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70 Cards in this Set

  • Front
  • Back
Neuropathic pain medications all increase what neurotransmitters?
serotonin
NE
What antidepressant increases serotonin and NE, making it a good choice for a depressed patient with chronic pain?
venlafaxine
NSAIDs have what two mechanisms which eventually cause stomach ulcers?
burns the stomach lining

prevents stomach from protecting itself with a mucous membrane
What pain med is not anti-inflammatory, but do not cause ulcers?
acetaminophen
What pain meds are better for rheumatoid arthritis because they are anti-inflammatory?
NSAIDS
What medication increases the mucous membrane of the stomach?
misoprostol
What medications have no beneficial effect on the stomach lining, but are better tolerated?
PPIs
Analgesia is caused by opioids acting on what receptor?
mu
oxycodone + tylenol =
percocet
oxycontin =
slow release oxycodone
hydrocodone + tylenol =
vicodin
tylenol + codeine =
tylenol # 3
High doses of methadone may cause what side effect?
increased QTc interval
Respiratory depression is possible if high doses of opiates are taken with what other drugs?
benzos
alcohol
What should always be done if opiate therapy is going to be used for awhile?
switch to long acting opioid
What component of pain is a "reaction to pain to avoid tissue damage"?
sensory component
What component of pain is a "recognition of potentially painful actions and consequences"?
cognitive component
What component of pain is a "emotional response to pain that can impact the perceived intensity of the pain"?
emotional component
What are the 2 types of addaptive pain?
nociceptive

inflammatory
What type of pain is caused by heat, cold, intense mechanical force, or chemical irritants?
nociceptive (adaptive)
What are the 2 types of maladaptive pain?
neuropathic

functional
What type of pain is caused by an abnormal central processing of pain and increased sensitivity?
functional (maladaptive)
What is the pathway of a pain signal?
nociceptors stimulated
sent to dorsal root ganglion in spinal cord
travels up spinal cord to cortex
What does PQRST stand for in pain assessment?
P = precipitant
Q= quality
R= region
S= subjective (impact on life)
T= time related (when is it worse)
What antidepressants should be used before TCAs for neuropathic pain?
venlafaxine
duloxetine
mirtazapine
Which drug is a serotonin/NE reuptake inhibitor and an opiate agonist?
tramadol
How do NSAIDs work?
block COX
reduce PGE2 and PGI2

decreases nociception
decreases central pain transmission
decreases inflammation
NSAIDs that block what enzyme theoretically cause less ulcers?
COX2 inhibitors
What NSAID is potent and good for gout pain?
indomethacin
What is the only COX2 selective NSAID on the market?
celebrex
What is the recommended limit of daily dose of acetaminophen to avoid hepatotoxicity?
< 4g
Which opiate is metabolized by glucuronidation and does not go through the CYP450 system?
morphine
Which opiate's active metabolite is morphine
codeine
Which opiates are broken down to the active metabolite oxymorphone?
oxycodone
hydrocodone
Which opiate should never be used due to cardiotoxicity?
propoxyphene (darvon)
What neuropathic pain meds are calcium channel blockers?
gabapentin
pregabalin
What neuropathic pain meds are sodium channel blockers?
carbamazepine
lidocaine
oxcarbazepine
lamotrigine
What antidepressants have anticholinergic effects and should be avoided in the elderly with neuropathic pain?
TCAs
What neuropathic pain med should be avoided in elderly patients with increased risk of falls?
gabapentin
What are the first line treatments for neuropathic pain?
gabapentin or pregabalin

SNRIs

TCAs

5% lidocaine patch for localized pain
Why is carbamazepine not a good choice for neuropathic pain?
many DDIs
What drug slows the progression of arthritis?
glucosamine sulfate
What meds can be used in prophylactic therapy for migraines?
propranolol
TCAs
valproic acid
topiramate
How do opiates relieve pain?
reduce centrally mediated pain transmission

inhibits pain signal
How do neuropathic pain meds relieve pain?
reduction in central and neuronal level firing rates
What are causes of Na depletion?
primary renal disease
adrenal insufficiency
diuretic therapy
During volume depletion, urine Na concentration is usually what?
<15 mEq/L
During volume depletion, the fractional excretion of Na is usually what?
<1%
During volume depletion, the urine osmolality is usually what?
>450 mOsm/kg
What is the ratio of BUN to creatinine usually in volume depletion?
> 20:1 (BUN:Cr)
A urine Cl concentration of <10 mEq/L may be seen if volume depletion is combined with what condition?
metabolic alkalosis
Edema will occur if ECF volume accumulates to what levels?
>2.5 L
In the absence of cardiac or cerebral vascular disease, blood products should be given at what Hb level?
<7g/dl
Patients with coronary or cerebral vascular disease should be given blood products when their Hb level is what?
<10 g/dl
Patients may need infusion of clotting factors or FFP if they have received how many units of blood?
> 8-10
How quickly can infusion pumps replenish fluids and blood?
1 L of fluids in 10-15 min
1 unit blood in 20 min
Adults in shock are given how much fluid?
1 L
Children in hypovolemic shock are given how much fluid?
20 mL/kg
How quickly should fluids be given in intravascular volume depletion?
500 mL/hour
Adequate end-organ perfusion is best indicated by a urine output of what?
> 0.5-1 mL/kg/hr
Volume depletion should be assumed in a sick/injured patient with a CVP of what?
< 3 mm Hg
How much of an increase in CVP in response to a 100 mL fluid bolus suggests limited cardiac reserve?
> 3-5 mm Hg
Patients with hemorrhagic shock from a visceral lac should not receive fluid resucitation at a MAP of what?
60-80 mm Hg
To minimize the use of blood products during hemorrhagic shock, a target Hct of what is used?
Hct 23-28%
What crystalloid fluid should not be used to replace intravascular volume?q
Dextrose 5%
What crystalloid fluid only adds to the extra cellular fluid?
normal saline
What crystalloid fluid is excellent at replacing intravascular volume?
5% albumin (plasma protein solutions)
What maintenance fluid has a net effect of administering pure water and is distributed throughout the total body water?
Dextrose 5%
What is the distribution of 1,000 mls of Dextrose 5%?
2/3 to ICF
1/3 to ECF
Dextrose 5% will cause what change in ADH?
ADH will decrease
(renal water excretion will rise)