Naplex (Pain Management)

Front 1

What are the types of pain?

Back 1

Acute - caused by injury, illness, or surgery - associated with physical symptoms (hypertension, tachycardia, diaphoresis)
Chronic benign - exists beyond an expected time for healing - associated with psychological effects (depression, anxiety)

Front 2

Acetaminophen MOA, Max dose, Contraindications

Back 2

MOA: central cyclooxygenase inhibition and decreased prostaglandin synthesis
Max dose: 4,000 mg
Contraindications: Hepatic disease, Alcoholism

Front 3

Aspirin MOA, Max dose, Contraindications

Back 3

Inhibition of prostaglandin synthesis
5.4 g/day
Allergy, Fever in children, Active bleeding
***Anti-inflammatory only at high doses 3 g/day

Front 4

Name the non-acetylated salicylates

Back 4

Salsalate
Diflunisal

Front 5

What are the primary side effects of NSAIDs

Back 5

GI upset, bleeding
Diminished renal function
Edema
Rash
Increased blood pressure

Front 6

Name the acetic acids

Back 6

Etodolac
Diclofenac (Voltaren, Flector, Zipsor, Cataflam)
Indomethacin (Indocin)
Ketorolac (Toradol)
Nabumetone (Relafen)

Front 7

Name the propionic acids

Back 7

Fenoprofen
Flurbiprofen
Ibuprofen (Motrin, Advil, Caldolor) - Max dose 3.2 g/day
Ketoprofen
Naproxen (Naprosyn, Naprelan)
Naproxen sodium (Anaprox)
Oxiprozin

Front 8

Name the fenamates

Back 8

Meclofenamate (Meclomen)

Front 9

Name the oxicams

Back 9

Piroxicam (Feldene)
Meloxicam (Mobic)

Front 10

Name the selective COX-2 inhibitor

Back 10

Celexocib (Celebrex)

Front 11

Many NSAIDs have these three drug interactions

Back 11

Warfarin
ACE Inhibitors
Lithium

Front 12

Key counseling point with NSAIDs

Back 12

Take with food

Front 13

What is unique about indomethacin?

Back 13

Fat-soluble - crosses BBB and can cause CNS disturbances
Most commonly used to treat gout

Front 14

NSAIDs only have the contraindication of hypersensitivity, except Ketorolac which has these contraindications

Back 14

Active PUD or bleeding
History of bleeding
Severe renal impairment
Labor and delivery
***It is only approved for mod-severe pain and for less than 5 days duration due to risk of GI and renal dysfunction***

Front 15

What is unique about the oxicam NSAIDs?

Back 15

They have more COX-2 selectivity than other NSAIDs and slightly less GI symptoms

Front 16

What differentiates celecoxib?

Back 16

Few GI toxicity than with NSAIDs
Cardiovascular adverse effects prompted withdrawal of rofecoxib from market

Front 17

Vicodin/Lortab

Tylenol #3

Back 17

Hydrocodone/APAP

Codeine/APAP

Front 18

Embeda

Avinza/Kadian

Back 18

Morphine sulfate/naltrexone

Morphine sulfate extended release

Front 19

Percocet/Roxicet

Back 19

Oxycodone/APAP

Front 20

Duragesic

Back 20

Fentanyl

Front 21

Dilaudid

Demerol

Back 21

Hydromorphone

Meperidine

Front 22

Dolophine

Nucynta

Back 22

Methadone

Tapentadol

Front 23

Types of pain continued

Back 23

Malignant pain - may be acute, chronic, or intermittent - often related to cancer or chemotherapy

Front 24

Pain is also defined by source - describe the difference between somatic, visceral and neuropathic pain

Back 24

Somatic originates from skin, muscles, tendons, ligaments, and bones - localized, sharp, throbbing, or aching in nature

Front 25

Visceral

Back 25

Visceral pain originates from organs such as liver, intestine, stomach - poorly localized, likely to generate "referred pain"
***Opioids not as effective***

Front 26

Neuropathic

Back 26

Results from nerve damage - typically burning in nature, also aching, numb, electric shock
***Opioids usually ineffective***

Front 27

Differentiate binding of the mu, kappa and delta opioid receptors

Back 27

mu - analgesia, sedation, euphoria, respiratory depression, physical dependence, constipation
kappa - analgesia, respiratory depression (also anxiety, strange thoughts, nightmares, hallucination more common)
delta - analgesia with no adverse effects (no available delta agonists)

Front 28

Describe the adverse effects of opioid antagonists

Back 28

CNS - sedation, euphoria
Neuroendocrine - altered hormone levels, convulsions (very high doses)
Respiratory - depression, decreased cough
Cardiovascular - vasodilation, orthostatic hypotension
Gastrointestinal - N/V, constipation (no tolerance)

Front 29

adverse effects continued

Back 29

Genitourinary - urgency/retention
Biliary - Decreased biliary and pancreatic secretion
Skin/Eye - Flushing, sweating, pruritis

Front 30

Fentanyl

Back 30

Injection (Sublimaze)
Transdermal (Duragesic)
Lozenge (Actiq)
Disintegrating tablet (Fentora)

Front 31

Hydromorphone

Back 31

Dilaudid

Front 32

Levorphanol

Back 32

Levo-Dromoran

Front 33

Methadone

Back 33

Tablet (Dolophine)
Liquid (Methadose)
Injection (Methadone)

Front 34

Morphine

Back 34

IR tablet (MSIR)
Liquid (MSIR)
Injection (Duramorph, Astramorph)
CR tablet (Avinza, Kadian, MScontine, Oramorph)

Front 35

Oxycodone

Back 35

Tablet (Roxicodone)
Capsule (OxyIR)
CR tablet (Oxycontin)

Front 36

Oxycodone/APAP

Back 36

Percocet
Roxicet

Front 37

Oxymorphone

Back 37

Opana