Non-Opioid Analgesic Medications for Pain Management Pt. 1 (Muzyk)

T/F: Acetaminophen is indicted for for mild-moderate pain and as an add-on to agents with a different mechanism for additive analgesia; conditionally recommended for osteoarthritis when NSAIDs can't be used

True

For most adults, what is the maximum daily dose of acetaminophen?

3-4 g

For adults >60-65, what is the maximum daily dose of acetaminophen?

2-3 g

For patients taking warfarin, what is the maximum daily dose of acetaminophen?

2 g

Why should concomitant use of alcohol and acetaminophen be avoided?

hepatoxicity

Other salicylates (methyl salicylate, trolamine salicylate) are used as ___ analgesics

topical

Salicylate toxicities include GI ulceration/bleeding, renal toxicity, and salicylism. What are some symptoms of salicylism?

anion gap metabolic acidosis

tinnitus

CNS toxicity

Aspirin is the original NSAID — effective for mild-moderate pain with excellent anti-inflammatory activity; no tolerance or dependence.

How does the activity of aspirin differ from other NSAIDs?

has irreversible antiplatelet activity

What is the typical daily dosing of aspirin?

2.6 - 4 g

T/F: NSAIDs are effective for neuropathic pain

False

T/F: NSAIDs (except aspirin) reversibly inhibit platelets

True

Which of the following is NOT a major toxicity of of NSAIDs?

hepatoxicity

T/F: Ibuprofen blunts aspirin's antiplatelet effect by competing for the platelet binding site

True

Which patients may have an NSAID hypersensitivity?

asthma

aspirin-intolerant

nasal polyps

In pregnancy, renal damage due to NSAID use occurs at...

20 weeks

In pregnancy, premature ductus arteriosus closure due to NSAID use occurs at...

30 weeks

Which patients have the highest risk of GI toxicity?

age > 60

high dose/ prolonged use

concurrent use of certain meds

Which medications do not increase the risk of GI toxicity?

misoprostol

Which option should NOT be used for GI protection for NSAID use?

alcohol

T/F: Misoprostol can be used for GI protection when using NSAIDs; however, it is contraindicated in pregnancy and can cause diarrhea

True

Celecoxib's GI protection can be achieved by using lowest effective NSAID dose for the shortest duration. When does celecoxib's GI protection stop?

6 months

The following increases the risk of NSAID ____ toxicity:

age >65

heart failure,

kidney/liver disease

dehydration

concurrent diuretics or ACE inhibitors/ARBs

renal

T/F: NSAIDs are contraindicated after CABG surgery and in end-stage liver disease

True

T/F: Aspirin does not cancel out celecoxib's GI protection

False

T/F: Celecoxib has a reduced cardiovascular risk compared to non-selective NSAIDs

False

Ibuprofen and naproxen are the most familiar OTC options. Which one has a longer DOA i.e. has a lower dosing frequency?

naproxen

Ketorolac has high GI toxicity risk — limit to ____ maximum duration

5 days

What ketorolac dose must be avoided in elderly patients?

20 mg

T/F: Celecoxib is the only COX-2 selective agent marketed in the US

True

Nabumetone, oxaprozin, and piroxicam are...

long-acting options for chronic pain

Injectable non-opioids (ketorolac, ibuprofen, acetaminophen, meloxicam) are useful perioperatively and in the ED, and may decrease ____ when combined

opioid requirements

T/F: Rx topical diclofenac (gel, patch, solution) has very low systemic absorption but carries zero NSAID exposure risk

False

T/F: OTC topical salicylates provide modest, low-quality-evidence benefit for acute and chronic musculoskeletal pain — inexpensive and generally safe

True

Monitor NSAID therapy for all off the following EXCEPT:

renal changes (edema, rising creatinine)

GI bleeding signs (melena, coffee-ground emesis)

dropping H&H (Hgb & Hct)

immunosuppression

platelet effects (bruising, bleeding gums)

cardiac chest pain

immunosuppression