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Therapeutics III > Rogers Pain Part 1 > Flashcards

Rogers Pain Part 1 Flashcards

1
Q

Role of pharmacists in treatment of pain

A

-Assessment of pain
-Recommend OTC medications
-Refer patients to prescribers
-Recommend initial prescription analgesics to providers
-Educate patients on analgesic therapy
-Evaluate safe and effective use (abuse, side effects, etc.)
-Adjust medication therapy based on response

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2
Q

What questions would you want to ask to subjectively assess a patient’s pain?

A

-Palliative or precipitating factors
-Quality of pain
-Region of pain location
-Severity
-Time-related nature of pain
-Impact of pain on you
-What have you tried to control the pain?

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3
Q

Objective information to assess pain

A

-Behavioral changes
-Physiological changes

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4
Q

Examples of physiological changes when someone is in pain

A

-Dilated pupils
-Paleness
-Sweating
-Tachycardia
-Tachypnea

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5
Q

What are the different pain intensity scales?

A

-Verbal
-Numeric
-Visual
-Wong-Baker

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6
Q

Types of pain

A

-Acute (less than 3 months)
-Chronic (more than 3 months)

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7
Q

Types of chronic pain

A

-Nociceptive (tissue)
-Neuropathic (nerve)
-Mixed (tissue and nerve)

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8
Q

Goals of therapy

A

-Correct underlying cause of pain if possible
-Minimize pain and symptoms from pain/injury (may not be possible to be free of pain)
-Improve quality of life (QOL) and activities of daily living (ADLs)
-Limit pharmacotherapy side effects

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9
Q

Patient factors to consider when selecting an analgesic

A

-Hepatic/renal function
-Past medical history
-Previous analgesic therapy
-Routes for medication administration
-Type of pain (neuropathic vs nociceptive)
-Severity of pain

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10
Q

Medication factors to consider when selecting an analgesic

A

-Allergies
-Cost
-Drug-drug interactions
-Duration of action/dosing frequency
-Potency
-Routes of administration
-Side effects

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11
Q

Types of non-pharmacologic therapy

A

-Physical manipulation
-Heat or ice
-Massage
-Acupuncture
-Exercise

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12
Q

Step 1 of the WHO analgesic treatment ladder

A

-Non-opioid
-+/- adjuvant analgesic

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13
Q

Step 2 of the WHO analgesic treatment ladder

A

-Opioid for mild-moderate pain
-+ non-opioid
-+/- adjuvant analgesic

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14
Q

Step 3 of the WHO analgesic treatment ladder

A

-Opioid for moderate-severe pain
-+ non-opioid
-+/- adjuvant analgesic

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15
Q

When do you move up the WHO analgesic treatment ladder?

A

Step up if pain is persisting or increasing

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16
Q

When do you step down the WHO analgesic treatment ladder?

A

Step down if pain is resolving or toxicity occurs

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17
Q

What non-opioid analgesics are used as primary treatment?

A

-Acetaminophen
-NSAIDs

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18
Q

What non-opioid analgesics are used as adjunct treatment?

A

-Gabapentinoids
-Serotonin-norepinephrine reuptake inhibitors (SNRIs)
-Tricyclic antidepressants (TCAs)
-Skeletal muscle relaxants
-Antiepileptics
-Topical agents

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19
Q

What properties does acetaminophen have?

A

Analgesic and antipyretic

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20
Q

Available formulations of acetaminophen

A

-Tablet
-Capsule
-Chewable tablet
-Liquid/gel
-IV solution
-Suppository

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21
Q

Recommended dosing for acetaminophen for adults

A

-325-1000mg PO Q4-6H PRN
-Max dose: 3-4g/day

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22
Q

Recommended dosing for acetaminophen for pediatrics

A

-10-15mg/kg PO Q4H PRN
-Max dose: 75mg/kg/day or 3-4 g/day

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23
Q

Side effects of acetaminophen

A

Hepatotoxicity (acute liver failure most likely 10g or more dose)

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24
Q

What is the strength of a regular acetaminophen tablet?

A

325mg

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25
Q

What is the strength of an extra strength acetaminophen tablet?

A

500mg

26
Q

What is the strength of an acetaminophen tablet used for arthritis?

A

650mg ER

27
Q

What is the strength of an acetaminophen chewable tablet?

A

80 or 160mg

28
Q

Acetaminophen clinical pearls

A

-Gold standard for osteoarthritis due to fewer side effects in geriatric patients than NSAIDs
-Educate patients about max daily doses, including combination products
-Injection is expensive (often restricted use)

29
Q

What properties do NSAIDs have?

A

-Analgesic
-Antipyretic
-Anti-inflammatory

30
Q

NSAID side effects

A

-GI bleeding (black box warning)
-Nephrotoxicity
-Fluid retention
-Increase CV events (black box warning)

31
Q

NSAID clinical pearls

A

-Take with food
-Caution use in geriatric patients due to increased side effects (Beer’s list)
-Avoid systemic NSAIDs in patients with cardiac history (can use topical NSAIDs)
-Avoid in severe liver disease or chronic kidney disease

32
Q

Aspirin available formulations

A

-Chewable tablet
-Tablet
-EC tablet
-Capsule
-ER capsule
-Suppository

33
Q

Recommended dosing for adults taking aspirin

A

-325-1000mg PO q4-6h PRN
-Max 4g/day

34
Q

Recommended dosing for pediatric patients taking aspirin

A

Avoid (Reye’s syndrome)

35
Q

Aspirin clinical pearls

A

-Avoid using for pain in patients taking blood thinners or antiplatelets
-Some formulations available OTC

36
Q

What Reye’s syndrome

A

-Rare but serious condition that causes swelling in the brain and liver
-Associated with children/teens using aspirin when they have viral infections such as flu or chickenpox (with or without fever)

37
Q

Ibuprofen available formulations

A

-Capsule
-Tablet
-Chewable tablet
-Suspension
-IV solution

38
Q

What is the strength of a regular ibuprofen tablet?

A

200mg

39
Q

Recommended dosing for an adult taking ibuprofen

A

-200-800mg PO q6-8h PRN
-Max: 3200mg/day

40
Q

Recommended dosing for a pediatric patient over 6 months old taking ibuprofen

A

-5-10mg/kg PO q4-6h PRN
-Max: 40mg/kg/day or 2400mg, whichever is less

41
Q

Ibuprofen clinical pearls

A

Some formulations available OTC

42
Q

Diclofenac available formulations

A

-Capsule
-Tablet
-IV solution
-Suppository
-Topical gel (Voltaren 1% gel)
-Topical solution
-Ophthalmic solution
-Patch

43
Q

Recommended dosing for adults taking diclofenac

A

50mg PO q8h or 2-4g applied topically 4 times/day

44
Q

Diclofenac clinical pearls

A

-Minimal systemic side effects with topical gel
-Some formulations available OTC

45
Q

Naproxen available formulations

A

-Capsule
-Tablet
-DR/ER tablet
-Suspension

46
Q

Recommended dosing for adults taking naproxen

A

-220-500mg PO q6-12h
-Max 1000mg/day

47
Q

Naproxen clinical pearls

A

Some formulations available OTC

48
Q

Ketorolac available formulations

A

-Tablet
-IV/IM solution
-Nasal spray
-Ophthalmic solution

49
Q

Ketorolac recommended dosing for adults

A

-15-30mg IV/IV q6h prn
-10mg PO q6h prn

50
Q

Ketorolac recommended dosing for pediatric patients

A

0.5mg/kg/dose IM/IV q6h prn

51
Q

Ketorolac clinical pearls

A

-Maximum duration is 5 days (parenteral + oral)
-Increased risk of GI bleeds when used for more than 5 days
-Oral dosing is intended as a continuation of IM or IV therapy

52
Q

Celecoxib available formulations

A

-Capsule
-Oral solution (less common)

53
Q

Celecoxib recommended dosing for adults

A

200mg PO BID

54
Q

Celecoxib clinical pearls

A

COX 2 selective- less GI toxicity

55
Q

Aspirin brand name

A

Bayer

56
Q

Acetaminophen brand name

A

Tylenol

57
Q

Ibuprofen brand name

A

Advil, motrin

58
Q

Diclofenac brand name

A

Voltaren

59
Q

Naproxen brand name

A

Aleve, Naprosyn

60
Q

Ketorolac brand name

A

Toradol

61
Q

Celecoxib brand name

A

Celebrex

Therapeutics III (42 decks)

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