pain

Chronic is pain defined as pain that persists for ≥ ____ months

3

Pediatric APAP dose

• <12 years old

• 10-15 mg mg/kg q4-8hr

APAP names (2)

Tylenol, FeverAll

APAP/oxycodone names (2)

Endocet, Percocet

Excedrin components

APAP/aspirin/caffeine

Midol complete components

APAP/caffeine/pyrilamine

T/F: APAP can be used with warfarin

True but if used chronically (>2g/d) it can increase the INR

Aspirin is an ______ inhibitor of COX-1 and COX-2 with antiplatelet benefit

A. Reversible

B. Irreversible

B. Irreversible

What NSAID agent has lower GI risk but higher CV risk?

Celecoxib

T/F: all RX non-aspirin NSAIDs require dispensing with a medguide

True

NSAID BW (3)

• GI risk (use with PPI)

• CV risk (MI/stroke)

• Dont use after CABG surgery

NSAID adverse effects (5)

• Renal failure

• HTN

• Nausea

• Photosensitivity

• Premature closure of the ductus arteriosus (do not use in third trimester)

non-aspirin NSAID examples (4)

• Ibuprofen (advil, motrin)

• Indomethacin (indocin)

• Naproxen (aleve)

• Ketorlac

Aleve/esomperazole name

Vimovo

Max ibuprofen dose

3.2 g/day

Ibuprofen children dose

5-10 mg/kg/dose q6-8hr

When using ibuprofen OTC, its recommended to limit self treatment to <___ days

<10 days

What medication should be avoided in psych conditions due to high risk for CNS side effects?

Indomethacin

Naproxen OTC dose

200 mg PO BID-TID

Ketorlac max duration is ___ days

5

What non-aspirin NSAID agent has a nasal spray that needs to be primed 5 times before use?

Ketorolac

• <65 yo and ≥50 kg: EACH NOSE

• >65 yo or <50kg: ONE NOSE

COX-2 selective agent (3)

• Celecoxib (celebrex) - highest COX2 activity

• Diclofenac

• Meloxicam

Celecoxib contraindication (1)

sulfa allergies

Diclofen/misoprostol brand

Arthrotec

• Avoid in females of childbearing age

What is the max voltaran gel dose?

32 g/day

Aspirin brands (3)

Ascriptin, Bufferin, Ecotrin

What symptom is caused with aspirin overdose?

Tinnutis

What is an example of a non-acetylated salicylate?

Magnesium sulfate (Doan's extra strength)

How should you spread out aspirin & NSAID concomitant doses?

Take aspirin 1 hour before or 8 hours after ibuprofen

NSAIDs can increase the levels of _______

Lithium

T/F: OPIOIDS HAVE A REMS PROGRAM

True - requiring education for pts and providers

Buprenorphine MOA

Partial mu agonist at low doses (treats pain) and antagonist at high doses (OUD)

T/F: Opioid pruritus can be treated with diphenhydramine

True

Codeine single entity tablets = C__

Codeine/APAP = C___

Codeine oral solution = C__

Codeine single entity tablets = CII

Codeine/APAP = CIII

Codeine oral solution = CV

Codeine is a prodrug metabolized to morphine through ________

CYP2D6

Do not use codeine in children < ____ yo for any indication

and age < ____ following tonsilectomy/adenoidectomy surgery

12, 18

This is for codeine and tramadol

Fentanyl brand name (1)

Sublimaze

Fentanyl patch pearls

• 1 patch Q72H to hairless skin

• Do not cover with heating pad

• Dispose by folding together and flushing down toliet

When is fentanyl patch indicated?

• Don't use in opioid naive patients

• Indicated if ≥ morphine 60 mg/day for at least 7 days

Buprenorphine is a C___ substance

CIII

Buprenorphine formulations (3)

• Buccal form (Bulbuca)

• Patch (Butrans)

• IV injection

Buprenorphine (butrans) patch is worn how often?

weekly

What opioid has a BW for QT prolongation?

Methadone

What opioid can decrease testosterone and contribute to sexual dysfunction?

Methadone

Mepiridine brand name (1)

Demerol

What opioid has a metabolite that is renally cleared and if it accumulates can cause seizures? (1)

Mepiridine

Morphine brand names & formulations

• ER: MS Contin

• IV: Duramorph, Infumorph

Oxycodone brand names & formulations

• IR: Roxicodone

• CR: Oxycontin

• ER, solution

What opioids are our CYP3A4 substrates (3)

Hydrocodone

Oxycodone

Fentanyl

What agents do not have cross reactivity in patients with a morphine allergy? (3) **

• Fentanyl

• Meperidine

• Methadone

MME table underlined (3)

• Morphine IV/IM 10mg - PO 30 mg

• Hydromorphone IV/IM 1.5 mg - PO 7.5 mg

• Oxycodone IV/IM x - PO 20

Prescription options for OID (4)

• Methylnaltrexone (Relistor): mu antagonist

• Naloxegol (Movantik): mu antagonist

• Naldemedine (Symproic): mu antagonist

• Lubiprostone (Amtiza): Chloride channel activator

MOA of lubiprostone

• Chloride channel activator

• Indication: OID

MOA of methylnaltrexone

Peripherally acting mu opioid antagonist

Centrally acting analgesics (2)

• Tramadol

• Tapentadol

Tramadol MOA

Mu opioid receptor agonist and NE/5-HT reuptake inhibitor

Tramadol is a controlled substance C___

CIV

Opioid use disorder agents (3)

• Buprenoprhine

• Naltrexone

• Lofexidine

Buprenorphine/naloxone

• SL film: suboxone

• SL tablet: zubsolv

Pregabalin is a controlled substance C___

CV

What is pregabalin approved for? (3)

Fibromyalgia

Postherptic neuralgia

Neuropathic pain

What agents can be used for trigeminal neuralgia?

Carbamazepine

Carisoprodol MOA & indication

Antispasmodics - muscle relaxant

Carisoprodol is a controlled substance C___

CIV

What is the correct indication for Lidoderm patch?

A. Postherpetic neuralgia

B. Diabetic neuropathic pain

C. Post-polio syndrome

D. Ankylosing spondylitis

E. Fibromylagia

A. Postherpetic neuralgia

Do not apply more than ____ lidocaine patches at one time

3

How long is a lidocaine patch worn for?

12 hours/day

How often is capsaicin cream applied?

TID-QID

Capsaicin cream name

Zostrix

Medications used for postherpetic neuralgia? (2)

• Gabapentin

• Pregabalin

acetaminophen boxed warning

hepatotoxicity

benefit of cox-2 selective NSAIDs

decrease GI risk

ibuprofen OTC dose

200-400 mg q4-6 hr

risks that medguide for NSAIDs cover

GI

CV

CABG

side effects of all NSAIDs

Increased BP

Nausea

Premature PDA closure if given during third trimester

aspirin warnings

avoid in children and teens with any viral infection due to risk of Reye's

Dyspepsia

Bleeding

tramadol boxed waringing

respiratory depression and death have occurred following tonsilectomy and/or adenoidectomy in children

CYP450 2D6 ultra rapid metabolizers

tramadol and tapentadol warnings

seizure

serotonin syndrome

do not use with CYP266 or 3A4 inhibitors

tramadol specific warning

hypoglycemia