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Ocular Pharmacology > Therapeutic Pain Management > Flashcards

Therapeutic Pain Management Flashcards

Exam 2

1
Q

How much neuronal loss occurs in people with chronic pain?

A

5-11% neuronal loss, this is equivalent to 10-20 years of aging

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2
Q

What is pain?

A

The sensation of harmful stimulation

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3
Q

What is suffering?

A

The emotional component of subjective distress

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4
Q

Who has a lower pain threshold?
Younger/Older?
Men/Women?
Energized/Tired?

A

Older
Men
Fatigued

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5
Q

Which neurotransmitter is associated with pain and depression?

A

Seratonin

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6
Q

Explain acute pain.

A

Acute pain lasts from seconds - 3 months and is easily localized. Acute pain is the result of a specific injury, and subsides when the condition resolves. Acute pain can be recurrent with episodes being separated by periods of time that are pain-free.

Examples include recurrent corneal erosions, corneal uclers, corneal abrasions, etc

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7
Q

Explain chronic pain.

A

Chronic pain lasts more than 3-6 months and is not easily localized or defined. Chronic pain can be the result of a known medical condition and traditional analgesics are less effective and require higher doses. Chronic pain can be treated but is unlikely to be cured.

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8
Q

What is neurotrophic pain?

A

Chronic pain associated with nerve damage

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9
Q

What is dysesthesia?

A

Abnormal sensations such as burning, tingling, and/or pins/needles

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10
Q

What is allodynia?

A

Pain associated with non-painful stimuli

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11
Q

What is the first thing you should ask about a patient’s pain?

A

Subjective rating 1-10

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12
Q

What is FOLDAR?

A 
Pain management acronym 
F: Frequency 
O: Onset
L: Location 
D: Duration 
A: Association 
R: Relief
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13
Q

What are the three types of topical ophthalmic medications used to treat pain? Give a couple of examples of each.

A

Cycloplegics:
Homatropine (Gold Standard for synechia)
Cyclopentolate

NSAIDS:
Voltaren

Corticosteroids: (Only for pain from inflammation) 
Prednisolone Acetate (Pred Forte)
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14
Q

How do cycloplegics manage pain?

A

Relax ciliary body

Block AcH receptors

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15
Q

What are the three types of oral medications used to treat pain? Give an example of each.

A

OTC non-narcotic analgesics:
Aspirin
Acetaminophen
Ibuprofen

Prescription Non-Narcotic analgesics:
Indomethacin

Prescription Narcotic Analgesics (Controlled substances) :
Codeine
Hydrocodone
Tramadol

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16
Q

What are the three mechanisms for non-narcotic analgesics?

A
  1. Central Acting: Interrupt pain signal in the CNS
  2. Peripheral Acting: Prevent the discharge of pain the pain receptor.
  3. Anesthetic agent: Interrupt pain signal from reaching the CNS.
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17
Q

What are the benefits of non-narcotic analgesics?

A
  1. Ceiling effect, so no increase in effect with an increase in dosage
  2. No tolerance of dependence develop
  3. Not addictive
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18
Q

What are the different OTC non-narcotic analgesics?

A

Aspirin
Acetaminophen (APAP)
Ibuprofen
Naproxen

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19
Q

What is the MOA of aspirin?

A

Irreversible inactivation of COX-1 and COX-2, inhibiting prostaglandin synthesis

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20
Q

What are the clinical indications of aspirin?

A

Analgesic (mild to moderate)
Anti-pyretic (fever)
Antiinflammatory (with high dosage)
Anticoagulant/cardio-protective effects**

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21
Q

What are the adverse effects of aspirin?

A

GI upset/irritation
Prolonged bleeding time
**When taken daily for 12+ months, 59% increase in the incidence of wet AMD

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22
Q

What are the contraindications of aspirin use for pain?

A

Stomach ulcers/GI bleeding
Asthma
Excessive alcohol use
Pregnancy (Avoid in 3rd trimester)

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23
Q

What pregnancy category is aspirin?

A

Category D, fetal harm can occur, so don’t use in the third trimester of pregnancy

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24
Q

What is the MOA of acetaminophen?

A

Unknown, but may inhibit central prostaglandin synthesis (COX-2) Acetaminophen has NO anti-inflammatory properties

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25
Q

What are the indications for acetaminophen?

A

Mild to moderate pain
anti-pyretic
Synergistic with narcotics

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26
Q

What are the adverse effects of acetaminophen?

A

Acute liver failure (leading cause in the US)

Serious and potentially fatal skin reactions (SJS)

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27
Q

What are the contraindications for acetaminophen?

A

Liver toxicity/damage
Alcoholism (1-2 drinks per day)
Hypersensitivity to acetaminophen

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28
Q

What is the new limited dosage of acetaminophen?

What is the new limit of acetaminophen that can be in combo drugs?

A

3250 mg in 24 hours for adults and children over 12.

Combo drugs can have no more than 325mg per dose.

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29
Q

What pregnancy category is acetaminophen?

A

Category B, the safest analgesic for pregnant women

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30
Q

What is the MOA of ibuprofen/naproxen?

A

The mechanism is unknown but thought to be a COX-2 inhibitor preventing prostaglandin synthesis.

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31
Q

What are the indications for ibuprofen/naproxen?

A

Mile-moderate pain
Anti-inflammatory
Anti-pyretic
Some rheumatologic conditions

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32
Q

What are some adverse effects of ibuprofen/naproxen?

A

GI upset/GI bleeding, you should always take naproxen with food/water/antacids
Renal failure
Increased risk of cardiovascular thrombotic events
Nystagmus/diplopia with moderate/severe overdose

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33
Q

What are the contraindications of ibuprofen/naproxen?

A

Hypersensitivity to aspirin/NSAIDs (anaphylaxis)
Ulcers
Renal insufficiency
CAPG (Coronary Artery Bypass Graft) pain management peri-surgery

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34
Q

What pregnancy category is naproxen/ibuprofen?

A

C, don’t use in the third trimester

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35
Q

What dosages is acetaminophen available in?

A

325mg

500mg extra strength

36
Q

What is the recommended dosage for acetaminophen? What is the max dose of acetaminophen?

A

Recommended Dose: 650mg q4 hours

Max Dose: 3250mg q24hr

37
Q

What dosages is aspirin available in?

A

81 and 325mg tablets

38
Q

What is the recommended dosage of aspirin?

A

650-975 mg q4-6 hours

39
Q

Which OTC non-narcotic analgesic should not be used in kids with a fever or with flu-like symptoms in an effort to avoid causing Reye’s syndrome?

A

Aspirin

Reyes causes brain and liver damage

40
Q

What dosages is ibuprofen available in?

A

100mg in children and 200mg in adults

41
Q

What is the recommended dose of ibuprofen?

What is the max dose of ibuprofen?

A

Recommended dose: 200-400mg q4-6 hours
Max Dose: 1200mg q24 hours
Do not use longer than 10 days

42
Q

What dosages is naproxen available in?

A

220mg

43
Q

What is the recommended dosage of naproxen?

What is the max dose of naproxen?

A

Recommended dosage: 220mg q8-12 hours with 2 pills as a loading dose
Max Dose: 2 tabs (440mg) in 12 hours or 3 tabs (660mg) in 24 hours
Do not use longer than 10 days

44
Q

Which OTC non-narcotic analgesics should not be used longer than 10 days? Why?

A

Naproxen or Ibuprofen (NSAIDs), prolonged NSAID use causes corneal melts

45
Q

Which prescription non-narcotic is used in a combination treatment with oral pred to treat of scleritis?

A

Indomethacin

46
Q

What dosages is indomethacin available in?

A

25, 50, 75mg capsules

47
Q

What is the recommended dosage for indomethacin for scleritis?

A

25-50mg TID

48
Q

What is the black box warning for indomethacin?

A

Not for acute pain, can cause renal failure

49
Q

How long can you take ketorolac for?

A

5 days only

50
Q

What are the different kinds of prescription narcotic analgesics? Define them.

A

Opiate: Natural substance from opium (Codeine and morphine)

Opioid: Substances that do not occur naturally, can be synthetic or semi-synthetic. Synthetics are manufactured chemically, semi-synthetics are a hybrid chemical alteration of natural opioids.
Synthetic opioid: fentanyl and methadone
Semi-synthetic opioid: Hydrocodone and oxycodone

Narcotic:
Agents that produce insensibility.

51
Q

What is the MOA of prescription narcotic agents?

A

bind u receptors decreasing pain AND suffering

52
Q

What are some general precautions that should be considered when prescribing prescription narcotic analgesics?

A
  1. They do NOT have a ceiling effect meaning an increase in dosage increases the effect.
  2. Tolerances can develop requiring more of the drug for a similar effect
53
Q

What are the different prescription narcotic analgesics? What schedule is each drug?

A

Codeine (II)
Hydrocodone (II)
Tramadol (IV)

54
Q

What is codeine usually combined with? What is the reason for combining codeine with these agents?

A

Codeine + Aspirin: Will add anti-inflammatory benefits

Codeine + Acetaminophen: Synergystic effect for good pain control (act on separate parts of CNS)

55
Q

What is hydrocodone a derivative of? Is hydrocodone more or less potent than codeine? By how much?

A

Hydrocodone is a derivative of codeine and is six times more potent. Hydrocodone is therefore used for moderate to severe pain compared to codeine which is used for moderate pain.

56
Q

Is codeine or hydrocodone more addictive?

A

Hydrocodone

57
Q

Why might you prescribe hydrocodone over codeine for somebody if they present with moderate pain?

A

Hydrocodone can be prescribed for someone with a codeine allergy

58
Q

What are 3 adverse effects of opioid analgesics?

A

Nausea/Vomiting
Headache
Blur

59
Q

What are 5 contraindications of opioid analgesics?

A 
Kidney/Liver disease
Head injury 
Pregnant
History of alcohol use 
Respiratory disease (COPD/Apnea)
60
Q

What are the components of Tylenol #3 and Tylenol #4? What schedule is Tylenol #3/#4?

A

Acetaminophen and codeine

Schedule III

61
Q

What is the formulation of Tylenol #3?

A

300mg APAP; 30mg codeine Tablets

62
Q

What is the formulation of Tylenol #4?

A

300mg APAP; 60mg codeine tablets

63
Q

What is the recommended dosage of Tylenol #3/#4?

A

15-60mg codeine q4-6 hours

64
Q

What is the max dosage of Tylenol #3/#4?

A

360mg of codeine per day

65
Q

What is the age limit for Tylenol #3? Tylenol #4?

A

Tylenol #3: >7 years

Tylenol #4: > 13 years

66
Q

What pregnancy category is Tylenol #3/#4?

A

C

67
Q

What are the possible combinations of aspirin and codeine?

A

30mg codeine and 325mg aspirin

60mg codeine and 325mg aspirin

68
Q

What is the recommended dosage of aspirin/codeine combinations?

A

1-2 tablets q4-6 hours

69
Q

What is the max dosage of aspirin/codeine combinations?

A

360mg codeine per day

70
Q

What is the pregnancy category of aspirin/codeine combinations?

A

D (ASA)

71
Q

What schedule is aspirin/codeine combinations?

A

Schedule III

72
Q

What are the formulations of Acetaminophen/Hydrocodone combinations?

A

300mg APAP; 5mg hydrocodone (Vicodin)
300mg APAP: 7.5mg hydrocodone (Vicodin ES)
300mg APAP; 10mg hydrocodone (Vicodin HP)
325mg APAP; 5, 7.5, 10mg hyrdocodone (Norco (tablets))
300mg APAP; 10mg hydrocodone (Lortab (solution))

73
Q

What is the recommended dosage of acetaminophen/hydrocodone combinations? (Vicodin)

A

1 tab q4-6 hours

74
Q

What is the max dosage of acetaminophen/hydrocodone combinations? (Vicodin)

A

Hydrocodone: 60mg/day
APAP: 650mg q4-6 hours, 3250mg total

75
Q

What is the age limit for acetaminophen/hydrocodone combinations?

A

> 16 years (Vicodin/Vicodin ES/Vicodin HP)

>2 years (Norco/Lortab)

76
Q

What are the formulations of Ibuprofen/Hydrocodone combinations?

A

200mg ibuprofen; 7.5mg hydrocodone

77
Q

What is the recommended dosage of ibuprofen/hydrocodone?

A

1 tablet q4-6 hours

78
Q

What is the max dosage of ibuprofen/hydrocodone?

A

5 tablets

79
Q

What is the age limit for ibuprofen/hydrocodone combinations?

A

> 16 years

80
Q

What is the recommended dosage of acetaminophen/hydrocodone (Norco/Lortab)

A

2.5-10mg q4-6 hours

81
Q

If a patient is experiencing MILD pain, what should you consider for treatment?

A

Topical medications should be considered,
cycloplegics are great for mild pain
Artificial tears
steroids

82
Q

If a patient is experiencing MODERATE pain, what should you consider for treatment?

A

Non-opioid analgesics (5-7/10 on a subjective scale)

Acetaminophen and ibuprofen

83
Q

If a patient is experiencing SEVERE pain, what should you consider for treatment?

A

Prescription narcotic analgesics

Tylenol #3, Vicodin, Tramadol

84
Q

How is tramadol different from other opioids?

A

Also is an antidepressant

85
Q

Optometrists should never prescribe more than a __ day supply of opioids.

A

3 day

Ocular Pharmacology (8 decks)

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