Pain

Front 1

Mild Pain(1-3)

Back 1

APAP

ASA

NSAIDS

COX 2

Front 2

Moderate Pain (4-7)

Back 2

NSAIDS

Opioid + APAP

Tramadol

Front 3

Severe pain (8-10)

Back 3

Opioids

Front 4

Aspirin

Back 4

Back (Definition)

Front 5

NSAID Selectivity

Back 5

Back (Definition)

Front 6

Cox 2 inhibitor - Celebrex Advantages

Back 6

Advantage over nonselective

Decreased pain and inflammation with minimal GI side effects

No effect on platelet aggregation- improves bleeding profile

Front 7

Cox 2 inhibitor - Celecoxib - Disadvantages

Back 7

Disadvantages

Rénal Dysfunction

Avoid patients with a "sulfa allergy"

CV events

Front 8

Phenanthrenes

Back 8

Morphine

Hydromorphone

Levorphenol

Oxymorphone

Codéine

Hydrocodone

Oxycodone

Front 9

Phenylpiperidines

Back 9

Meperidine

Fentanyl

Sulfentanil

alfentanyl

Remifentanyl

*all have serotenergic properties

Front 10

Phenylheptanes

Back 10

Methadone

Front 11

Morphine

Back 11

Back (Definition)

Front 12

NSAIDS adverse events

Back 12

Back (Definition)

Front 13

NSAIDS BBW

Back 13

Back (Definition)

Front 14

NSAIDS: TORADOL

Back 14

Back (Definition)

Front 15

NSAIDS: KETORALAC | TORADOL

Back 15

Back (Definition)

Front 16

COX 2 - CELECOXIB | CELEBREX

Back 16

Back (Definition)

Front 17

HYDROMORPHONE

Back 17

Back (Definition)

Front 18

METHADONE

Back 18

Back (Definition)

Front 19

CODEINE

Back 19

Back (Definition)

Front 20

HYDROCODONE

Back 20

Back (Definition)

Front 21

FENTANYL

Back 21

Back (Definition)

Front 22

Explain how acetaminophen blocks pain impulse generation

Back 22

Inhibits the synthesis of prostaglandins in the CNS

Front 23

Your patient has medical conditions of active hepatitis B, osteoarthritis, and psoriasis. What would be a safe dose of Acetaminophen for this patient’s treatment of OA related to joint aches?

Back 23

Maximum 2g per day for hepatic impairment

Metabolized by liver

If patient does not have liver impairment or alcoholism: max dose: 4g/day

Front 24

Name 3 adverse events related to NSAID use

Back 24

GI bleed

Acute Kidney Injury

Fluid Overload / Retention

Avoid use with other nephrotoxic drugs ie. lasix,ace inhibitors

Front 25

COX inhibition

Back 25

Back (Definition)

Front 26

True or False: Celecoxib is a COX 2 inhibitor that may be used in the prevention of CV events in patients with a hx of GI ulcers and no allergies to sulfa

Back 26

FALSE ; COX 2 inhibitors have a high risk for CV events and have no effect on platelet aggregation. COX 2 has anti platelet and vasodilation properties when blocked it causes clotting but decreases inflammation

Front 27

Name 3 different types of medications from different classes that treat neuropathic pain

Back 27

SNRIs (Duloxetine)

Gabapentin (calcium ion ligand channel blockers)

Nortryptylline (TCA)

Front 28

Your 70yo patient receives 10mg IVP morphine over 5 minutes for a complaint of crushing chest pain. You notice his O2 saturation is 85% and his RR has dropped to 6 breaths per minute. What is the best medication to treat in this emergent situation?

Back 28

Naloxone for acute reversal

Front 29

Your patient presents to the ED complaining of 10/10 low back pain. When evaluating the appropriate pain intervention you note that he/she has an allergy to morphine. What would be a safe and appropriate medication to receive for severe pain?

Back 29

Meperidine (subclass: Phenylpiperidines)

Morphine is in the opioid agonist class of phenanthrene.

Use a drug in a different sub class.

Front 30

Name three side effects that are not expected from morphine

Back 30

Liver failure, tachycardia, diarrhea

Expected side effects: hallucinations, pruritis , respiratory depression

Front 31

Your patient with cancer related pain reports inadequate relief from current interventions. You consider starting him on methadone due to his high tolerance of opiates. Which test would be the MOST important to complete before you prescribe methadone?

Back 31

EKG

Methadone has risk for prolonged QT interval. QT must be <500.

Front 32

If your patient receives 1.5mg of hydromorphone IVP, and the prescriber decided to change the prescription to morphine. Which is the appropriate correlating dose?

Back 32

10mg IVP (Ratio is 1.5 to 10)

Front 33

ANTAGONIST

Back 33

Back (Definition)

Front 34

ANTAGONIST

Back 34

Back (Definition)

Front 35

OPIOID CONVERSIONS

Back 35

Back (Definition)

Front 36

TRAMADOL

Back 36

Back (Definition)

Front 37

CLASS WIDE OPIOID ADVERSE EFFECTS

Back 37

Back (Definition)

Front 38

Dependence VS Tolerance

Back 38

Back (Definition)

Front 39

TOLERANCE DEVELOPMENT

Back 39

Back (Definition)

Front 40

CONSIDERATIONS: CHRONIC PAIN REGIMENS

Back 40

Back (Definition)

Front 41

TREATMENT STRATEGIES FOR NEUROPATHIC PAIN

Back 41

Back (Definition)

Front 42

Aspirin | Salicylates

Back 42

Irreversibly binds to COX 1 and COX 2 enzymes

Antiinflammatory

Antipyretic

Anti platelet (irreversible)

Analgesia

Front 43

ASPIRIN TIME

Back 43

Onset = 15-20

Peak = 1-3

Half-life = 3

Élimination = Urine & Liver