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23 Cards in this Set

  • Front
  • Back
What should you prescribe for pain?
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
What is COX-1 in charge of? COX-2?
Cox-1: PLATELET AGGREG (tA2)

Cox-2: PLATELET INHIB (prostacyclin)
What is the biggest difference between Non-opioid analgesics and opioids?
CEILING effect, but NO tolerance

Opioids have NO ceiling effect
What should you give for neuropathic pain?
TCA, anticonvulsant (GABAPENTIN, pregabalin)
What are the non-opioid analgesics?
APAP, NSAIDs, Cox-2 selective inhibitors, tramadol (ish)
What is the MOA of acetaminophen (APAP)?
Blocks PG synthesis in CNS -> analgesic and antipyretic
What are the AEs of acetaminophen (APAP)?
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
What should you watch out for/CI with acetaminophen (APAP)?
Hidden APAP (tylenol and percocet)

Dec liver enzymes (glutathione) with ETOH, prior liver dz, Isoniazid/Zidovudine
What is the use of acetaminophen (APAP)?
Mild-Mod pain or Additive with opioids
DOC for OSTEOARTHRITIS

Good for ASA allergies, GI sensitivity, bleeding disorders
What are the NSAIDs for analgesia?
Ibuprofen, Ketoprofen, Naproxen (Na), Etodolac, Ketorolac
What are the NSAIDs for anti-inflammatory?
Oxaprozin, Piroxicam, Nabumetone, Sulindac
What is the MOA of NSAIDs?
Block arachidonic acid cascade at COX1 and COX2 -> dec PG synthesis (PGE2: pain-nociceptors and fever-hypothalamus)
What are the AEs of NSAIDs?
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)
What are the cautions/CIs of NSAIDs?
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!
What should you prescribe for GI AEs/protection? What should you go for renal AEs?
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
What drug interactions do NSAIDs have?
Protein bound (warfarin,sulfonylureas, ANTICONVULSANTS)

anti-HTN drugs (diuretics, ACE-I, BB)

INC lithium
What is the use of NSAIDs?
Minor aches/pains, bone pains

Ceiling effect (combine with opioids)
What are Naproxen (Na), Etodolac, and Ketorolac good for? When is it not appropriate to use Oxaprozin or Piroxicam?
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
What are the COX2 selective inhibitors?
Rofecoxib, Valdecoxib taken off

CELECOXIB
What are the AEs and uses of Celecoxib?
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
What is Tramadol? When are its AEs? When should it be used?
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
What are the adjuvant agents for pain?
ADs and others
What are the ADs for pain? When are they used?
TCAs: Amitriptyline (anticholinergic AEs), Nortriptyline (better AEs)

Use: fibromyalgia, migraine, neuropathic pain

Venlafaxine: neuropathic pain, HA, fibromyalgia
Duloxetine: Diabetic peripheral neuropathy