Pain pt1 Flashcards
the complaint of Pain is split into 2 categories:
Acute Pain
Chronic Pain
What kind of pain? Short duration Identifiable pathology Predictable prognosis Treatment of underlying pathology eliminates or mediates pain
And how it is treated?
Acute pain
Tx with analgesics
What kind of pain? Long duration (usu > 3 mos) Pathology may be unclear Potential lack of physical findings Unpredictable prognosis
And how is it treated?
Chronic pain
Treatment often requires multidisciplinary approach (or a multimodal approach – multiple medications to to control he pain)
Ankle fracture is an example of ___ pain. How is it managed?
Acute pain
Reduced, casted, use an analgesic, elevate and ice the area.
What type of pain does not qualify as ‘acute’ or ‘chronic’?
Pain from cancer
6 categories of drug treatments for pain
NSAIDS (ASA, Ibuprofen, etc.)
COX-2
Opioids
Tricyclic antidepressants (amitriptyline)
Centrally-acting agents (that are non-narcotic)
Muscle relaxants
Glucocorticosteroids
Describe the WHO 3-Step Ladder for Pain
A patient rarely explicitly falls into one of these categories, nor do the drugs work consistently in each patient
1: Mild - nonopiod +/- adjuvant
2: Moderate - Opiod for mild to moderate pain +/- nonopiod +/- adjuvant
3: Severe - Opiod for moderate to severe pain +/- nonopiod +/-adjuvant
COX-2 vs COX-1
COX-2 is selective, lower incidence of bleeding.
Why is aspirin not always just given at a higher dose such as 325 (instead of 81)?
Who is it used for?
325 deaggregates more platelets. Causes more bleeding. It’d kill ppl at risk for bleeding. So it’s only used for very serious cases unless they are aspirin insensitive.
3 types of drugs for Acute & Chronic pain
Acetaminophen, NSAIDs, Opioids
4 drugs used for Neuropathic pain, neuralgias. These drugs are ____ drugs, but they also work for neuralgias.
Carbamazepine, phenytoin, tricyclics, gabapentin, others
These are antiepileptic drugs, but work for neuralgias
Top 2 most common types of Neuropathic Pain
diabetic peripheral neuropathy
post-herpetic neuralgia.
Acetaminophen.
What is it used for?
What property does it not have?
What 2 things must you keep in mind about this drug?
Analgesic
Low effect on peripheral COX
Few drug-drug interactions
*Not antiinflammatory - not for inflamm’n, used specifically for the pain.
Analgesic ceiling (if you give a higher dose it won’t do anything)
Liver toxicity (really horrible way to die! Acetylcysteine only helps so much)
__ is why FDA limited the daily dosing for acetaminophen.
What’s the max dose of Acetaminophen per day?
Liver toxicity
Max dose: FDA has lowered it so you can only take 4g in one day ONCE, the subsequent days must be <4g.
What’s a concern about Acetominophen-containing products?
Patients may take products other than Tylenol, not knowing it contains Acetominophen and may become acetominophen toxicitiy. Must warn them that it contains Acetominophen.
Vicodin (Hydrocodone/Acetaminophen) is about to be reclassified from sched _ to a sched _ drug. Why?
From schedule 3 to schedule 2. this reclassifying of schedules will make no difference in NY. But there are 10 states where PA’s cannot prescribe Schedule II drugs in the outpatient setting.
B/c it is most commonly the drug ppl are prescribed that gets them addicted to narcotics”
NY state requirement for prescribing Sched 2 drug:
requires you to log online in outpatient setting before prescribing controlled substance meds istop website: updates prescription in real time for patients.
Just started this year b/c of overdoses, deaths. So if a patient needs a Sched 2 pain med, you check istop before you write the prescription to see if they are addicted and seeing prescribers to get their fix. ISTOP Dramatically stops “doc-shopping”
Aspirin
Effects (3)
Additional benefits (2)
Analgesic, Antiinflammatory, Antipyretic
Inhibits COX
Irreversibly inhibits platelet aggregation
Irreversible inhibitor of COX
Aspirin Side effects (3)
what’s another important note about aspirin for pain?
Nonselective inhibitor of COX (adverse effects)
Drug-drug interactions (with anything else that may increase bleeding)
Reye’s syndrome ( this is why you don’t give Aspirin to kids with fevers)
Aspirin has an Analgesic ceiling
“there is an additional benefit of 22% reduction if you combine with ___”. Aspirin is cheap, but ___ ain’t cheap. Wouldn’t be used if not necessary.
clopidogrel
Aspirin Dosing & Effects
80-160mg: Antiplatelet 325-1000 - Antipyretic, analgesic 325-6000 - Antiinflammatory, tinnitus 6-10g - Resp alkalosis 10-20g - Fever, dehydration, acidosis >20g - Shock, coma
Any aspirin dose over ___ has antiplatelet effects
over __ adds on antipyretic & analgesic effect
over __ adds on inflammatory and tinnits (adverse)
> 75mg
325 mg
1 g
If aspirin follows by bleeding, it’s reversed how?
FFP (platelets)
*when should you stop aspirin?
5 days if applying pressure can get bleeding to stop.
Otherwise 7 days.
cardiologist would never want a patient to stop aspirin if they’re on stent thrombosis.
Also won’t stop it for Orthopedics doing total knee replacement, a bloody surgery. Tourniquet can control bleeding in this patient
