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Pharm Exam 5 > Unit VI Pain (Chapter 24 & 25) > Flashcards

Unit VI Pain (Chapter 24 & 25) Flashcards

1
Q

Give examples of opioid agonists (5)?

A 
Morphine
Fentanyl (transdermal)
Methadone
Codeine
Hydrocodone
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2
Q

Indication for use of transdermal Fentanyl?

A

Persistent severe pain w/opoid tolerance

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3
Q

What is the risk that comes with taking Methadone?

A

QT prolongation

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4
Q

Monitoring parameters with Methadone?

A

EKG at initiation of therapy

Repeat in 30 Days then annually

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5
Q

Indication for use of Codeine?

A

Mild to moderate pain

Cough

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6
Q

Codeine has the same effect as what other meds?

A

325 mg ASA

Tylenol

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7
Q

What is the risk associated with the use of Hydrocodone?

A

Vicodin is associated with hepatotoxicity r/t acetaminophen

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8
Q

What is the benefit of using an opioid agonist-antagonist over an opioid agonist?

A

Lower potential for abuse

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9
Q

What is a risk of using an opioid agonist-antagonist?

A

Can precipitate withdrawal

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10
Q

Give an example of an Opioid Agonist-Antagonist?

A

Pentazocine

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11
Q

What side effect of Morphine and other Opioid Agonists is lessened with the use Pentazocine?

A

Pentazocine has a limited risk of respiratory depression

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12
Q

Indication for use of Pentazocine?

A

Mild to Moderate Pain

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13
Q

Contraindication for Pentazocine?

A

Opioid dependence (NEVER use or will precipitate withdrawal symptoms)

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14
Q

Give an example of Opioid Antagonist

A

Naloxone

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15
Q

Indication of use for Naloxone

A

Reversal of Opioid OD

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16
Q

Give an example of a Nonopioid Central Acting Analgesic?

A

Tramadol (Ultram)

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17
Q

Indication for use of Tramadol (Ultram)

A

Moderate to moderately severe pain

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18
Q

ABSOLUTE contraindication for use of Tramadol (Ultram)?

A

MAOI use

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19
Q

6 Considerations of opioid use with chronic, non-cancer pain:

A

1) Only use when nonopioid or more conservative methods have failed
2) Discuss risk vs. benefit
3) Use one prescribed and one pharmacy
4) Comprehensive follow-up required
5) Stopping opioids after attempting opioid rotation was unsuccessful
6) Document this entire process

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20
Q

How long does it take for opioid dependence to develop?

A

After 20 or more days of use

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21
Q

How should opioids be tapered to discontinue use?

A

Slowly taper over 3 days

If dependence is high, taper over 7-10 days

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22
Q

Name triggering factors for headaches (4)

A

Stress
Fatigue
Acute illness
Sensitivity to alcohol

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23
Q

Name possible underlying causes for headaches (5)

A 
HTN
Hyperthyroidism
Tumors
Infection
Disorders of the ENT
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24
Q

What are the defining characteristics (signs and symptoms) of migraine headaches (2)?

A

Throbbing pain, unilateral or bilateral pain

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25
Q

Is it more common to have a migraine with or without aura?

A

Without is more common

26
Q

What class of drugs are used for ABORTIVE treatment of mild to moderate migraines?

A

NDAIDS

27
Q

What class of drugs are used for ABORTIVE treatment of moderate to severe migraines(2)?

A

Serotonin Agonist or

Ergot Alkaloid

28
Q

What two specific drugs are used as ADJUNCT therapy for the treatment of migraine headaches?

A

Metoclopramide (Reglan)

Prochlorperazine (Compazine)

29
Q

How does Metoclopramide (Reglan) help treat migraines when given with NSAIDs?

A 
increases absorption (especially when given with ASA)
Can be as effective as Sumatriptan and costs less
30
Q

What is important to know about the use of Acetaminophen for the treatment of migraines?

A

Acetaminophen should only be used in combo with drugs, not alone (ie Excedrine migraine)

31
Q

When can opioids be considered for the treatment of migraines?

A

Only use opioids for SEVERE migraines that do not respond to first-line treatments

32
Q

Example of Serotonin Receptor Agonists (Triptans)

A

Sumatriptan (Imitrex)

33
Q

MOA of Sumatriptan (Imitrex)?

A

Vasoconstriction and decreased perivascular inflammation

34
Q

Adverse Effects of Sumatriptan (Imitrex)?

A

Coronary Vasospasm (biggest concern)

35
Q

Contraindication of Sumatriptan (Imitrex) (5)?

A 
CAD
Hx of ischemic heart disease
MI
Uncontrolled HTN
Heart disease of any kind
36
Q

Patient Education regarding side effects for Sumatriptan (Imitrex)?

A

Chest symptoms such as heavy arms or chest pressure is not dangerous and should subside with use

37
Q

Is Sumatriptan (Imitrex) safe for use in pregnancy?

A

NO

38
Q

Sumatriptan (Imitrex) Drug Interactions?

A 
Ergot Alkaloids (excessive vasoconstriction)
Other Triptans (excessive vasoconstriction)

MAOI (sumatriptan toxicity)
SSRI/SNRI (serotonin syndrome)

39
Q

What are the second-line drugs used for the abortive treatment of migraines after Sumatriptan (Imitrex)?

A

Ergot Alkaloids (Ergotamine)

40
Q

Why is Sumatriptan (Imitrex) preferred over Ergotamine for the treatment of migraine headaches?

A

Ergotamine has a greater risk of dependence than Sumatriptan (Imitrex)

41
Q

Indication for use of Ergot Alkalines/Ergotamine?

A

Migraine headache that has not responded to Triptans

42
Q

Adverse effects of Ergot Alkalines (6)?

A 
NV
Weakness in legs
Myalgia
Numbness and tingling in the fingers and toes
Angina-like pain 
Tachycardia or bradycardia
43
Q

What is the term used for Ergot Alkaloid OD?

A

Ergotism

44
Q

s/s of Ergotism (4)?

A

Cold
Pale
Numb extremities
Development of muscle pain followed by gangrene–especially high in those with sepsis, PVD, or renal/hepatic impairment

45
Q

Ergot Alkaloid Drug Interactions?

A

Triptans (prolonged vasospastic response)

(should be dosed separately by at least 24 hours)

46
Q

Ergot Alkaloid Contraindications (8)?

A 
hepatic/renal impairment
sepsis
CAD
PVD
Uncontrolled HTN
Pregnancy
Drug dependency
CYP
47
Q

When should preventative drug therapy for migraines begin?

A

When a patient has 3 or more headaches a month

48
Q

How long does it take for preventative drug therapy for migraines to take effect?

A

4-6 weeks

49
Q

What drug classes are used for preventative therapy for migraines?

A

Beta Blockers
Antiepiletptics
TCAs
Estrogens & Triptans

50
Q

What beta blockers are used as a preventative therapy for migraines (3)?

A

Propranolol
Timolol
Atenolol

51
Q

Use caution giving beta-blockers for preventative therapy for migraines in patients with what underlying condition?

A

Asthma

52
Q

What Antiepileptics are used as preventative therapy for migraines?

A

Divalproex-Depakote ER

Topiramate (Topamax)

53
Q

Black Box warning for Divalproex-Depakote ER?

A

Fatal pancreatitis/hepatitis

54
Q

Contraindication for Divalproex-Depakote ER for preventative therapy for migraines?

A

Pregnancy

55
Q

What TCAs are used for preventative therapy for migraines?

A

Amitriptyline (Elavil)

56
Q

Adverse Reactions for use of amitriptyline (Elavil) for preventative treatment of migraines(2)?

A

Hypotension

Anticholinergic Effects

57
Q

Indication for use of Estrogens and Triptans for preventative treatment of migraines?

A

Menstrual headaches

58
Q

Cluster headaches are characterized by what duration of symptoms?

A

Last 15min-2 hours

1-2 attacks every day for 2-3 months

59
Q

s/s & defining characterisitcs of Custer headaches(7)?

A 
No aura
No N&V
More debilitating
Less common than typical migraines
Mostly occurs in males
No family history association
Management is different than typical migraines
60
Q

Fist line prophylactic treatment for cluster headaches?

A

Verapamil

61
Q

Second-line prophylactic treatment for cluster headache?

A

Lithium

62
Q

How are cluster headaches treated once they begin?

A

Sumatriptan (Imitrix) or oxygen

Pharm Exam 5 (5 decks)

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