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TOP 200 II > Week 3 Pain Part 2 > Flashcards

Week 3 Pain Part 2 Flashcards

1
Q

Acetaminophen

A

Tylenol
Feverall

OTC (PO tablet,liquid), Rx IV and suppository as well

Analgesics/Anti-inflammatory

Analgesic/Antipyretic

Nonopioid Analgesic

Mild pain (headaches, arthritis), Fever

Liver toxicity (4GRAMS/DAY), rare: hypersensitivity reaction (rash)

Warfarin (> 2 grams/day of APAP), Alcohol( >3 drinks/day) , Phenytoin, Carbamazepine

Boxed Warning: Hepatoxicity, CI: other APAP; Precautions: alcohol use, serious and potentially fatal skin reactions

• Patient Counseling
o Do not exceed appropriate maximum daily dose
o Do not use any other acetaminophen containing products (e.g. cough and cold, combination opiates)
o Counsel parents to try to avoid administering acetaminophen right before temperature monitoring as it will lower temperature and give inaccurate assessment of fever
o Avoid use of alcohol
o Acetaminophen and NSAIDs can be used acutely together for pain control
• Not recommended in young children due to overdose risks
• Each should be dosed every 6 hours on a rotating schedule (i.e. acetaminophen administered, ibuprofen administered three hours later)

• Clinical Pearls
o Preferred analgesic during pregnancy and lactation
o Preferred agent for fever alone
o Also available as an IV product, suppository (Rx)
o Available OTC

o Acetaminophen can be used in children three months of age and older

o Concentrated 80 mg/0.8 mL products should no longer be used

o DO NOT USE DOSING DEVICE FOR ANY OTHER LIQUID PRODUCT THAN THE PRODUCT IT COMES WITH

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2
Q

Celecoxib

A

Celebrex

Analgesics/Anti-inflammatory

Anti-inflammatory

COX-II Selective NSAID

Pain, joint conditions

GI (see notes), Cardiovascular (see notes), Kidney damage, tinnitus

Anticoagulants, ASA(increased bleeding risk), ACE-I, ARB( counteract vasodilation), Corticosteroids ( increased GI side effects), Sulfonylureas ( increased risk of hypoglycemia), SSRI ( increased bleeding risk)

See notes for precautions:
Boxed Warning: GI/Cardiovascular

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3
Q

Diclofenac

A

Voltaren
Flector

PO, gel, patch

Analgesic/Anti-inflammatory

Anti-inflammatory

NSAID

Pain, joint conditions

GI (see notes), Cardiovascular (see notes), Kidney damage, tinnitus

Anticoagulants, ASA(increased bleeding risk), ACE-I, ARB( counteract vasodilation), Corticosteroids ( increased GI side effects), Sulfonylureas ( increased risk of hypoglycemia), SSRI ( increased bleeding risk)

See notes for precautions:
o Precautions
 Avoid use or monitor closely in patients with:
• History of gastric/peptic ulcer disease or bleeding**
• Uncontrolled high blood pressure (HTN)
• Kidney disease (renal)
• Elderly patients**
• Cardiac diseases (heart attack, stroke, blood clot)**
Boxed Warning: GI/Cardiovascular

• Patient Counseling
o Counsel parents to try to avoid administering ibuprofen right before temperature monitoring as it will lower temperature and give inaccurate assessment of fever
o Do not take more than maximum dose
o Take with food or milk to decrease GI irritation
o Avoid use with aspirin unless pharmacist/physician approves
 If both are taken, aspirin should be taken at least 30 MINUTES before NSAID
o Warn patients about serious risks associated with long-term use
 Especially in high risk populations
o Try to use the medication for the shortest time possible
o Long-term analgesia with acetaminophen has less risk for most patients

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4
Q

Ibuprofen

A

Motrin
Advil

PO (tablet, liquid)

Analgesics/Anti-inflammatory

Anti-inflammatory

NSAID

Pain, joint conditions,FEVER, dysmenorrhea

GI (see notes), Cardiovascular (edema, increased BP), Kidney damage, tinnitus

Anticoagulants, ASA(increased bleeding risk), ACE-I, ARB( counteract vasodilation), Corticosteroids ( increased GI side effects), Sulfonylureas ( increased risk of hypoglycemia), SSRI ( increased bleeding risk)

See notes for precautions: Boxed Warning: GI/Cardiovascular

o Ibuprofen can be used in children six months of age and older

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5
Q

Meloxicam

A

Mobic
PO
Analgesics/Anti-inflammatory
Anti-inflammatory
NSAID
Pain, joint conditions
GI (see notes), Cardiovascular (see notes), Kidney damage, tinnitus
Anticoagulants, ASA, ACE-I, ARB, Corticosteroids, Sulfonylureas, SSRI
See notes for precautions: Boxed Warning: GI/Cardiovascular

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6
Q

Naproxen

A

Aleve (OTC)
Naprosyn (Rx)

PO (tablet, liquid
)
Analgesics/Anti-inflammatory

Anti-inflammatory

NSAID

Pain, joint conditions, fever, dysmenorrhea

GI (see notes), Cardiovascular (see notes), Kidney damage, tinnitus

Anticoagulants, ASA(increased bleeding risk), ACE-I, ARB( counteract vasodilation), Corticosteroids ( increased GI side effects), Sulfonylureas ( increased risk of hypoglycemia), SSRI ( increased bleeding risk)

See notes for precautions: Boxed Warning: GI/Cardiovascular

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7
Q

Sumatriptan

A

Imitrex

PO, nasal, SQ

Analgesics/Anti-inflammatory
Antimigraine/Central Vasoconstrictor

Serotonin Agonist

Antimigraine

Acute tx migraine or cluster HA

GI (see notes), Cardiovascular (see notes), Kidney damage, tinnitus

Anticoagulants, ASA, ACE-I, ARB, Corticosteroids, Sulfonylureas, SSRI

See notes for precautions:
	Perform a cardiovascular evaluation in those at risk for coronary artery disease [CAD] (i.e. smoker,  MALE >40 YEARS                                                         of age, high blood pressure)
	Cardiac/cerebrovascular events
	Vasospasm-related events
	Serotonin syndrome

Boxed Warning: GI/Cardiovascular

• Warnings
o Contraindications
 Ischemic heart disease (past heart attack, stroke, chest pain)
 Use of ergot alkaloid within 24 hours
 Use of serotonin agonist within 24 HOURS
 Use of MAOI within 14 days

• Patient Counseling
o Take at first sign of a migraine. For treatment only of migraine, not prevention.
o Tablet only: If a satisfactory response has not be obtained after two hours, a second dose may be administered.
 Other dosage forms allow for re-dosing as well, but some after 1 hour.
o Take exactly as directed and do not overdose. Overuse may lead to worsening of headaches.
o Report any risk factors for heart disease or any unusual side effects immediately to one of your health care providers.

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8
Q

Carisoprodol

A

Soma

Central Nervous System

C-IV DEA Schedule)

Skeletal Muscle Relaxant

Unclear, central depressant, blocks neuronal signaling

Acute musculoskeletal pain

Dizziness, somnolence, nervousness, withdrawal syndrome (Carisoprodol ONLY)

CNS depressants

• Patient Counseling
o Be cautious when first starting due to risk of dizziness and drowsiness. Do not operate machinery/vehicles until you know how it will affect you
o Avoid alcohol and other CNS depressants

• Clinical Pearl
o cyclobenzaprine and carisoprodol should be limited to short-term use (2-3 weeks)
o Use is cautioned in elderly patients and should be carefully monitored

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9
Q

Cyclobenzaprine

A

Flexeril

Central Nervous System

Skeletal Muscle Relaxant

Centrally acting skeletal muscle relaxant

Muscle Spasm

dizziness, somnolence, nervousness, dry mouth, confusion, constipation
hypotention (Cyclobenzaprine ONLY)

CNS depressants, TCAs (  amitriptyline, nortriptyline)

• Patient Counseling
o Be cautious when first starting due to risk of dizziness and drowsiness. Do not operate machinery/vehicles until you know how it will affect you
o Avoid alcohol and other CNS depressants

• Clinical Pearl
o cyclobenzaprine and carisoprodol should be limited to short-term use (2-3 weeks)
o Use is cautioned in elderly patients and should be carefully monitored

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10
Q

Tizanidine

A

Zanaflex

Central Nervous System

Skeletal Muscle Relaxant

Centrally acting skeletal muscle relaxant, alpha 2 agonist

Relief of spasticity from central nervous system diseases

dizziness, somnolence, nervousness, dry mouth, confusion, constipation, hypotension (tizanidine ONLY)

CNS depressants, ciprofloxacin

• Patient Counseling
o Be cautious when first starting due to risk of dizziness and drowsiness. Do not operate machinery/vehicles until you know how it will affect you
* rise slowly from sitting position
*take with or without food consistently
o Avoid alcohol and other CNS depressants

• Clinical Pearl
o Use is cautioned in elderly patients and should be carefully monitored

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11
Q

Which of the following skeletal muscle relaxants may cause constipation and dry mouth?
A. Tramadol
B. Tizanidine
C. Carisoprodol

A

B. Tizanidine

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12
Q 
Which of the following medications is an over-the-counter NSAID?
A. acetaminophen
B. oxycodone
C. meloxicam
D. ibuprofen
A

D. ibuprofen

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13
Q 
Which of the following	NSAIDs would have the lowest projected risk for	GI side effects?
A. Ibuprofen
B. Celecoxib
C. Meloxicam
D. Naproxen
A

B. Celecoxib

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14
Q

Based on the side effects of NSAIDs, what do you think an accurate counseling point to share with patients would be?
A. Take on an empty stomach first thing in the morning
B. Take with a small snack
C. Take with a full glass of water
D. Take regardless of meals

A

B. Take with a small snack

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15
Q 
What is the preferred	over-the-counter	
analgesic in pregnancy?
A. Ibuprofen
B. Naproxen
C. Acetaminophen
A

C. Acetaminophen

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16
Q

Which over-the-counter analgesic would be safe
to provide to a 4month year old infant?
A. Ibuprofen
B. Acetaminophen

A

B. Acetaminophen

17
Q

Based on the side effects of sumatriptan, what
patient might be contraindicated from receiving the medication?
A. Patient with Type2 Diabetes
B. Patient with a previous heart attack
C. Patient taking an antidepressant (SSRI)— interacts, but generally not significant due to occasional sumatriptan use
D. Patient of child-bearing age

A

B. Patient with a previous heart attack

interacts, but generally not significant due to occasional sumatriptan use

TOP 200 II (14 decks)

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