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70 Cards in this Set
- Front
- Back
Neuropathic pain medications all increase what neurotransmitters?
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serotonin
NE |
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What antidepressant increases serotonin and NE, making it a good choice for a depressed patient with chronic pain?
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venlafaxine
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NSAIDs have what two mechanisms which eventually cause stomach ulcers?
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burns the stomach lining
prevents stomach from protecting itself with a mucous membrane |
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What pain med is not anti-inflammatory, but do not cause ulcers?
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acetaminophen
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What pain meds are better for rheumatoid arthritis because they are anti-inflammatory?
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NSAIDS
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What medication increases the mucous membrane of the stomach?
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misoprostol
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What medications have no beneficial effect on the stomach lining, but are better tolerated?
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PPIs
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Analgesia is caused by opioids acting on what receptor?
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mu
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oxycodone + tylenol =
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percocet
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oxycontin =
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slow release oxycodone
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hydrocodone + tylenol =
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vicodin
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tylenol + codeine =
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tylenol # 3
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High doses of methadone may cause what side effect?
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increased QTc interval
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Respiratory depression is possible if high doses of opiates are taken with what other drugs?
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benzos
alcohol |
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What should always be done if opiate therapy is going to be used for awhile?
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switch to long acting opioid
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What component of pain is a "reaction to pain to avoid tissue damage"?
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sensory component
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What component of pain is a "recognition of potentially painful actions and consequences"?
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cognitive component
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What component of pain is a "emotional response to pain that can impact the perceived intensity of the pain"?
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emotional component
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What are the 2 types of addaptive pain?
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nociceptive
inflammatory |
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What type of pain is caused by heat, cold, intense mechanical force, or chemical irritants?
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nociceptive (adaptive)
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What are the 2 types of maladaptive pain?
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neuropathic
functional |
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What type of pain is caused by an abnormal central processing of pain and increased sensitivity?
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functional (maladaptive)
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What is the pathway of a pain signal?
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nociceptors stimulated
sent to dorsal root ganglion in spinal cord travels up spinal cord to cortex |
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What does PQRST stand for in pain assessment?
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P = precipitant
Q= quality R= region S= subjective (impact on life) T= time related (when is it worse) |
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What antidepressants should be used before TCAs for neuropathic pain?
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venlafaxine
duloxetine mirtazapine |
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Which drug is a serotonin/NE reuptake inhibitor and an opiate agonist?
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tramadol
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How do NSAIDs work?
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block COX
reduce PGE2 and PGI2 decreases nociception decreases central pain transmission decreases inflammation |
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NSAIDs that block what enzyme theoretically cause less ulcers?
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COX2 inhibitors
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What NSAID is potent and good for gout pain?
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indomethacin
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What is the only COX2 selective NSAID on the market?
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celebrex
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What is the recommended limit of daily dose of acetaminophen to avoid hepatotoxicity?
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< 4g
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Which opiate is metabolized by glucuronidation and does not go through the CYP450 system?
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morphine
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Which opiate's active metabolite is morphine
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codeine
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Which opiates are broken down to the active metabolite oxymorphone?
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oxycodone
hydrocodone |
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Which opiate should never be used due to cardiotoxicity?
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propoxyphene (darvon)
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What neuropathic pain meds are calcium channel blockers?
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gabapentin
pregabalin |
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What neuropathic pain meds are sodium channel blockers?
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carbamazepine
lidocaine oxcarbazepine lamotrigine |
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What antidepressants have anticholinergic effects and should be avoided in the elderly with neuropathic pain?
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TCAs
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What neuropathic pain med should be avoided in elderly patients with increased risk of falls?
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gabapentin
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What are the first line treatments for neuropathic pain?
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gabapentin or pregabalin
SNRIs TCAs 5% lidocaine patch for localized pain |
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Why is carbamazepine not a good choice for neuropathic pain?
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many DDIs
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What drug slows the progression of arthritis?
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glucosamine sulfate
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What meds can be used in prophylactic therapy for migraines?
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propranolol
TCAs valproic acid topiramate |
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How do opiates relieve pain?
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reduce centrally mediated pain transmission
inhibits pain signal |
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How do neuropathic pain meds relieve pain?
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reduction in central and neuronal level firing rates
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What are causes of Na depletion?
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primary renal disease
adrenal insufficiency diuretic therapy |
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During volume depletion, urine Na concentration is usually what?
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<15 mEq/L
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During volume depletion, the fractional excretion of Na is usually what?
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<1%
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During volume depletion, the urine osmolality is usually what?
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>450 mOsm/kg
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What is the ratio of BUN to creatinine usually in volume depletion?
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> 20:1 (BUN:Cr)
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A urine Cl concentration of <10 mEq/L may be seen if volume depletion is combined with what condition?
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metabolic alkalosis
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Edema will occur if ECF volume accumulates to what levels?
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>2.5 L
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In the absence of cardiac or cerebral vascular disease, blood products should be given at what Hb level?
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<7g/dl
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Patients with coronary or cerebral vascular disease should be given blood products when their Hb level is what?
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<10 g/dl
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Patients may need infusion of clotting factors or FFP if they have received how many units of blood?
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> 8-10
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How quickly can infusion pumps replenish fluids and blood?
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1 L of fluids in 10-15 min
1 unit blood in 20 min |
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Adults in shock are given how much fluid?
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1 L
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Children in hypovolemic shock are given how much fluid?
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20 mL/kg
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How quickly should fluids be given in intravascular volume depletion?
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500 mL/hour
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Adequate end-organ perfusion is best indicated by a urine output of what?
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> 0.5-1 mL/kg/hr
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Volume depletion should be assumed in a sick/injured patient with a CVP of what?
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< 3 mm Hg
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How much of an increase in CVP in response to a 100 mL fluid bolus suggests limited cardiac reserve?
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> 3-5 mm Hg
|
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Patients with hemorrhagic shock from a visceral lac should not receive fluid resucitation at a MAP of what?
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60-80 mm Hg
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To minimize the use of blood products during hemorrhagic shock, a target Hct of what is used?
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Hct 23-28%
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What crystalloid fluid should not be used to replace intravascular volume?q
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Dextrose 5%
|
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What crystalloid fluid only adds to the extra cellular fluid?
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normal saline
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What crystalloid fluid is excellent at replacing intravascular volume?
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5% albumin (plasma protein solutions)
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What maintenance fluid has a net effect of administering pure water and is distributed throughout the total body water?
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Dextrose 5%
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What is the distribution of 1,000 mls of Dextrose 5%?
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2/3 to ICF
1/3 to ECF |
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Dextrose 5% will cause what change in ADH?
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ADH will decrease
(renal water excretion will rise) |