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23 Cards in this Set
- Front
- Back
What should you prescribe for pain?
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Mild (0-3): NSAID, APA, or ASA
Moderate (4-6): add opioid, for neuropathic: AD/anticonvulsant, for bone: NSAID Severe (7-10): dose regularly, extra drug PRN |
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What is COX-1 in charge of? COX-2?
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Cox-1: PLATELET AGGREG (tA2)
Cox-2: PLATELET INHIB (prostacyclin) |
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What is the biggest difference between Non-opioid analgesics and opioids?
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CEILING effect, but NO tolerance
Opioids have NO ceiling effect |
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What should you give for neuropathic pain?
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TCA, anticonvulsant (GABAPENTIN, pregabalin)
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What are the non-opioid analgesics?
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APAP, NSAIDs, Cox-2 selective inhibitors, tramadol (ish)
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What is the MOA of acetaminophen (APAP)?
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Blocks PG synthesis in CNS -> analgesic and antipyretic
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What are the AEs of acetaminophen (APAP)?
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Low effect on COX in periphery so good for GI, no renal tox
HEPATIC TOX at high doses, MCC drug-induced Dose <3250 mg/day for chronic use |
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What should you watch out for/CI with acetaminophen (APAP)?
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Hidden APAP (tylenol and percocet)
Dec liver enzymes (glutathione) with ETOH, prior liver dz, Isoniazid/Zidovudine |
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What is the use of acetaminophen (APAP)?
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Mild-Mod pain or Additive with opioids
DOC for OSTEOARTHRITIS Good for ASA allergies, GI sensitivity, bleeding disorders |
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What are the NSAIDs for analgesia?
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Ibuprofen, Ketoprofen, Naproxen (Na), Etodolac, Ketorolac
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What are the NSAIDs for anti-inflammatory?
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Oxaprozin, Piroxicam, Nabumetone, Sulindac
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What is the MOA of NSAIDs?
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Block arachidonic acid cascade at COX1 and COX2 -> dec PG synthesis (PGE2: pain-nociceptors and fever-hypothalamus)
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What are the AEs of NSAIDs?
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GI (PGE1 with COX1): minor dyspepsia, triad (ULCER, OBSTRUCTION, BLEEDING)
RENAL (PGE2 with COX2): edema, HTN, heart failure Reversible platelet inhibition (D/C before surgery) Hypersensitivity (asthma, anaphylaxis), Hepatotox (rare) |
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What are the cautions/CIs of NSAIDs?
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GI: >60 YO, HX PUD, chronic use, tob/etoh, drugs
Nabumentone, Etodolac (low risk) -> Indomethacin (high risk) Renal: age, HF, renal insuff, volume depletion, HTN PREGNANCY! |
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What should you prescribe for GI AEs/protection? What should you go for renal AEs?
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Misoprostol helps ulcers, not dyspepsia (AE: diarrhea, good for NSAIDs/opioids)
Proton Pump inhibitors (Omeprazole): DOC Renal: monitor Cr, rx Etodolac or avoid all NSAIDs if >2.5 |
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What drug interactions do NSAIDs have?
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Protein bound (warfarin,sulfonylureas, ANTICONVULSANTS)
anti-HTN drugs (diuretics, ACE-I, BB) INC lithium |
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What is the use of NSAIDs?
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Minor aches/pains, bone pains
Ceiling effect (combine with opioids) |
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What are Naproxen (Na), Etodolac, and Ketorolac good for? When is it not appropriate to use Oxaprozin or Piroxicam?
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Naproxen (Na): Na for fast onset, 1st line for dysmenorrheal
Etodolac: less GI Ketorolac: only IV Oxaprozin/Piroxicam: not short term, T1/2 > 50 hrs |
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What are the COX2 selective inhibitors?
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Rofecoxib, Valdecoxib taken off
CELECOXIB |
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What are the AEs and uses of Celecoxib?
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Thrombosis/CV: clots
Hypersensitivity: sulfa allergy, rxn to aspirin/NSAIDs Nephrotoxic Use in pts with high GI risk, no cardiac hx NOT with low-dose aspirin |
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What is Tramadol? When are its AEs? When should it be used?
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Weak opioid agonist (mu receptor)
Mild opioid-like AE, INC SEIZURES (bad with bupropion, TCAs), SEROTONIN syndrome (ADs, meperidine) Use for mod-severe pain, alternative to NSAID/opioids |
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What are the adjuvant agents for pain?
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ADs and others
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What are the ADs for pain? When are they used?
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TCAs: Amitriptyline (anticholinergic AEs), Nortriptyline (better AEs)
Use: fibromyalgia, migraine, neuropathic pain Venlafaxine: neuropathic pain, HA, fibromyalgia Duloxetine: Diabetic peripheral neuropathy |