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37 Cards in this Set
- Front
- Back
What are the types of pain?
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Acute - caused by injury, illness, or surgery - associated with physical symptoms (hypertension, tachycardia, diaphoresis)
Chronic benign - exists beyond an expected time for healing - associated with psychological effects (depression, anxiety) |
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Acetaminophen MOA, Max dose, Contraindications
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MOA: central cyclooxygenase inhibition and decreased prostaglandin synthesis
Max dose: 4,000 mg Contraindications: Hepatic disease, Alcoholism |
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Aspirin MOA, Max dose, Contraindications
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Inhibition of prostaglandin synthesis
5.4 g/day Allergy, Fever in children, Active bleeding ***Anti-inflammatory only at high doses 3 g/day |
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Name the non-acetylated salicylates
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Salsalate
Diflunisal |
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What are the primary side effects of NSAIDs
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GI upset, bleeding
Diminished renal function Edema Rash Increased blood pressure |
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Name the acetic acids
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Etodolac
Diclofenac (Voltaren, Flector, Zipsor, Cataflam) Indomethacin (Indocin) Ketorolac (Toradol) Nabumetone (Relafen) |
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Name the propionic acids
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Fenoprofen
Flurbiprofen Ibuprofen (Motrin, Advil, Caldolor) - Max dose 3.2 g/day Ketoprofen Naproxen (Naprosyn, Naprelan) Naproxen sodium (Anaprox) Oxiprozin |
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Name the fenamates
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Meclofenamate (Meclomen)
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Name the oxicams
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Piroxicam (Feldene)
Meloxicam (Mobic) |
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Name the selective COX-2 inhibitor
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Celexocib (Celebrex)
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Many NSAIDs have these three drug interactions
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Warfarin
ACE Inhibitors Lithium |
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Key counseling point with NSAIDs
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Take with food
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What is unique about indomethacin?
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Fat-soluble - crosses BBB and can cause CNS disturbances
Most commonly used to treat gout |
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NSAIDs only have the contraindication of hypersensitivity, except Ketorolac which has these contraindications
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Active PUD or bleeding
History of bleeding Severe renal impairment Labor and delivery ***It is only approved for mod-severe pain and for less than 5 days duration due to risk of GI and renal dysfunction*** |
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What is unique about the oxicam NSAIDs?
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They have more COX-2 selectivity than other NSAIDs and slightly less GI symptoms
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What differentiates celecoxib?
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Few GI toxicity than with NSAIDs
Cardiovascular adverse effects prompted withdrawal of rofecoxib from market |
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Vicodin/Lortab
Tylenol #3 |
Hydrocodone/APAP
Codeine/APAP |
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Embeda
Avinza/Kadian |
Morphine sulfate/naltrexone
Morphine sulfate extended release |
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Percocet/Roxicet
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Oxycodone/APAP
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Duragesic
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Fentanyl
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Dilaudid
Demerol |
Hydromorphone
Meperidine |
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Dolophine
Nucynta |
Methadone
Tapentadol |
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Types of pain continued
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Malignant pain - may be acute, chronic, or intermittent - often related to cancer or chemotherapy
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Pain is also defined by source - describe the difference between somatic, visceral and neuropathic pain
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Somatic originates from skin, muscles, tendons, ligaments, and bones - localized, sharp, throbbing, or aching in nature
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Visceral
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Visceral pain originates from organs such as liver, intestine, stomach - poorly localized, likely to generate "referred pain"
***Opioids not as effective*** |
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Neuropathic
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Results from nerve damage - typically burning in nature, also aching, numb, electric shock
***Opioids usually ineffective*** |
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Differentiate binding of the mu, kappa and delta opioid receptors
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mu - analgesia, sedation, euphoria, respiratory depression, physical dependence, constipation
kappa - analgesia, respiratory depression (also anxiety, strange thoughts, nightmares, hallucination more common) delta - analgesia with no adverse effects (no available delta agonists) |
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Describe the adverse effects of opioid antagonists
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CNS - sedation, euphoria
Neuroendocrine - altered hormone levels, convulsions (very high doses) Respiratory - depression, decreased cough Cardiovascular - vasodilation, orthostatic hypotension Gastrointestinal - N/V, constipation (no tolerance) |
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adverse effects continued
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Genitourinary - urgency/retention
Biliary - Decreased biliary and pancreatic secretion Skin/Eye - Flushing, sweating, pruritis |
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Fentanyl
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Injection (Sublimaze)
Transdermal (Duragesic) Lozenge (Actiq) Disintegrating tablet (Fentora) |
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Hydromorphone
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Dilaudid
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Levorphanol
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Levo-Dromoran
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Methadone
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Tablet (Dolophine)
Liquid (Methadose) Injection (Methadone) |
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Morphine
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IR tablet (MSIR)
Liquid (MSIR) Injection (Duramorph, Astramorph) CR tablet (Avinza, Kadian, MScontine, Oramorph) |
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Oxycodone
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Tablet (Roxicodone)
Capsule (OxyIR) CR tablet (Oxycontin) |
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Oxycodone/APAP
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Percocet
Roxicet |
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Oxymorphone
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Opana
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