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PHRM 845 > ROGERS > Flashcards

ROGERS Flashcards

1
Q

what percent of americans have chronic pain

A

30%

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2
Q

subjective questions to ask a pt about pain

A

PQRSTU
precipitating factors
quality of pain
region
severity
time related
impact on U
also what have you tried

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3
Q

objective factors of pain

A

behavior changes
dilated pupils
paleness
sweating
tachycardia
tachypnea

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4
Q

which pain scale is helpful in kids?

A

Wong-Baker
(faces)

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5
Q

what is nociceptive pain

A

tissue

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6
Q

what is neuropathic pain

A

nerve

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7
Q

non-pharm options for pain

A

correct cause
exercise
acupuncture
massage
heat/ice
chiropractor

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8
Q

treatment ladder step 1

A

non opioid
+/- adjuvant analgesic

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9
Q

treatment ladder step 2

A

opioid for mild/mod pain
+ non opioid
+/- adjuvant analgesic

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10
Q

treatment ladder step 3

A

opioid for mod/severe pain
+ non opioid
+/- adjuvant analgesic

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11
Q

Tylenol dosage forms

A

tablet
capsule
chewable
liquid/gel
IV
suppository

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12
Q

Tylenol dosing adults

A

325-1000 mg q4-6h
max: 3-4 g /day

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13
Q

Tylenol dosing kids

A

10-15 mg/kg q4h
max: 75 mg/kg/day or 3-4 g

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14
Q

Tylenol hepatotoxicity likely with what dose

A

> 10 g dose

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15
Q

NSAID side effects

A

GI bleed
nephrotoxicity
fluid retention
increase in CV events

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16
Q

when to avoid NSAIDs

A

liver disease
CKD
Beers
CV history

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17
Q

counseling tip for NSAIDs

A

take with food

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18
Q

aspirin

A

tablet
capsule
chewable
ec tablet
er capsule
suppository

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19
Q

ASA dosing adult

A

325-1000 mg q4-6h
max: 4 g /day

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20
Q

ASA in children

A

AVOID

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21
Q

when to avoid ASA

A

children
pts on blood thinners

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22
Q

what is Reyes syndrome

A

swelling in brain and liver
(when kids have a viral infection)

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23
Q

ibuprofen dosage forms

A

tablet
capsule
chewable tablet
IV
suspension

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24
Q

ibuprofen dosing adult

A

200-800 mg q6-8 h
max: 3200 mg /day

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25
Q

ibuprofen dosing kids

A

> 6 months
5-10 mg/kg q 4-6h
max: 40 mg/kg/day or 2400 mg

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26
Q

diclofenac dosage forms

A

tablet
capsule
IV
suppository
topical gel
topical solution
ophthalmic
patch

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27
Q

diclofenac dosing

A

50 mg PO q8h or 2-4g QID topically

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28
Q

naproxen dosage forms

A

tablet
capsule
DR/ER tablet
suspension

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29
Q

naproxen dosing

A

220-500 mg PO q6-12 h
max: 1000 mg/day

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30
Q

ketorolac dosage forms

A

tablet
IV/IM solution
nasal spray
ophthalmic

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31
Q

ketorolac dosing adults

A

15-30 mg IV q6h
10 mg PO q6h

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31
Q

ketorolac dosing kids

A

0.5 mg/kg/dose IM/IV q6h

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32
Q

maximum duration of ketorolac

A

5 days

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33
Q

when is oral dosing used with ketorolac

A

continuation of IV or SUBQ

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34
Q

celecoxib dosage forms

A

capsule
oral solution

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35
Q

celecoxib dosing

A

200 mg PO BID

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36
Q

gabapentin / pregabalin uses

A

fibromyalgia
neuropathies
post op pain

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37
Q

gabapentin doing and max dose

A

100-300 mg TID
3600 mg / day

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38
Q

pregabalin dose and max

A

75 mg BID
max: 600 mg

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39
Q

pregabalin is what schedule

A

IV

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40
Q

gabapentin is what schedule

A

not scheduled

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41
Q

pregabalin and gabapentin side effects

A

sedation
dizzy

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42
Q

gabapentin and pregabalin are ____ dosed

A

renally

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43
Q

venlafaxine max dose

A

225 mg /day

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44
Q

duloxetine max dose

A

60 mg/day

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45
Q

duloxetine renal considerations

A

avoid in CrCl < 30

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46
Q

side effects of nortriptyline and amitriptyline

A

anticholinergic
sedation

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47
Q

when to use amitryptiline and nortriptyline in fibromyalgia/neuropathy

A

last line

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48
Q

max of nortriptyline and amitriptyline dose

A

150 mg /day

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49
Q

when to use muscle relaxants

A

musculo skeletal pain / pulled muscle

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50
Q

muscle relaxant drugs

A

cyclobenzaprine
baclofen
methocarbamol
carisoprodol
tizanidine

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51
Q

muscle relaxants duration of use

A

< 3 weeks

52
Q

which muscle relaxant has abuse potential

A

carisoprodol
schedule IV

53
Q

cyclobenzaprine max

A

30 mg

54
Q

baclofen max

A

80 mg

55
Q

carisoprodol max

A

1050 max

56
Q

methocarbamol max

A

8 g

57
Q

tizanidine max

A

24 mg

58
Q

carbemazepine max

A

1200

59
Q

carbemazepine risk

A

hypersensitivity with HLA B 1502 allele
autoinduction of hepatic enzymes

60
Q

topical agent for pain

A

lidocaine

61
Q

lidocaine dosage forms

A

patch
injection
topical

62
Q

what can happen with continuous use of lidocaine patch

A

tolerance
12 hour break between patch

63
Q

Beers oral NSAID recommendation

A

avoid chronic and acute use unless needed to but with a PPI or misoprostol

64
Q

Beers recommendation ketorolac and indomethacin

A

avoid

65
Q

Beers recommendation carisoprodol, cyclobenzaprine, methocarbamol

A

avoid

66
Q

Beers tizanadine and baclofen

A

don’t avoid but substantial side effects

67
Q

Beers reccomendation SNRI, TCA, carbamazepine

A

use with caution

68
Q

Beers recommendations opioids and benzos together

A

avoid

69
Q

Beers recommendations opioids and gaba/prega

A

avoid unless tapering off or swtiching to gaba

70
Q

Beers recomendation two anticholinergics (like TCA and muscle relaxant)

A

avoid

71
Q

Beers recommendation of CNS agents

A

avoid three or more CNS active drugs

72
Q

best pain medications for elderly

A

tylenol
topical
SNRI
gaba

73
Q

side effects muscle relaxants

A

anticholinergic

74
Q

side effects venlafaxine/duloxetine

A

nausea, headache, sedation

75
Q

weak opioid agonists

A

tramadol
codeine

76
Q

signs of overdose

A

bradycardia
decreased respiratory rate
hypotension
pale
sedation
pinpoint pupils

77
Q

signs of withdrawal

A

tachycardia
increased respiratory rate
hypertension
sweating
insomnia
dilated pupils

78
Q

pts who should get naloxone

A

hx overdose
hx substance disorder
benzo use
higher opioid dosages

79
Q

narcan dosing frequency

A

2-3 mins

80
Q

who is codeine not recommended for

A

breastfeeding mothers
children <12

81
Q

tramadol is ____ dosed

A

renal

82
Q

tramadol risk

A

serotonin syndrome with other serotonin meds

83
Q

codeine dosage forms

A

tablet
syrup`

84
Q

tramadol dosage forms

A

tablet
capsule
solution

85
Q

morphine dosage forms

A

tablet
capsule
solution
IV
suppository

86
Q

hydromorphone dosage forms

A

tablet
oral solution
injection solution
suppository

87
Q

hydrocodone dosage forms

A

tablet
oral solution

88
Q

hydrocodone use with a 3A4 inhibitor will do what

A

increase concentration

89
Q

oxyodone dosage forms

A

tablet
capsule
oral solution

90
Q

which oxycodone formation is abuse deterrent

A

ER

91
Q

fentanyl dosage forms

A

buccal
sublingual
lozenge
injectable sol
patch

92
Q

fentanyl renal considerations

A

can use in impairment

93
Q

who can use the noninjectible forms of fentanyl

A

opioid tolerant: 60 mg morphine daily for a week

94
Q

swithcing between doses for fentanyl

A

not one to one between dosage forms

95
Q

fentanyl patch duration

A

every 72 hours

96
Q

methadone dosage forms

A

tablet
oral solution
injectible solution

97
Q

which pain drug QTC prolong

A

methadone

98
Q

which drug do we need to avoid with hx of seizures

A

tramadol

99
Q

dilaudid

A

hydromorphone

100
Q

duragesic

A

fentanyl

101
Q

demerol

A

meperidine

102
Q

which meds available in ER

A

tramadol
morphine
hydropmorphone
hydrocodone
oxycodone

103
Q

naural opiates

A

codeine
morphine

104
Q

synthetic opioids

A

fentanyl
methadone
miperidine
tramadol

105
Q

if pt has allergy to natural or semi synthetic what can we give them?

A

synthetic

106
Q

how much to reduce dose by when switching

A

25-50%

107
Q

what type of opioid should be selected first?

A

IR, lowest effective dose

108
Q

when should clinicains follow up with starting opioid therapu

A

1-4 weeks

109
Q

what strength if not working should we taper opioids

A

> 50 MME

110
Q

how to taper if pt has taken opiods > 1 year

A

reduce by 10% per month

111
Q

how to taper if pt has taken opioids for weeks to months

A

reduce by 10% per week

112
Q

what to do once lowest dose has been obtained and we’re tapering?

A

interval can be extended

113
Q

frequency at which we can stop opioids?

A

once daily

114
Q

who does 2014 chronic pain law apply to

A

> 60 pills / month for 3+ months
15 MME for 3+ months
transdermal patch 3+ months
ER med

115
Q

7 day prescribing law

A

initial opioid rx for a patient cant be more than 7 day supply
unless: cancer, palliative care, substance abuse disorder, professional judgement

116
Q

Inspect requirement

A

before prescribing opioid or benzo prescribers must check
no exceptions
on pain contract - check every 90

117
Q

what does a pain contract do

A

if pt gets opioid from other prescriber than original will no longer write

118
Q

what is OPEN and reccomendations

A

michican opioid prescribing engagement network
scheduled dosing of acetaminophen and ibuprofen
alternate tylenol 650 with ibuprofen 600 alternate every 3 hours for 3 days or until not needed

119
Q

uses for patient controlled analgesia (PCA)

A

post-operative
pancreatitis
sickle cell crisis

120
Q

first line low back pain

A

acetaminophen
NSAIDs

121
Q

second line low back pain

A

SNRIs
TCAs

122
Q

osteoarthritis first line

A

acetaminophen
oral/topical NSAIDs

123
Q

osteoarthritis second line

A

intra articular hyaluronic acid
capsaicin

124
Q

fibromyalgia FDA approved meds

A

pregabalin
duloxetine

125
Q

fibromyalgia options not FDA approved

A

TCAs
gabapentin
venlafaxine

126
Q

neuropathic pain first line

A

SNRIs
gaba/preg

127
Q

neuropathic second line

A

TCAs
topical lidocaine

128
Q

hospice meds

A

morphine IV under the tongue (pain)
lorazepam IV or SL (anxiety)
ondansetron ODT (nausea/vomit)
atropine drops/ scopalomine patch (secretions)

PHRM 845 (38 decks)

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