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PAM Semester 2 > Pharmacotherapeutics Exam 1 > Flashcards

Pharmacotherapeutics Exam 1 Flashcards

1
Q

Pharmacology

A

the study of substances that interact with living systems through chemical processes

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2
Q

Toxicology

A

branch of pharmacology that deals with the undesirable effects of chemicals on living systems

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3
Q

Drug vs Medicine

A

Drug:
Substances which act on the body and are used for prevention, diagnosis and treatment

Medicine:
Substances that have definite form and therapeutic use for treatment

all drugs are not medicine
All medicines are drugs

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4
Q

Pharmacogenetics

A

using a persons genetic makeup to help guide drugs and their doses for a particular person

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5
Q

Pharmacodynamics vs Pharmacokinetics

A

Pharmacodynamics (PD)
Drug action and mechanism

Pharmacokinetics (PK)
Absorption, distribution, metabolism, excretion

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6
Q

Pharmacodynamics

A

What the drug does to the body

Drug action and mechanism

the biochemical and physiological effects of drugs on the body

the mechanisms of drug action in the body

the relationship between drug concentration and drug effect.

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7
Q

Pharmacokinetics

A

What the body does to the drug

Absorption, distribution, metabolism, excretion

the rate and extent to which drugs are absorbed into the body and distributed to the body tissues

the rate and pathways by which drugs are eliminated from the body by metabolism and excretion

the relationship between time and plasma drug concentration.

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8
Q

Targets for drug binding

A

Receptors
Ion channels
enzymes
transporters

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9
Q

factors that can affect responses to drugs

A

Drug interactions
Adherence to a drug regimen
Tolerance and resistance
Vomiting

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10
Q

DEA

A

The agency which controls the distribution of drugs that may be easily abused.

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11
Q

FDA

A

The leading enforcement agency at the federal level for regulations concerning drug products.

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12
Q

Controlled Substances Act of 1970

A

(CSA) established by US Congress, identifies 5 groups or schedules of drugs as controlled substances and put strict guidelines on their distribution.

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13
Q

Drug schedules

A

I-V

Schedule I being worst, no acceptable medical uses, high potential for abuse

Schedule V being best , low potential for abuse

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14
Q

Schedule I

A

Schedule I – High potential for abuse and no accepted medical use in the US.

Heroin, some opium derivatives, and hallucinogenic substances, Marijuana?

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15
Q

Schedule II

A

Schedule II – High potential for abuse and may lead to physical or psychological dependence, but also has a currently accepted medical use in the US.

Amphetamines, cocaine, methadone, and various opiates

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16
Q

Schedule III

A

Schedule III – Potential for abuse is less than those in Schedules I and II and there is a currently accepted medical use in the US, but abuse may lead to moderate or low physical dependence or high psychological dependence.

Anabolic steroids , compounds that contain codeine

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17
Q

Schedule IV

A

Schedule IV – Low potential for abuse relative to Schedule III and current accepted medical use in the US, but abuse may lead to limited physical dependence or psychological dependence.

Phenobarbital, sedative chloral hydrate, and some anesthetics

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18
Q

Schedule V

A

Schedule V – Low potential for abuse relative to Schedule IV and current accepted medical use in the US, but abuse may lead to limited physical dependence or psychological dependence.

Limited amounts of codeine included in this group
Exempt narcotics are in this group

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19
Q

Florida prescription monitoring program

A

Eforce

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20
Q

When must you have a written prescrition

A

Schedule II drugs require a written prescription

Schedule III - V may be oral or written (also fax)

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21
Q

How are medications assessed

A

Medications are assessed based on safety, efficacy, and cost-effectiveness

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22
Q

Efficacy

A

Efficacyis the capacity to produce an effect

maximum response that can be achieved by a drug

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23
Q

Effectiveness

A

Effectivenessdiffers from efficacy in that it takes into account how well a drug works in real-world use

maximum response achieves when the drug is taken exactly as prescribed

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24
Q

Drug Formulary

A

Drug formulary is a list of approved drugs that a health plan or a State/Territory, often has agreed to cover, and defines the prescription drug benefit

The purpose of using a drug formulary is to provide high-quality care using the most cost-effective medications. Typically, a drug formulary is developed by experts using clinical evidence.

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25
Q

Guideline vs protocol

A

A guideline is defined as “a statement or other indication of policy or procedure by which to determine a course of action.”

In contrast, a protocol is “a precise and detailed plan for the study of a biomedical problem or for a regimen or therapy.”

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26
Q

Therapeutic index=

A

the ratio that compares the blood concentration at which a drug becomes toxic and the blood concentration at which the drug is effective

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27
Q

Pharmacodynamic-

A

activity of the drug at the site of action is directly or indirectly altered

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28
Q

Antagonism-

A

opposes the drugs action

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29
Q

Addition/summation-

A

opposes the drugs action adds to the drugs action

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30
Q

Synergism/potentiation-

A

enhances the action of the drug

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31
Q

a change in behavior caused by biochemical

A

Addiction: changes in the brain after continuous substance abuse

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32
Q

Dependence:

A

stopping would cause withdrawal (physical/mental symptoms)

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33
Q

Tolerance:

A

a state in which an organism no longer responds to a drug & a higher dose is required to achieve the same effect

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34
Q

Number 1 abused prescription drug

A

Alprazolam (Xanax) Number #1

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35
Q

FDA MedWatch

A

Prescribers are encouraged to voluntarily report any adverse effects by approved drugs.

Monitoring system

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36
Q

Recalls Class 1

A

Class I – strong likelihood that the product will cause serious adverse effects or death

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37
Q

Recalls Class 2

A

Class II – product may cause temporary but reversible adverse effects, little likelihood of serious adverse effect

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38
Q

Recalls Class 3

A

Class III– the product is not likely to cause adverse effects

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39
Q

Recalls

A

Action to remove a drug from the market and are voluntary on the part of manufacturer

3 classes

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40
Q

Drug regulatory authorities often have other important functions including:

A

Pharmacovigilance.

Regulating clinical trials.

Regulating herbal and homeopathic medicines.

Inspecting and maintaining standards of drug development and manufacture

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41
Q

Other offices of FDA

A

Center for Drug Evaluation and Research (CDER)

Center for Biologic Evaluation and Research (CBER)

Center for Devices and Radiological Health (CDRH)

Center for Food Safety and Applied Nutrition (CFSAN)

Center for Veterinary medicine (CVM)

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42
Q

Exclusivity

A

Exclusivity refers to exclusive marketing rights granted by the FDA upon approval and was designed to promote a balance between new drug innovation and generic drug competition.

Patents and exclusivity may or may not run concurrently and may or may not cover the same aspects of the drug product.

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43
Q

Patent / exclusivity Times

A

The terms also vary because a patent runs 20 years from filing (subject to extension) while exclusivity is granted according to the type of drug, usually between 6 months and 7 years.

Must demonstrate equivalence with FDA approval
Over 50% of all meds are generic.

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44
Q

Who can prescribe

A

Under the CSA, only licensed medical practitioners are authorized to prescribe controlled substances listed in Schedules II-V to patients.

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45
Q

Open vs closed formularies

A

“Open” formularies list drugs favored by the organization and serve an educational role. Typically there are no incentives to prescribe from the list.

“Closed” formularies are lists of drugs that are available for coverage by the organization. Coverage for medications not on the list may be available only if the physician believes that the drug is clearly preferable and obtains a waiver.

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46
Q

What can’t A PA prescribe in FLorida

A

In State of Florida:
\
Prescribing physician assistants are able to prescribe any medication except those specifically prohibited by the Formulary Committee of the PA council and the Boards of Medicine.

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47
Q

Primary vs secondary caregiver

A

Primary (gatekeeper)
GP, faily physician, PCP, urgent care, ED

Secondary:
Specialists

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48
Q

Clinical testing phases

A

Phase 1-3 testing

Phase 4 marketing

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49
Q

How are drugs classified

A 
Body system (cardiology)
Therapeutic use (channel blocker)
site  action (cellular site)
molecular structure (steroid, alkaloid(
Legal (schedule 1-5)
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50
Q

Medication reconciliation (MR)

A

The process of comparing a patient’s medication orders to all of the medications that the patient has been taking.

This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.

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51
Q 
Medication reconciliation (MR)
5 Steps
A

(1) develop a list of current medications
(2) develop a list of medications to be prescribed
(3) compare the medications on the two lists
(4) make clinical decisions based on the comparison
(5) communicate the new list to appropriate caregivers and to the patient

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52
Q

High risk medications list

A

A PINCH

Anti infectives
Potassium (electrolytes)
Insulin
Narcotics (sedatives)
Chemotherapeutic drugs
Heparin (anticoagulants)
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53
Q

JCO

Do not use abbreviation list

A 
U (unit)
IU (International Unit)
QD / QOD (every day)
Trailing zero (xxx.0mg)
MS, MSO4, MsSO4 (Morphine/mag sulfate)

Write out words

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54
Q

Osteoarthritis medications

A

NSAIDS

Capsacin
Duloxetine
Intraarticular glucocorticoids

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55
Q

Osteoarthritis, when to use capsacin

A

Topicalcapsaicinis an option when one or a few joints are involved and other interventions are ineffective or contraindicated; however, its use may be limited by common local side effects.

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56
Q

Cox 2 selective NSAIDS Drugs

A

Celebrex

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57
Q

Semi-selective NSAIDS Drugs

A 
Meloxicam
diclofenac
etodolac
indomethacin
prioxicam
nabumetome
sulindac
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58
Q

non-selective NSAIDS Drugs

A

Ibprophen

Naproxen

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59
Q

Irreversible non-selective NSAIDS Drugs

A

Asprin

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60
Q

What drug types should RA patients initially be started on

A

DMARDS

Shown better outcomes than NSAIDS & steroids

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61
Q

What test should you get if you are taking hydroxychloroquine

A

Eye exam

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62
Q

What test should you get if you are taking a biologic agent or Janus kinase (JAK) inhibitor

A

TB test

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63
Q

What tst should all patients get prior to intiating DMARD treatment

A

HEP B, HEP C screening

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64
Q

RA patients with flares

A

Patients with RA flares should be treated as patients with sustained disease activity and should have modifications of their baseline drug therapies

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65
Q

DMARD Types

A 
TNF Inhibitors
Newer TNF inhibitors
B cell Agent
T cell action
IL 6 Inhibitor
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66
Q

Why DMARDS over other drugs

A

NSAIDS offer only symptomatic relief

They have no effect on bone or cartilage

Inflammation is maximal at an early age

If given early DMARDS can stabalize joint function near normal

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67
Q

Osteomyelitis antibiotic Unknown Pathogen:

A

Vanc

Ceph (3rd or 4th gen)

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68
Q

Osteomyelitis antibiotic for Staph (non MRSA)

A 
Nafcillin
Oxacillin
Cefazolin
Flucloxacillin
Ceftriaxone
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69
Q

MRSA Drug

Osteomyelitis

A

Vanc

Alt - daptomycin

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70
Q

Gram negative pathogen drug

Osteomyelitis

A 
cipro
levaquin
Ceph
Ertapenem
Meropenem
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71
Q

Enterococci drug

Osteomyelitis

A

Ampicillin
Aqueous Cyrstalline Penecillin G
Vanc

Combo: ampicillin plus Ceftriaxone

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72
Q

Streptococci Drug

Osteomyelitis

A

Ampicillin
Aqueous Cyrstalline Penecillin G
Ceftriaxone
Vanc

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73
Q

Cutibacterium Drug

Osteomyelitis

A

Aqueous Cyrstalline Penecillin G

Ceftriaxone

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74
Q

Septic arthritis pathogen

A

Septic arthritis is usually monomicrobial.

Staphylococcus aureus(including methicillin-resistantS. aureus) is the most common cause of septic arthritis in adults

75
Q

Acute Bacterial arthritis managment

A

Management of acute bacterial arthritis consists of joint drainage and antibiotic therapy.

76
Q

Septic arthritis Drugs

A

Clindamycin (600mg TID)

Sulfa (2 DS tabs BID) or (4mg/kg per dose)

Doxy (100mg BID)

77
Q

Three main therapeutic options for management of osteonecrosis

A

supportive care,

joint-preserving procedures (eg, core decompression and its variants, bone grafting),

total hip arthroplasty when advanced collapse has occurred.

78
Q

Fibromyalgia treatment

A

Aimed at reducing the major symptoms
including chronic widespread pain, fatigue, insomnia, and cognitive dysfunction

May respond to non pharmacological measures

Psych factors, Cognitive behavior therapy

If meds are needed
amitriptyline, duloxetine, milnacipran, pregabalin

cyclobenzaprineis an alternative to amitriptyline

79
Q

Fibromyalgia patients with severe sleep issues

A

pregabalintaken at bedtime

Gabapentinis an acceptable alternative for patients for whom cost or regulatory constraints limit the availability of pregabalin

80
Q

Fibromyalgia Meds

A

amitriptyline, duloxetine, milnacipran, pregabalin

amitriptyline for sleep

cyclobenzaprineis an alternative to amitriptyline

81
Q

Muscle relaxants approved for spaticity

A

baclofen
dantrolene
tizanidine

82
Q

Muscle relaxants approved for muscle spasms

A 
carisoprodol
chlorzoxazone
cyclobenzaprine
metaxalone
methocarbamol
orphenadrine
83
Q

Differneces between Antispasmodic and antispastic agents

A

anti-spasmodics
Block nerves from signaling brain
Injury, trauma

Anti-spastics
Act on skeletal muscle, blocks nerves at spinal cord
MS, Stroke, CP, infection, spinal injury

84
Q

Treatment for gout flares

A

Oral steroids, NSAIDS, or colchicine

Treatment depends on factors such as age, comorbidities, other medications etc.

Aspirinis not used for the treatment of gout flares because of the paradoxical effects of salicylates

85
Q

NSAIDS for gout

A

Naproxen 500mg BID
or
indomethacin 50mg TID

86
Q

In gout patients who are unable to take oral medications and/or who have only one or two actively inflamed joints

(and in whom infection has been excluded)

A

suggest arthrocentesis and intraarticular injection of glucocorticoids. We prefertriamcinoloneacetonide

87
Q

Gout patients on anti coags

A

low dose colchicine

88
Q

Long term chronic gout treatment

A

improvement in patient physical function and health-related quality of life

Allopurinal

89
Q

When should uricosuric agents be avoided (chronic gout)

A

Uricosuric agents should be avoided in patients with urolithiasis and risk of uric acid nephropathy.

90
Q

Gout prophylaxis

A

colchicine

91
Q

Pseudogout Joint injection

A

Injections into large joints, including the knees and shoulders, usetriamcinoloneacetonide mixed with 1 or 2 mL of 1%lidocaine.

92
Q

Acute pseudogout not treated with injection

A 
NSAID (naproxen 500BID)
or
Colchicine (1.2mg / 06.mg)
or
Oral prednisone (30-50 mg tapered)
93
Q

JRA

A

NSAID for nondisabling symptoms

no Aspirin (Reyes Syndrome)

94
Q

JIA

A

No cure for JIA

NSAIDS, Steroids (oral/injection), DMARDS, biologic agents

all help with…..

Decrease inflammation, pain, swelling
Make it easier for children to stay active
prevent damage to joints
increase quality of life

95
Q

First step for osteopenia/osteoporosis

A

Lifestyle modification
smokin, vitamin D, calcium, exercise, fall prevention,alcohol

1200mg calcium 800mg Vitamin D

96
Q

osteopenia/osteoporosis first line meds

A

Bisphosphonates (oral)

97
Q

osteopenia/osteoporosis anabolic agent

A

teriparatide

98
Q

IV bisphosphonate for osteopenia/osteoporosis

A

Zoledronic acidis the only IV bisphosphonate that has demonstrated efficacy for fracture prevention

99
Q

Polyarteritis nososa MIld disease meds

A

Inital dose of prednisone

100
Q

Polyarteritis nososa Mod/severe disease meds

A

glucocorticoids andcyclophosphamidecombined

101
Q

Polymyalgia rheumatica (PMR)

A

In all patients with PMR
initial treatment withprednisone.

The symptomatic response to glucocorticoid treatment is typically rapid

102
Q

Polymiositis

A

for inflammatory myopathy associated with significant muscle weakness

We typically beginprednisone

We suggest initiating a glucocorticoid-sparing agent at the same time glucocorticoids are begun. The first-line glucocorticoid-sparing agents areazathioprineandmethotrexate

103
Q

Reactive arthritis (reiter syndrome)

A

Rare disease even in rheumatology

arthritis coexisting with infection

Pathogens are Chlamydia and trachomatis

104
Q

Reactive arthritis (reiter syndrome) treatment

A

NSAIDS (not DMARDS)
(naproxen 500mg bid)
(diclofenac50 mg TID)
(indomethacin 50mg TID)

if no response, then intraarticular glucocorticoids

105
Q

Sjogren syndrome

A

All patients benefit from nonpharmacologic and preventive interventions

smiking, diet, meds, imms, pregenancy counseling

106
Q

SLE (lupus) therapy goals

A

ensure long-term survival,

achieve the lowest possible disease activity,

prevent organ damage,

minimize drug toxicity,

improve quality of life,

educate patients about their role in disease management

107
Q

SLE (lupus) nonpharm interventions

A 
sun protection
diet
nutrition
exercise
smoking
imms
treatment of comorbidities 
avoiding certain meds
pregnancy counseling
108
Q

SLE (lupus) meds

A

hydroxychloroquineorchloroquine

with or without

nonsteroidal antiinflammatory drugs (NSAIDs),
and/or
short-term use of low-dose glucocorticoids

109
Q

MOA of SLE drug Hydroxychloroquine

A

Hydroxychloroquine (antimalarial)

inhibts chemotaxis of eosinophils and locomotion of neutrophils, impairs complement antibody reactions

110
Q

MOA of SLE drug ibprofen

A

Advil

inhibits inflammatory reactions and pain by decreasing prostoglandin synthesis

111
Q

MOA of SLE drug Naproxen

A

Aleve

inhibits inflammatory rxn and pain by decreasing cyclooxygenase

this results in prostoglandin synthesis

112
Q

MOA of SLE drug DMARDS

A

Immunomodulators

Cyclophosphamide

113
Q

Raynauds meds

A

-dipines (amlodipine, nifedipine etc)

Calcium channel blockers

White - no blood flow
blue - no oxygen
red - blood flow returns

114
Q

Which of the below medication best treats Raynaud’s phenomenon?

Lisinopril
Nifedipine
Clonidine
Metoprolol

A

Nifedipine

115
Q

What is the MOA for the drug Salagen?

Anticholinergic
TNF modulator
Histamine 2 blocker
Cholinergic

A

Cholinergic

116
Q

Which of the below contraindication is a contraindication for the drug, denosumab (Prolia)?

Pregnancy
QT Interval prolongation
Hepatic dysfunction
Renal dysfunction

A

Pregnancy

117
Q

Which of the below contraindication is not a contraindication for the drug, Probenecid?

Acute gouty attack
Uric acid kidney stones
Concomitant salicylates
Pregnancy

A

Pregnancy

118
Q

Which of the following is the MOA for allupurinol?

Xanthine oxidase inhibitor
TNF Modulator
Folic acid antagonist
COX-2 inhibitor

A

Xanthine oxidase inhibitor

119
Q

Which of the following is not a 1st-line medication for osteoarthritis?

Naproxen
Oxycodone
Duloxetine
capsaicin

A

Oxycodone

120
Q

What the precise mechanism of action for the drug Celebrex?

Semiselective for COX
Selective for COX-2
Nonselective to COX-2
Selective for COX-1

A

Selective for COX-2

121
Q

Acute vs chronic pain

A

Acute -
cause generally known
short duration of pain
usually self limiting

Chronic-
Cause often unknown
pain persists
outcome is often pain control

122
Q

Nociceptive pain

A

Pain due to actual tissue injuries such as burns, bruises or sprains

123
Q

Neuropathic pain

A

Peripheral neuropathic pain as the case post-herpetic neuralgia or diabetic neuropathy

Central neuropathic pain - cerebral vascular accident sequella

124
Q

Psychogenic pain

A

Pain caused by psychologic factors such as headaches or abdominal pain caused by emotional, psychological, or behavioral factors

125
Q

Breakthrough pain

A

Rapid onset
severe
self limiting

types: incident, spontaneous/idiopathic, end of dose failure

126
Q

Incident pain

A

A type of breakthrough pain

Induced by activiteis like moving, walking, coughin, talking, turning in bed

127
Q

Glutamate

A

main excitatory neurotransmitter in the nervous system

leading role in pain transmission

role inchronic pain

128
Q

Substance P

A

Neurons release substance P

It then stimulates mast cells and blood vessels

129
Q

Nerve Growth Factor

A

makes a protein callednerve growth factorbeta (NGFβ)

important in the development and survival ofnervecells

especially those that transmit pain, temperature, and touch sensations (sensory neurons).

130
Q

Pain assessment tools

A

Universal (1-10)

Verbal descriptor (no pain/ severe pain)

Wong baker (faces

Activity tolerance (No pain/can be ignored/bedrest required)

131
Q

S/S of pain

A 
Dilated pupils
diaphoresis
Pallor
vasoconstriction
elevated resp
elevated HR
elevated BP
elevated BGL
132
Q

Drugs that can mask pain

A

SSRIs and SNRIs

133
Q

Narcotic vs opioid

A

Narcotic-
Produce sleep, or stupor while also relieving pain

Opioid-
any synthetic compound that has opiate like qualities but is not derived from opium

134
Q

Narcotic

A

Produce sleep, or stupor while also relieving pain

135
Q

Opioid

A

any synthetic compound that has opiate like qualities but is not derived from opium

136
Q

Narco

A

Numbness (Greek)

137
Q

Opiate

A

A compund derived from the opium plant

138
Q

Opioid pathways

A

Peripheral sensitization
Descening modulation
Central sensitization

139
Q

Opioid Receptor Mu

A 
Analgesia
miosis
Respiratory depression
euphoria
physical dependence
suppression of opiate withdrawl
140
Q

Opioids
semi-synthetic
vs synthetic

A 
Semi- synthetic
substituted derivatives of morphine and codeine
hydromorphone
oxymorphone
levorphanol
oxycodone
hydrocodone
Synthetics
Non morphians
Meperidine
Fentanyl
Sufentanil
Alfentanil
Remifentanil
141
Q

Opioids

semi-synthetic

A

Substituted derivatives of morphine and codeine

hydromorphone
oxymorphone
levorphanol
oxycodone
hydrocodone
142
Q

Opioids

synthetic

A

Non morphians

Meperidine
Fentanyl
Sufentanil
Alfentanil
Remifentanil
143
Q

Non opioid analgesics

A 
Acetaminophen (tylenol/paracetamol)
Aspirin (ASA)
Ibprofen (motrin)
Tramadol (ultram) (***opioid agonist but non opioid)
Ketorolac (toradol)
144
Q

Types of pain antidepressants can treat

A

Neuropathic
fibromyalgia
nociceptive

145
Q

Med for Postherpetic neuralgia

A

Gabapentin

Lyrica (pregabalin)

146
Q

Med for Diabetic neuropathy

A 
Carbamazepine
phenytoin
gabapentin
lamtrigine
Lyrica (pregabalin)
147
Q

Topical treatments

A

Lidocain and capsaicin are topical & local

Lidocaine blocks nerves from feeling pain

Capsaicin depletes local neurons of substance P which is needed for nociceptive pain signals

148
Q

How does lidocaine block pain

A

Lidocaine blocks nerves from feeling pain

149
Q

How does capsaicin block pain

A

Capsaicin depletes local neurons of substance P which is needed for nociceptive pain signals

reversibly deplets sensory nerve endings of substance P and by reducing the density os the epidermal nerve fibers

150
Q

MOA of Lidocaine

A

Alters depolarization in neurons by blocking the fast voltage gated sodium channels in the cell membrane

With sufficient blockade, the membrane of the presynaptic neuron will not depolarize and so fail to trasnmit action potential, leasding to anaesthetic effects

151
Q

MOA of capsaicin

A

reversibly deplets sensory nerve endings of substance P and by reducing the density os the epidermal nerve fibers

152
Q

Long acting vs Ultralong acting drugs

A

Long acting
Morphine, oxycontin

Ultralong acting
methadone

153
Q

Pain assessment

A

A thorough pain assessment is vital to the initial evaluation of a patient and must be performed to guide treatment decisions

154
Q

opioid naive

A

Naïve implies that the patient is not already taking opioids

“Opioid tolerant” implies patients are chronically receiving opioids on a daily basis.

Opioid naïve implies patients are not chronically receiving opioids on a daily basis.

Some states “Opioid naïve” means a patient who has not used opioids for more than seven consecutive days during the previous 30 days

155
Q

How can dosing be done

A

incrementally or through titration

156
Q

Cross tolerance

A

the development of tolerance to the effects of pharmacologically related drugs, particularly those that act on the same receptor site

157
Q

equianalgesia

A

“approximately equal analgesia,”

is used when referring to the doses of various opioid analgesics that are estimated to provide the same pain relief

158
Q

Nociceptive first line treatment

A

NSAIDS

159
Q

Neuropathic first line treatment

A

Anti-depressants (TCA’s, SNRI)
or
anti-epileptic drugs

160
Q

Central sensitization first line treatment

A

Anti-depressants (TCA’s, SNRI)
or
anti-epileptic drugs

161
Q

Neuropathic pain

1st, 2nd, 3rd line

A

1st: Antiepileptic, antidepressnts
2nd: capsaicin, lidocaine patch, tramadol
3rd: botulinum toxin, strong opioids

162
Q

Partial agonsit

A

buprenorphine

Subutex

163
Q

opioid antagonists

A

Naloxone (Narcan)

Naltrexone (Revia)

164
Q

Naloxone (Narcan)
vs
Naltrexone (Revia)

A

Naloxone (Narcan)
reduces the effects of oan opiate or overdose

Naltrexone (Revia)
used to help treat addicts and alcoholics who are trying to quit

165
Q

Opioid misuse

A

use in any way not directed by a prescriber

166
Q

Diversion

A

when the legal supply chain of prescription analgesic drugs is broken, and drugs are transferred from a licit to an illicit channel of distribution or use

167
Q

Abuse

A

regularly uses drugs
vulnerable to drug problems
neglecting responsibilities
do not exhibit dependence symptoms

168
Q

Addiction

A

ABCDE

In ability to ABSTAIN
Impairment in BEHAVIOR control
CRAVING or increase hunger for drug
DIMINISHED recognishion of problems with behavior
A dysfunctional EMOTIONAL resonse
169
Q

Toxicity

A

Overdose

An overdose occurs when too much opioid fits in too many receptors slowing and then stopping breahting

170
Q

Withdrawal

A

following cessation of opiates, alcohol or benzos

within 2 to 4 days with methadone and 8 to 10 hours after meperidine

include excessive lacrimation, sweating, piloerection, rhinorrhea, repeated yawning, myalgia, nasal congestion, diarrhea and abdominal cramps.

symptoms usually peak between 36 to 48 hours and gradually subside in 72 hours.

chronic drug addicts, the symptoms may last for 7 to 14 days

severe withdrawal cases, one may use clonidine

171
Q

Marijuana Schedule

A

Schedule 1

most opioids are schedule II

172
Q

Chemicals of marijuana

A

TetrahyrdoCannabidol (THC)
Psychoactive compound

Cannabidol (CBD)
no psychoactive properties

173
Q

States marijuana is legal

A

33 states allow medical marijuana

11 states allow recreational marijuana

174
Q

General vs local

A

General
Synaptic block

Local
Conduction block

175
Q

5 types of local anaesthesia

A 
Topical
infiltraion
Nerve Block
Spinal
Epidural
176
Q

Amides vs esters

A

Amides have 2 i’s in name
i.e. Bupivacaine

Esters have 1 i in name
i.e. Tetracaine

177
Q

Nitrous oxide MOA

A

Antagonism of NDMA receptors in CNS

178
Q

What to do when opioids are required

A

Check E force database

also should check for any controlled substance

179
Q

If an opioid use disorder is identified

A

ensure patient has immediate access to effective addiction treatment including initiation of medication for opioid use disorder

(ie,methadone,buprenorphine,naltrexone).

180
Q

Mild Pain treatments

A

NOT opioids

Tylenol
NSAIDS
Cox 2

181
Q

Moderate Pain treatments

A

Oxycodone 3-4 tabs of 5mg QD
hydrocodone 3-4 tabs of 5mg QD
hydromorphone 3-4 tabs of 2mg QD

Tramadol-avoid prescribingdue to unreliable analgesia
can be used if others are unavailable for use
(3-4 50mg tabs QD)

For older frail adults, lower opioid doses
2.5mg QD

182
Q

Severe Pain treatments

A

Oxycodone 4-6 tabs of 5mg QD
hydrocodone 4-6 tabs of 5mg QD
hydromorphone 4-6 tabs of 2mg QD

183
Q

7 steps of prescription

A 
Precribers info
Patient Info
Recipe (Rx)
Signatur (Sig)
Dispensing instructions (Disp)
Number of refills
Prescribers signature

PAM Semester 2 (22 decks)

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