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173 Cards in this Set
- Front
- Back
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acute or chronic
pain signals remain active in the nervous system for weeks, months, years |
chronic
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acute or chronic
limited or no effect on vital signs |
chronic pain
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acute or chronic
observable signs |
acute
ex. tachycardia |
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acute or chronic
acute pain doesn't last longer than 3-6 months |
acute
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acure or chronic
well defined, recent onset, clear cause |
acute
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acute or chronic
limited or no effects on vitals |
chronic
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t/f
chronic pain is a prolonged version of acute pain |
f
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acute vs chronic
defined as pain lasting greater than 6 mo |
chronic
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acute vs chronic
pain resolved after trauma treated or healed |
acute
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associated probs w/ acute?
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uncommon
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which pain is treated w/ a multimodal approach
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chronic
ca related |
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which has a predictable prognosis of pain
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acute pain
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which pain has autonomic nervous system involvement
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acute pain
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is there an associated pathology w/ chronic pain
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possibly none/past injuries
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pqrst +2
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Palliative
Quality Radiation Severity Temporal + 2 questions |
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+2 questions
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what do you do to releive the pain and does it work?
how is the pain affecting the quality of your life |
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meds for mild stage
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nonopioid
NSAIDS, ASA, paracetamol |
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meds for mod stage
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weak opioids
codeine, tramadol |
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meds for severe stage of pain
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strong opioids
morphine, oxycodone, fentanyl |
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limited daily dose of apap
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3250mg
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limit tablet strength of apap for
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immediate release formulations
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what should be limited for kids w/ apap
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liquid formulations
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what's the classification of the nsaid
asa choline mg trisalicylate salsalate |
salicyclic acid derivatives
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nsaid that's an alkanone
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nabumetone
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diclofenac and ketorlac are which nsaid class
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heteroaryl acetic acid
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arylpropionic acids meds
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ibuprofen
naproxen ketoprofen |
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what class is sulindac
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indole and indene acetic acids
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what meds are in the indole and indene acetic acids class
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indomethacin
sulindac etodolac |
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which meds are the enoic acid
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piroxicam
meloxicam |
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t/f
if one class is working then it's ok to switch to another class |
true
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what should be the last line for heart pts
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celecoxib
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dose in which cv risk associated w/ celecoxib
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400-800 mg/day
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adjuvant analgesics
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cortiocosteroids
anticonvulsants antidepressants topicals alpha-2 adrenergic agonist miscellaneous (baclofen) |
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topicals adjuvants:
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lidocaine
capsaicin not absorbed much . . . so liked |
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t/f
corticosteroids used for long term as adjuvant |
f
dexamethasone, prednisone |
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standard adjuvant analgesic
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gabapentin
pregabalin topiramate |
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which adjuvant can cause orthostatic hypotension
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tizanidine
alpha 2 adrenergic agonist |
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which adjuvant should you check renal fx first
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baclofen
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antidepressants used as adjuvants
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amitripyline
nortriptyline venalafaxine |
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t/f
an adjuvant can be used as a primary agent in pain control |
t
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what do you use to aid in opioid sparing
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adjuvant
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opioid refers to all ---- w/ morphine like pharmacologic activity which can be antagonized by an ---- antagonist
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agonist
opioid |
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opioids include:
--- - like compound derived from the opium alkaloids synthetic and semisyntetic ----- ---- peptides that normally interact w/ opioid receptors |
morphine
congerners endogenous |
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what is now the legal term for drugs that are abused
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narcotic
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opioids that diphenylheptanes
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methadone
propoxyphene |
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opioids that are phenlypiperdines
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merperidine
fentanly sufentanil reifentanil |
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----- is the strength of interaction btw a compound bind to its receptor
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affinity
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-- is the measure of the strength of activity or effect from this binding at the receptor
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efficacy
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t/f
antagonist has both efficacy and affinity |
f
only affinity |
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which has both affinity and efficacy
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agonist
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partial agonist has -- but only partial ---
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affinity
efficacy |
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ex of full agonist
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morphie
codeine oxycodone |
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t/f
full agonist does not require all receptors to be occupied |
t
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how much of receptor should be occupied by partial agonist
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close to full
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partial agonist exhibits a --- effect on the degree of analgesia they can produce
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ceiling
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t/f
resp effects are completely reversed w/ partial agonist when using naloxene |
f
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ex of partial agonist
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burprenorphine
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partial agonist can precipitate -- --- rxn
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opioid withdrawal
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t/f
there are no ceiling effects of burprenoprphine |
f
so increased dose lead to increased se |
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buprenorphine has low efficacy at the -- receptor
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mu
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buprenorphine antagonistic activity at kappa leads to
----- |
analgesic
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buprenorphine aids as an opioid --- ----
aids in --- and --- |
abuse deterrant
detox and maintenance |
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compounds that bind to the opiod receptor but don't activate the receptor
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antagonist
ex: naloxone and naltrexone |
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mixed agonist-antag create an agonist effect at one receptor subtype and a --- ---- or antagonist effect at another
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partial agonist
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ex of mixed agonist-antag
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pentazocine
nalbuphine |
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opioid antag are competitive at what receptors
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mu
kappy delta |
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what can be used naloxone to prevent iv abus
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burprenorphine (SL)
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opioid anta have high --- for mu receptor but lacks mu receptor ----
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affinity
efficacy |
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morphine is schedule ---
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2
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available forms of morphine
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IR
SR |
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prototypical mu receptor opiate
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morphine
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what is morphine metabolized by
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demethylation
glucoronidation |
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what should you what out w/ the elderly and morphine
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renal fx and morphine metabolites
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which metabolite is more potent that morphine
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mophine 6
additional analgesic effects |
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t/f
morphine-3 has high analgesic activity |
f
no analgesic activity little opioid receptor binding |
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which metabolite is believed to play a role in tolerance development
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morphine-3
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codiene is schedule 2 in the --- form
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pure
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when is codeine schedule 3
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in the combo form
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prototype of the weak opioid analgesic
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codeine
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codeine has week affinity to the -- opioid
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mu
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codeine is a --- and requires -- to morphine by cyp2d6
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prodrug
metabolism |
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common effects of codeine
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nausea
constipation |
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codeine doses greater than-- mg inapporpriate due to increasing se
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65 mg
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t/f
hydrocodone is only available in combo form |
t
w/ apap and nsaids |
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hydrocodone is metabolized to ----
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hydromorphone
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how can reduced analgesia occue w/ hydrocodone
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inhibitors of cyp 2d6:
paxil, prozac, bupriopion |
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which has stronger binding to the mu
hydrocodone or hydromorphone |
hydromorphone
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hydrocodone used for
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mod to mod severe pain
nonproductive cough |
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t/f
oxycodone is schedule 3 |
f
schedule 2 |
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where does oxycodone have activity
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multiple receptors:
mu kappa |
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oxycodone is an analgesic, not a -----
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prodrug
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does oxycodone metabolite have analgesic activity
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some
(oxymorphone: active metabolite) |
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schedule of oxymorphone
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schedule 2
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forms oxymorphone available in
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IR
ER |
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oxymorphone work on which receptors
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mu
delta |
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which is more potent
oxymorphone or morphine |
oxymorphone
10x more potent |
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t/f
take oxymorphone after meals |
f
on empty stomach. . .food increase serum levels up to 50% |
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what must be avoided w/ oxymorphone
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etoh
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t/f
hydromorphone available in combo form |
f
only in pure form |
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schedule of hydromorphone
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2
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which is more potent
morphine or hydromorphone |
hydromorphine
7:1 to 11:1 |
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what receptors w/ hydromorphone
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mu
delta |
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w/ renal dysfunction what med will you give instead of morphine
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hydromorphone
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t/f
metabolites of hydromorphone has analgesic activity |
f
no metabolites w/ analgesic acitivity |
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how is hydromorphone metabolized
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liver
(62% eliminated thru 1st pass effect) |
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analgesic activity due to what w/ tapentadol
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mu opioid agonist
inhibition of NE reuptake |
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what percent of tapentadol is protein binding
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20%
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di w/ tapentadol
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maoi. . . zyvox. . . 5ht syndrome
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tapentadol works
centrally/peripherally |
centrally
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ok to give tapentadol w/ etoh
|
f
increased cns depression |
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currently how is tapentadol supplied
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ir
(er in future) |
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ok to give methadone w/ renal disease
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t
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t/f
ok to give methadone as a long acting agent |
f
long 1/2 life but short acting analgesic effects |
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t/f
methadone has few drug interactions |
f
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methadone is a schedule --
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2
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methadone is a --- opioid agonist
and --- antagonist |
mu
NMDA |
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what's a good choice for morphine allergies
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methadone
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methadone used for --- pain control
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neuropathic
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methadone good for --- --- pain states
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opioid resistant
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which enantiomer has a higher affinity for opioid receptors
|
R
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where is methadone metabolized in
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liver
intestines |
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where is metadone excreted
|
feces
(good for renal disease) |
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t/f
there are many methadone active metabolites |
f
none |
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where does methadone redistribute to
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fat tissue due to high lipid solubility
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why when starting methadone there's low levels initially and then high levels a week later
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due to cyp3a4 induction for 5-7 days
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how long is analgesic for in methadone
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4-8 hrs
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why's there accumulation in methadone
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due to biphasic elimination
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methadone can cause arrhythmias such as
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torsades de pointes
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there's an incomplete cross tolerance btw methadone and -----
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other opioids
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t/f
never use a 1:1 ratio w/ methadone and morphine |
t
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fentanyl is a schedule ---
|
2
|
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fentanyl acts on the -- receptor
|
mu
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fentanyl is --- times more potent than ----
|
80
morphine |
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where is fentanly mainly metabolized
|
liver
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what cyp can lead to increased fentanyl bl levels
|
cyp3a4
|
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are metabolites of fentanyl acitve and toxic
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no
inactive and nontoxic |
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fentanyl is highly ---
and is --- bound |
lipophilic
protein bound |
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after fentanyl is absorbed thru the skin what happens
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it produces a drug depot and then diffuse thru the systemic circulation
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what can increase fentanyl absorption
|
elevated temp
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minimally effective bl concentrations seen in -- hrs for fentanyl
max conc seen in -- hrs |
12 (so don't use acutely)
36 |
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how long should you wait when switching from a tdf to lao fentanyl
|
24 hrs
before starting the full replacement dose |
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fentanyl is indicated for --- ---- ---who require at leaset equivalent dosing of to --- mcg of fentanyl
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opioid tolerant
25 |
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tdf is ci in mg of --- ----- ----
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post-op pain
mild pain intermittent pain |
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cyp ---- w/ fentanyl can increase the plasma conc
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3a4
|
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meperidine is a schedule --
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2
weak opioid agonist |
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meperidien is --- % effective of morphine w/ sign -- and local --- properties
|
10
anticholinergic anesthetic |
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t1/2 of meperidine
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3 hrs
|
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meperidine is metabolized by the ---
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liver
to normeperidine |
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t/f
if meperidine overdose occurs,then ok to use naloxone |
f
not reversible by naloxone |
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meperidine has signficant ---toxic properties
|
neuro
|
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typical presentations of meperidine
|
mood changes
tremors multifocal myoclonus seizures |
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t/f
ok to use merperidine long term |
f
not to be used more than 48 hrs |
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meperidien should be avoided in pts w/ -- disease
|
renal
|
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propoxyphene is a schedule ---
|
4
mild opioid agonist used in mild to mod pain |
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where is propoxyphene metabolized
|
liver
|
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propoxyphene can cause --- toxicity
|
cardiac
|
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propoxyphene is structurally r/t -- and equipotency similar to ----
|
methadone
codeine |
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se of propoxyphene
|
dizziness
sedation weakness falls mild visual disturbances agitation paradoxical excitement insomnia seizures after overdose |
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med used to help pain but prevent addiction
|
MS and Naltrexone
|
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dosing of MS and naltrexone
|
q 24 hr
q 12 hrs |
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se of MS and naltrexone
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constipation
Nausea pruritis |
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why will ms and naltrexone combo prevent "drug liking"
|
cuz if crushed, chewed or dissolved naltrexone will be released
|
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opioid se
|
nausea
sedation dry mouth constipation resp depression pruritis |
|
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what to used when constipated w/ opioids
|
senna or bisacodyl (at bedtime)
miralax |
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which opioid shown to have lower rates of constipation
|
fentanyl
|
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which has unstable drug levels and increased risk for falls
|
short acting
also clock watching frequent administration due to shorter t1/2 |
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which has uninterrupted sleep and aids pts in focusing on daily activities vs pain
|
long acting
|
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ratio of morphine to fentanyl conversion
|
2:1
so q 2 mg of morphine oral per day is equivalent to 1 mcg per hr tdf |
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t/f
when converting from fentanyl to morphine pain should be under control |
t
|
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|
once fentanyl/morphine conversion titrate dose upward no more than q 6 ---- until analgesic efficacy reached
|
days
|
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t/f
ok to decrease the dose of tdf when converting |
f
don't cuz dose tolerance already taken into account |
|
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t/f
methadone to morphine, etc is a linear conversion |
f
|
|
|
the -- the dose of the original opoid, the more potent the --- is
|
higher
methadone |
