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102 Cards in this Set
- Front
- Back
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T/F
all controlled substances are narcotics |
false; but all pure agonist narcotics are controlled substances
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A drug with a currently acceptable medical use with severe restrictions as the abuse potential is high...are what schedule of narcotic?
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schedule 2
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Heroine, LSD, and Marjiuana are what schedule of narcotic?
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Schedule 1
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What schedules can PA's write for?
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3, 4, 5,
Can write schedule 2 for inpatients, and 1 week of schedule 2 upon discharge |
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Vicodin, Tylenol with codiene are what schedule of narcotic?
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schedule 3
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Benzodiazepine's are what schedule of narcotic? What is a big problem with benzo withdrawal?
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Schedule 4, and benzo withdrawal can cause seizures
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What schedule of drug has high potential for abuse but less so thatn the substances of 1 and 2?
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obviously...schedule 3, such as vicodin, lortab, T3
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What schedule of drug have a limited physical or psychological liability relative to the other schedules, examples are Robitussin AC, lomotil...
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schedule 5
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What is the MOA of narcotic analgesics?
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reduce perception of pain
4 brain receptors of pain |
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What narcotic is opium poppy derived
is the gold standard to what other narcotics are compared oral, injectable, rectal options for moderate to severe pain |
morphine
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1mg of IV MS equals __mg of PO MS.
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3 mg
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Why is MS part of MONA?
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for its vasodialator effects
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fentanyl, such as Duragesic patches, or "suckers" are useful in what situations?
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pt's unable to swallow
for chronic pain |
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What are problems seen with duragesic patches?
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takes 12-18 hours to work
difficult to titrate dose patch is changes q3days |
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Dilaudid works especially well with what type of pt? And what is a problem with it?
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dialysis pt's
increased respiratory depression |
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oxycontin, percocet and percodan are all forms of what narcotic?
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oxycodone
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What narcotic is only available orally, is highly abusable and snortable, is a very good analgesic, but is not better than oral dilaudid or fentanyl?
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oxycodone
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Demerol should not be used in pt's with altered __ function.
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renal-is metabolized to neurotoxic byproduct. pt's with compromised renal fcn will not tolerate well
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What narcotic is better as a cough syrup than a analgesic?
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codeine
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Codeine is considered a __-drug as it gets metabolized to MS...if the pt has the enzyme to do so.
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pro-drug
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hydrocodone always comes with what?
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tylenol
motrin asa these are all good as transition meds from parenteral to otc |
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Darvon, darvocet are what schedule and what are they good for?
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schedule 4, good for mild pain
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Name 2 partial agonist narcotics
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nubain
stadol |
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What is a major problem with Nubain?
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it has a ceiling effect, the 2nd dose doesn't work as good as the first.
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What is the MOA of nubain and stadol?
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it binds to narcotic receptors and activates it.
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hydrocodone always comes with what?
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tylenol
motrin asa these are all good as transition meds from parenteral to otc |
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Darvon, darvocet are what schedule and what are they good for?
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schedule 4, good for mild pain
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Name 2 partial agonist narcotics
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nubain
stadol |
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What is a major problem with Nubain?
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it has a ceiling effect, the 2nd dose doesn't work as good as the first.
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What is the MOA of nubain and stadol?
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it binds to narcotic receptors and activates it.
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What is the methods that Stadol can be given? What works faster?
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IM, IV, NS.
nasal spray works the fastest |
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T/F
Stadol is not addictive. |
false; easily addictive
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What are the DOC for cancer pain?
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lots of continuous narcotics
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What are the maximum amt. of pure narcotics that you can give a patient?
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there is no maximum, give them as much as needed.
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What do you adjust your pt's narcotic dose to?
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1-effectiveness
2-adverse effects |
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What is the dose limiting side effect of narcotics?
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respiratory depression (fatal in overdose)
8-12 respirations per minute is the minimum |
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What are some non-dose limiting side effects of narcotics?
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-constipation
-euphoria -rash/itching |
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What do you give a pt. who has constipation from their narcotics?
1-stool softeners 2-stimulant laxative 3-fleets enemas |
stimulant laxatives
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Is a rash necessarily a reason to d/c a med?
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no, a rash is not an allergy, just a side effect
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Why do narcotics cause constipation?
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they slow GI motility.
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The need to increase the dose of opioid to achieve the same level of analgesia..is what?
-physical dependance -addition -tolerance -pseudoaddiction |
tolerance to narcotics
-will need to titrate dosages up over time |
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primary, chronic disease linked to genetic, psychosocial, and environmental factors; paitens have impaired control over drug use, compulsive use, continued use despite harm, cand craving for more...is ?
-tolerance -addiction -substance abuse |
addiction
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adaptation to a drug class noted by a specific withdrawal syndrome that can be produced by abrupt discontinuation or administration of an antagonist...is what?
-substance abuse -tolerance -physical dependence |
physical dependence
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a pattern of drug-seeking behavior in patients who are receiving inadequate pain control; that can be mistaken for addiciton..is ?
-addiction -tolerance -pseudoaddiction |
pseudoaddiction
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the use of any chemical for non-therapeutic purposes, or the use of medicaiton for purposes other than those for which it is prescribed..is ?
-addiction -substance abuse -pseudoaddiction |
substance abuse
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Is COX 1 or COX 2 responsible for prostaglandins that mediate pain, inflammation, fever, etc?
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cox 2
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What do COX 1 do?
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prostaglandins that protect GI mucosa and participate in hemostasis, renal perfusion, platelet aggregation, etc.
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Cyclooxygenase mediates conversion of arachidonic acid to prostaglandins and thromboxane A2 is the MOA of what?
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Cox inhibitors
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ASA inhibits what COX's?
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1 & 2
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What is an OTC alternative to ASA? that is both a cox 1&2 inhibitor.
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ibuprofen-has a short half life
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What NSAID is good only for the tx of gout or pericarditis, and not anything else?
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INDOMETHICIN/INDOCIN
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Which is worse for GI side effects, ibuprofen or indocin?
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indocin is slighly worse on the gut
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Another name for ketorolac is ?
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toradol
Vitamin V!!!!! ...sucks really |
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What is the maximum amount of time toradol can be given and why?
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5 day limit due to its harsh activity on the gut-worse than ASA
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The good thing about toradol is its alternative ....?
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route of administration
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Which NSAID may be a little better for long term use?
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relafen or lodine
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What is the bottom line management of a pt's pain and medication use?
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use what works
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What is the major s/e of all NSAID's?
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-GI EFFECTS
-renal effects-renal blood flow needs prostaglandins, too much inhibition will lead to renal failure -antiplatelet effects:promotes GI blding, blding everywhere -Pregnancy problems-can lead to PDA premature closure |
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What meds are more specific than NSAID's, inhibit COX 2, littil COX 1 inhibition?
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COX 2 inhibitors
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Celebrex is an example of what class of drug?
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cox 2 inhibitor
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T/F
Cox 2 inhibitors have both analgesic and anti-inflammatory properties. |
false; NO anti-inflammatory
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Can a pt. take an NSAid and a COX2?
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yep; sure can
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What drug inhibits Cox 1 & 2 but only works in the CNS?
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acetominophen
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Can you take tylenol and a Nsaid?
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yes, please do as tylenol has no antiinflammatory process.
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What is the maximum dose a day of tylenol for adults and kids?
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adults 4gm/qd
kids 10-15mg/kg/q 4 hrs. |
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What is tylenol used for?
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pain
fever osteoarthritis-DOC |
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What is the DOC in the tx of osteoarthritis?
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TYLENOL
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What is the most common drug in overdose?
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tylenol
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What are the 3 components to tylenol overdose treatment?
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-gastric lavage
-activated charcoal -acetylcysteine (mucomyst) |
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When is gastric lavage appropriate in a tylenol overdose?
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within 1-2 hours of ingestion
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What does activated charcoal do?
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it binds to whatever is left in the stomach and intestinal tract and prevents absorption.
It also gives your pt. diarrhea, so they poop the rest out quickly |
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What is the additive to charcoal that causes the diarrhea?
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sorbitol
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When is it appropriate to use activated charcoal in a tylenol overdose?
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within the first 1-2 hours of ingestion
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What does sorbitol do to cause diarrhea?
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it causes hypermotility within the gut, causes diarrhea
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What does acetylcysteine do to tylenol in an overdose situation?
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it binds to acetominophen metabolites and kicks it out of the body
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When should mucomyst be used in a tylenol overdose?
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within hours of ingestion...
p.s...it stinks really bad |
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What pain medicine binds to the same receptors as narcotics, but is not a narcotic? This drug also has some anti-depressant qualities r/t its serotonin reuptake properties?
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tramadol/ultram
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What is the maximum dose of Ultram that can be given a day?
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400mg/qd
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What is ultram used for?
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mild to moderate pain especially in a narcotic abuser.
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What is the prime s/e of ultram?
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nausea
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What are narcotic antagonists?
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the antidotes of narcotics
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What is the benefit to narcotic antagonists?
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save a life if OD
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What are the risks to narcotic antagonists?
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precipitate withdrawal especially narcotic tolerant patients
reactivate pain |
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Name 2 drugs that are narcotic antagonists?
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narcan
revex |
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What is the dose of narcan in the event of an opiod antagonist?
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0.2-0.4mg IV every 5 minutes until desired effect.
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When is it appropriate to use Revex instead of Narcan?
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only when narcan is not available as its onset of action is slower.
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T/F
Pt's who use PCA tend to use a little more narcotics then other patients, not on PCA. |
false; pca pt's tend to use less
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What medications can be used in a PCA?
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-meperidine
-morphine -dilaudid |
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The route of narcotic administration that is preferred is?
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oral whenever possible
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topical narcotics are good for narcotic tolerant patients?
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yep
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Does periodic pain need scheduled narcotic dosing?
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no-prn pain meds are appropriate
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Parenteral pain meds are used for what type of pain?
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acute pain-as they have quick onset
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T/F
there is no maximum dose of pure narcotics. |
true; give as much as they need
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What types of drugs can be used as adjunctive therapies to narcotic pain mgt?
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TCA's
SSRI's anti-convulsants local agents (capsaicin) or (lidocaine) |
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What are some s/e of the use of SSRI's in the tx of pain?
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sexual side effects
withdrawal with abrupt d/c nausea if poorly titrated |
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lidocaine, marcain, capsiacin, novocaine, and nesacaine are all examples of what ?
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topicals that can be used in the tx of pain.
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What is the 1st line DOC therapy in tx of neuropathic pain?
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lyrica (pregabalin)
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Lyrica is a good drug why?
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limited drug interactions
works in a couple of days not nearly as sedating...but might be habit forming |
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What is 2nd line tx for neuropathic pain?
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Neurontin
-it has no drug interactions but is slow acting takes a couple of weeks to work, and is eliminated by the kidneys |
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What drug is 3rd line tx for neuropathic pain?
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Tegretol
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What is a problem with Tegretol?
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enzyme inducer so it increases some drug metabolism so you must watch when starting or stopping other drugs
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Tegretol, dilantin, neurontin, and lyrica are what class of drugs?
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anti-convulsants
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