Exam 4 Mss

Front 1

pKa normally ____ the Ca2+ channel.

Back 1

closes

Front 2

What kind of headache?
Attacks on 15days/month; dull; bilateral; no N/V.

Back 2

Tension

Front 3

What kind of headache?
Unilateral; pulsatingl aggravated by rountine activites; N/V; photophobia \& phonophobia; improvement with sleep

Back 3

Migraine

Front 4

What kind of headache?
sudden onset; unilateral; restlessness; 90 minutes of falling asleep

Back 4

Cluster

Front 5

First line abortive medication management for migraines?

Back 5

NSAIDs
(except pediatrics)

Front 6

Metaclopramide (REGLAN), Prochlorperazine (COMPAZINE), and Promtheazine (PHENERGAN) are what?

Back 6

anti-emetic drugs that can be used especially for migraine pts

Front 7

____ are "specific acute treatment" for migraines.

Back 7

Ergots

Front 8

These migraine meds are CI if over 60 yo, pregnant, PVD, etc.

Back 8

Ergots

Front 9

_____ increases rizatriptan concentration by 70%.

Back 9

Propranolol

Front 10

Eletriptan is a potent CYP ____ inhibitor.

Back 10

3A4

Front 11

Ketoconazole, itraconazole, clarithromycin, ritonavir and nelfinavir are what???

Back 11

CYP3A4 inhibitors

Front 12

This drug is CI if >65, angina/CAD, severe renal/hepatic impairment, hemilegic or basilar migranes?

Back 12

Triptans

Front 13

15% of patients on triptans report these 2 AE.

Back 13

pressure and heaviness

Front 14

NSAIDs, Isomethapetene, ergotamines, and oral triptans are used for ____ pain in HA.

Back 14

moderate

Front 15

Triptans (oral), Sumatriptan (NS/SC) and SHE (NS/IM) are used for ____ pain in HA.

Back 15

severe

Front 16

DHE (IV), Opioids, and dopamine antagonists are used for _____ pain in HA.

Back 16

extremely severe

Front 17

When is Methysergide used with migraine management?

Back 17

very last line

Front 18

What are the 5 gold standard BB's used for Migraines?
(PNATM)

Back 18

propranolol, nadolol, atenolol, timolol, and metoprolol

Front 19

T/F. Asthma, COPD, and diabetic patients should not take BB's.

Back 19

TRUE
use CCB

Front 20

3rd degree Heart block patients should not take this "blocker"

Back 20

Ca2+ channel blocker

Front 21

These two TCA's most used with migraine pain?

Back 21

Amitriptyline (Elavil)
Nortriptyline (Pamelor)

use with comorbid depression

Front 22

Cyproheptadine (Periactin) is good to use for ___ patients with migraines.

Back 22

pediatric

Front 23

With Cluster HA's - use corticosteroids, methysergide, and ergotamine for ___ term preventive therapy.

Back 23

short term

Front 24

With Cluster HA's use verapamil, lithium, antiepileptics, and melatonin for ___ term preventive therapy.

Back 24

long ter

Front 25

Oxygen, triptans, ergotamines, and intranasal lidocaines are good for this acute HA.

Back 25

cluster

Front 26

PQRST is used to question patients presenting with pain. What does it stand for?

Back 26

P - palliative/provocative
Q - quality (description of pain)
R - radiation?
S - severity
T - temporal factors

Front 27

Moderate pain is from ___ - ___.

Back 27

5-6

Front 28

What do the elderly, infants/children, differ nationalties, and the cognitively impaired have in common?

Back 28

they are all at High Risk of having their pain left untreated

Front 29

Can you use APAP alone in treating migraines?

Back 29

no - only in combos is it useful

Front 30

These pharm agents are step #1 in pain management, used for mild/moderate pain, and chronic pain.

Back 30

non-opioids (APAP, ASA, and NSAIDs)

Front 31

High doses of APAP can effect the levels of this drug.

Back 31

Warfarin

Front 32

NSAIDs are CI in CrCl < ___ ml/min.

Back 32

40

Front 33

When choosing opioid therapy for pain the elements to consider are...

Back 33

cost, severity of pain, previous exposure of an opioid or not, drug's availability, the patient's preferences - esp routes, and the pts liver/kidney function

Front 34

This opioid could be used for SOB due to it relaxing the bronchioles.

Back 34

morphine

Front 35

This opioid is not used for post-operative pain but chronic, is CI if CrCl is <50, and CI if patient has hepatic disease.

Back 35

Oxymorphone

Front 36

This opioid can accumalte if patient has renal failure leading to seizures (thus CI), has poor oral absorption, and frequently used in ER.

Back 36

Meperidine

Front 37

This opioid's oral use is mainly for break-thru pain, is NOT for opioid naive patients, can be used buccally, and can cause problems while getting an MRI.

Back 37

Fentanyl (esp the patch)

Front 38

This opioid is not for naive pts, can cause QT prolongations, should not be increased in 5-7 days after initiating, and has NMDA receptor activity.

Back 38

methadone

Front 39

Antifungals, verapamil, diltiazem, paroxentine, fluoxetine, erythormycin, clarithromycin, amiodarone, ritonavir and nelfinavir do WHAT to methadone?

Back 39

increase it's levels

Front 40

Barbs, Carbamazepine, nevirapine, phenytoin, and rifampin do WHAT to methadone?

Back 40

decrease it's levels

Front 41

Can you used ER pain meds for break-thru pain?

Back 41

no

Front 42

What % of dose should be allotted for break-thru pain? How often should use it per day?

Back 42

5-15%; TID

Front 43

Can titrate Morphine SR (24 hours) every ___ day(s).

Back 43

2

Front 44

Can titrate Fentanyl patches every ___ days(s).

Back 44

3

Front 45

Can titrate Methadone every ___ day(s).

Back 45

5-7

Front 46

If pt is still experiencing moderate pain, titrate dose up by ___-____%.

Back 46

25-50%

Front 47

This opioid agent is good for patients with renal dysfuntion.

Back 47

Hydromorphone

Front 48

Given with food or alcohol, this opioid could cause severe sedation.

Back 48

Oxymorphone

Front 49

What 4 A's should be monitored?

Back 49

Analgesia, ADL's, adverse effects, aberrant drug-taking

Front 50

Respiratory depression tolerance develops with ____ days. N/V?

Back 50

5-7; 7-10

Front 51

If treating post-operative or overdose respiratory depression, what drug to use?

Back 51

Naloxone

Front 52

Which 2 opioids should be avoid if have renal disease?

Back 52

merperidine and codine

Front 53

Fentanyl and methadone are considered to the safest if have ___ issues.

Back 53

renal

Front 54

Which 3 labs should be looked at when assessing neuropathic pain?

Back 54

vitamin b12, folate, and fasting glucose

Front 55

What are the 5-FDA approved treatments for neuropathic pain?
(CDGLP)

Back 55

carbamazepine, duloxetine, gabapentin, lidocaine patch 5%, and pregabalin

Front 56

This neuropathic pain treatment can be dosed up to 3600 mg, can cause dementia & ataxia to worsen, and is required for renal adjustment.

Back 56

gabapentin

Front 57

This neuropathic pain treatment can be dosed up to 600mg/day, must be tapered off over 7 days in inadequate, can cause weight gain, and is required for renal adjustment.

Back 57

pregabalin

Front 58

T/F. Amitriptyline has the fewest AEs.

Back 58

False; desipramine has fewest

Front 59

With this neuropathic pain drug SSRIs, TCAs, tramadol, and zyvox are CI.

Back 59

cymbalta

Front 60

With this neuropathic pain drug chronic liver disease is CI and there is an increase in sweating.

Back 60

cymbalta

Front 61

Mexiletine blocks what channels?

Back 61

sodium

Front 62

Ketalar's SEs can be prevented by this drug.

Back 62

Haloperidol

Front 63

How can methadone be used for neuropathic pain?

Back 63

Bc it is a non-competitive NMDA antagonist

Front 64

Where is Clonidine effective in neuorpathic pain?

Back 64

spinal column

Front 65

Children's dose for APAP?

Back 65

>6 months:
10-15 mg/kg q4hours

(max 5 doses/24 hrs)

Front 66

Children's dose of Ibuprofen?

Back 66

>24 lbs (11 kg):
7.5 mg/kg q6-8 hours

(max 4 doses/24 hrs)

Front 67

Which triptan has the highest 5-HT 1B receptor affinity?

Back 67

Frova (Frovatriptan)

Front 68

Which triptan is metabolized by MAO-A, CYP 3A4, CYP 2D6, and renal?

Back 68

Axert (Almotriptan)

Front 69

Which triptan has the fastes time of onset?

Back 69

Maxalt (Rizatriptan)

Front 70

Which triptan is metabolized by CYP 1A2?

Back 70

Zomig (Zolmitriptan)

Front 71

How is Imitrex mainly metabolized?

Back 71

MAO-A

Front 72

What is the general SAR of triptans?

Back 72

indole ring that mimcis tryptamine
2-3 C spacer btwn indole and amine
tertiary amines = more potent
polar H-bonders at 5-post is req

Front 73

2 differences btwn SE and Imitrex:

Back 73

dimethylamino group and 5-mthylsufonamide

Front 74

In migraines, 5-HT agonism does what 2 things?

Back 74

1. increase Ca2+ in cells (by activating Gi, dec cAMP & pka)
2. inhibits release of CGRP, SP, and Neu.A (by acting on presynaptic receptor)

Front 75

PKa usually ____ the amount of Ca2+ in the cell.

Back 75

Decreases

Front 76

This opioid is a stong Ka agonist and weak mu-OR antagonsit; used as a nasal spray.

Back 76

(-)Butorphanol (Stadol)

Front 77

This opioid is a partial mu & kappa agonist; a delta antagonist; and doesnt cause tolerance.

Back 77

(-) Buprenorphine (Buprenex, Subutex)

Front 78

This opioid is a weak mu antagonist; agonist of kappa (with some protective properties)

Back 78

Pentazocine (Talwin)

Front 79

4 requirements for pure antagonism:

Back 79

5 ring system, 7/8 dihydro-6-one ring, 14beta-OH and 3-5 C-sub N

Front 80

pure opioid antagonist resemble what opioid?

Back 80

oxymorphone

Front 81

Aldentanil (Alfenta) gets its rapid duration due to what?

Back 81

decreased pKa (~6)

Front 82

Remifentanil (Ultiva) gets its rapid duration due to what?

Back 82

it's esters

Front 83

Fentanyl gets its short duration due to what property?

Back 83

being able to redistribute

Front 84

T/F Sufentanil has more respiratroy depression.

Back 84

Falso

Front 85

The (-) enantiomer of tramadol gives what property?

Back 85

nothing; BUT it's metabolite gives some analgesic effects

Front 86

The (+) enantiomer of tramadol gives what property?

Back 86

affinity for NET and SERT

Front 87

What are the 3 properties of Dextromethorphan?

Back 87

weak mu agonist
weak NMDA antagonist
sigma agonist

Front 88

What opioid's metabolite can cause grand mal seizures?

Back 88

Merperidine's
(with chornic use get Normeperidine thru N-demethylation)

Front 89

Addition of the beta-OH group to the 14 position in opioids does what?

Back 89

increases activity

Front 90

Fibromyalgia women to men ration?

Back 90

9:1

Front 91

Low levels of cortisol and/or growth hormones could contribute to this syndrome.

Back 91

FM

Front 92

Common age range of FM patients?

Back 92

20-50 years old

Front 93

3 criteria for ACR FM diagnosis

Back 93

1. widespread pain for at least 3 months
2. axial skeletal pain for at least 3 months
3. pain in at least 11 tender sites

Front 94

This disease can be treated by: Pregabalin, AD's, analgesics, lidocaine (shot & patch), tramadol, cyclobenzaprine, sedatives, gabapentin, and capsaicin.

Back 94

FM
(NOT NSAIDs!!!)

Front 95

Dose of FDA approved Pregabalin in FM.

Back 95

150-225 mg po BID
(dizziness, somnolence, peri endema)

Front 96

Cymbalta is a ___ SE/NE reuptake inhib and Milnacipran is ___.

Back 96

potent
selective

Front 97

3 features of Milnacirpan (Savella)

Back 97

improves physical funtion
improves global assesment
decreases pain

(take with food)

Front 98

For back pain use ice within ___ hours, and heat within ___.

Back 98

12-24
24-48

Front 99

What's the 1st line for back pain?

Back 99

APAP or NSAIDs

Front 100

This is injury to soft tissue of the neck...

Back 100

whiplash

Front 101

Main places to strains?

Back 101

lower back and hamstring

Front 102

When not to take salicylates?

Back 102

pregnant/lactating, asthma or nasal polyps, on warfarin, PUD, less than 18

Front 103

When not to take NSAIDs?

Back 103

pregnant???, asthmatic, HTN or heart failure, on warfarin

Front 104

Ibuprofen and digoxin causes what>

Back 104

increase dig levels

Front 105

Topically NSAID gel is used for what?

Back 105

OA

Front 106

Tiger Muscle Rub %'s?

Back 106

3,5,15

Front 107

Women to men ration of Lupus?

Back 107

10:1

Front 108

This drug is used for resistant discoid lupus.

Back 108

Azathioprine

Front 109

What 6 drugs cause Drug-Induced Lupus?
(HPQICM)

Back 109

hydralazine (if 100mg+)
procanamide (1 mo - 12 mo)
quinidine
isoniazide
chlorpromazine
methyldopa

Front 110

What are some lupus triggers?

Back 110

pregnancy, hair dyes, UVB, physical stress, some drugs, burns, infections, surgery
NOT VIRAL

Front 111

What are 5 AB's to check with lupus?

Back 111

AB againt: ANA, PL's, Sm, DNA, and histone (drug induced)

Front 112

Initial clinical presentation of lupus:

Back 112

fever, fatigue, and muscloskeletal pain

Front 113

In moderate to severe lupus use this drug

Back 113

Cytoxan

Front 114

Ages of MG?

Back 114

females < 40
Males > 60

Front 115

Medications to avoid if have MG?

Back 115

lithium, phenytoin
aminoglycosides, fluoroquinolones
tetracycline
lidocaine, quinidine and procainamide

Front 116

This drug is the standard of care for MG?

Back 116

Azathioprine (along with predinsone)