Week 1 Pain Part 1 Flashcards
Codeine/APAP 30/300mg
Tylenol #3
PO (tablet, liquid)
Analgesics/Anti-inflammatory
Opioid Analgesic/Analgesic Combinaiton
Opioid Analgesic (alters pain response)
Moderate-severe pain
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Fentanyl
Duragesic
Patch
Analgesics/Anti-inflammatory
Opioid Analgesic
Synthetic Opioid Analgesic
Moderate-severe chronic pain in opioid-tolerant patients
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Precautions: Cachectic, debilitated patients, and elderly
Have 4 strengths
Patient couselings
o Patch cannot be cut
o Apply to clean, dry, unbroken skin
o When patch is removed, fold upon itself and flush immediately
o Wash hands after handling
o Do not apply heat to patch
Increased absorption toxicity risk
o For use in opioid-tolerant patients only
Should discontinue all other ER opioids or around-the-clock opioids when initiating
o Takes 12-24 hours when first starting for the medication to start working
Hydrocodone/APAP
Vicodin (Zohydro ER is hydrochodone only)
FYI: Lortab, Norco
Analgesics/Anti-inflammatory
Opioid Analgesic/Analgesic Combinaiton
Semi-Synthetic Opioid Analgesic
Moderate-severe pain
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Methadone
Dolophine
Methadose, Methadose Intensol
PO (tablet, liquid)
Analgesica/Anti-inflammaotry
Opioid analgesic
Synthetic Opioid Analgesic
Moderate-severe pain; addiction
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Morphine
ER=MS Contin
Analgesics/Anti-inflammatory
Opioid Analgesic
Opioid Analgesic
Moderate-severe pain
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Oxycodone ER
Oxycontin
Analgesics/Anti-inflammatory
Opioid Analgesic
Semi-Synthetic Opioid Analgesic
Moderate-severe pain
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Oxycodone IR
Roxicodone
Analgesics/Anti-inflammatory
Opioid Analgesic
Semi-Synthetic Opioid Analgesic
Moderate-severe pain
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Oxycodone/APAP
Percocet
Endocet/Roxicet2
Analgesics/Anti-inflammatory
Opioid Analgesic/Analgesic Combinaiton
Semi-Synthetic Opioid Analgesic
Moderate-severe pain
Constipation, Sedation, N/V, Respiratory Depression, Euphoria, Itching, Dizziness
Benzodiazepines, CNS depressants, Muscle Relaxants
Boxed Warning Accidental ingestion, addiction, respiratory depression; precautions: respiratory/CNS depression, constipation
Naloxone
Narcan (NASAL SPRAY)
Evzio (AUTO-INJECTOR)
IM, SQ, Intranasal
Opioid Reversal
Opioid Antagonist
Blocks opioids at receptor sites
Opioid overdose; reversal of respiratory depression with therapeutic opioid doses,
opioid withdrawal, anxiety, restlessness, muscle aches, inability to sleep, sweating, ANGER
Opioids
Buddy system (family and friends need to be trained in how to properly administer), opiate withdrawal
o Patient Counseling
Initial dose is 2 mg; may repeat every 2-3 minutes as need
• Maximum dose is 10 mg
Immediate treatment is needed when naloxone is administered due to potential for opiate withdrawal and short duration of action
• Candidates for naloxone are those who:
o Take high doses of opioids for long-term pain (> 50mg morphine equivalents)
o Receive rotating opioid medication regimens
o Have been discharged from emergency medical care following opioid poisoning or intoxication
o Take certain extended-release or long-acting opioid medications
o Are completing mandatory opioid detoxification or abstinence programs
Tramadol
Ultram
Ultracet (combination with APAP)
Schedule: C4
Analgesics/Anti-inflammatory
PARITAL Opioid Analgesic
Opioid agonist at mu receptor; inhibits reuptake of Noriepinephrine and serotonin
Moderate-Severe Pain
Constipation/GI distress, sedation, HA, itching, sweating/flushing, physical dependence, rare: suicidal ideaion
Opioids; SNRI, SSRI, CNS acting medications (benzodiazepines, muscle relaxants)
• Patient Counseling
o Tolerance and physical dependence can occur. Do not stop abruptly.
o Laxative agents should be used to prevent/treat constipation
o Use caution when doing activities requiring alertness
o May increase risk for seizures
Buprenorphine Naloxone
Suboxone
SL tablet and film
Schedule: C3
Can only be prescribed by physicians who meet certain qualifying requirements
DEA number starts with an X
Opioid Addiction
Opioid Analgesic/Opioid Antagonist Combinaiton
B: works as an opioid at some sites, displaces at other; N: blocks opioids
Opioid dependence
drowsiness, dizziness, CNS depression, HA, withdrawal syndrome, pain Film: gum/mouth irritation
SSRIs, opioids
o Patient Counseling
Place the film or tablet under the tongue until it dissolves completely
Do not swallow
Additional film should be administered one at a time, on the opposite side of the tongue
If multiple tablets are required, they can be administered at the same time
Unused films should be opened and flushed down the toilet
The same dose should be used whenever switching between tablets and film
Monitor patients closely as the film may have greater bioavailability
Which of the following substances is a controlled substance?
Acetaminophen
Ibuprofen
Naloxone
Oxycodone
Oxycodone
What schedule is heroin?
CI
CII
CIII
CV
CI
Which of the following medications is a long-acting opioid?
Endocet®
Tylenol® III
Oxycontin®
Vicodin®
Oxycontin®
Would respiratory depression be more common with a long-acting or short-acting opioid medication?
Short-Acting
Long-Acting
Long-Acting
Which of the following medications has severe risk when co-administered with opioids?
Benzodiazepines
NSAIDs
Beta Blockers
Acetaminophen
Benzodiazepines
How often should a Duragesic® patch be applied?
Every 12 hours
Every 48 hours—only special circumstances after significant trial
Every 72 hours
Every 96 hours
only special circumstances after significant trial
Every 72 hours
Which of the following medications is converted to morphine to provide pain relief?
Methadone
Codeine
Hydrocodone
Oxycodone
Codeine
What drug would you anticipate to interact with tramadol?
Benzodiazepine
Beta Blocker
Insulin
Anticoagulant
Benzodiazepine
Which of the following would you expect to be a side effect of naloxone?
Sedation
Constipation
Restlessness
Hypotension
Restlessness
Patients who are battling addiction could receive this medication for their opioid tolerance…
Narcan®
Suboxone®
Suboxone®
• Definitions
o Narcotic:
o Opioid:
o Narcotic:
Broad definition for any substance with abuse or addictive potential
Risk for both abuse of the medication and diversion of the medication
o Opioid:
The opioid group includes naturally derived opiates (i.e. morphine) or those synthesized to have similar properties
• Classification of Pain
o Acute Pain
o Chronic Pain
o Cancer Pain
o Acute Pain
Resulting from surgery, acute illness, trauma, labor and medical procedures
Short-term (days) that can be a useful physiologic process to warn individuals
WHERE WE HAVE EVIDENCE OPIOIDS ARE EFFECTIVE
o Chronic Pain
Long-term pain that is often a result of changes to nerve function
GENERALLY, NO DATA TO SUPPORT EFFICACY AND SAFETY OF OPIOIDS
o Cancer Pain
Includes both acute and chronic pain
OPIOIDS USED HERE ALSO
_______ is converted to ________to provide its analgesic effect
Codeine is converted to morphine to provide its analgesic effect
Long acting opioids
Oxycodone ER (CII) Morphine sulfate (CII)- CR or ER Fentanyl transdermal (CII) Methadone (CII)
Short acting opioids
Acetaminophen/codeine (CIII-tablet, CV-liquid) Hydrocodone/acetaminophen (CII) Oxycodone/acetaminophen (CII) Oxycodone (IR)-CII Morphine (CII)
Allergies
o Morphine, codeine, hydromorphone, oxycodone and hydrocodone may cross react with each other
Patient counselings
o Patients need a stimulant laxative to prevent/treat constipation
o May cause drowsiness and impair your ability to operate machinery
o May cause physical or psychological dependence with prolonged use (May be habit-forming)
o Do not CUT or CRUSH controlled release medications (e.g. OxyContin®, MS Contin®)
o Can take with food to minimize nausea/vomiting
