RxPrep Study Materials: Pain Management Part 2 - Centrally Acting Analgesics, Opioid Overdose, Opioid Use Disorder, and Adjuvants

tapentadol, tramadol

What 2 drugs are mu-opioid receptor agonists and inhibitors of norepinephrine reuptake?

serotonin

Along with norepinephrine, tramadol also inhibits the reuptake of ________.

opioids

Both tapentadol and tramadol have the same boxed warnings as ________.

Ultram

What's the brand name for tramadol?

IV

Tramadol is a schedule ________ drug.

respiratory depression/death in children following adenoidectomy and/or tonsillectomy

What's the boxed warning associated with tramadol?

hypoglycemia, seizures, serotonin syndrome

What are 3 warnings associated with tramadol?

<12 years; <18 years

Tramadol should not be used in patients who are ________ old or in those ________ old following tonsillectomy/adenoidectomy surgery.

MAO inhibitors

What's a contraindication for tramadol?

constipation, dizziness, nausea, somnolence

What are 4 side effects of tramadol?

2D6

Tramadol requires conversion to its active metabolite by CYP________.

II

Tapentadol is a schedule ________ drug.

seizures, serotonin syndrome

What are 2 warnings associated with tapentadol?

constipation, dizziness, nausea, somnolence

What are 4 side effects of tapentadol?

centrally acting analgesics

Tramadol and tapentadol are examples of ________.

Suboxone; naloxone

Some opioid combination products, such as ________, are formulated with the abuse-deterrent medication ________.

Hysingla ER, OxyContin

What 2 opioid products are manufactured using specific technology designed to deter crushing, dissolving, or other modifications?

extreme sleepiness, extremely small "pinpoint" pupils, fingernails/lips turning blue/purple, slow/shallow breathing, slow heartbeat and/or BP

What are 5 signs/symptoms of opioid overdose?

naloxone

If opioid overdose is expected, give ________ and call 911.

opioids

Which lasts longer, naloxone or opioids?

true

True or False: Repeat doses of naloxone can be given if needed.

injection, nasal spray

What 2 formulations does naloxone come in?

Narcan

What's the brand name for naloxone nasal spray?

nasal spray

Which naloxone formulation has a slower onset of action, injection or nasal spray?

4; 1

Naloxone single-use nasal spray is ________ mg administered in (1/2) nostril(s).

2-3 minutes

Naloxone injection doses may need to be repeated every ________ until emergency medical assistance arrives.

naloxone

All approved ________ formulations can be administered for prevention of opioid overdose death.

acute withdrawal symptoms

What's a side effect of naloxone?

pain

What's an example of an acute withdrawal symptom that may be experienced with naloxone use?

opioid overdose

Naloxone and nalmefene are examples of drugs used in ________.

buprenorphine

partial mu-opioid agonist used in the treatment of opioid use disorder

low; higher

Buprenorphine is an agonist at (high/low) doses and an antagonist at (higher/lower) doses.

buprenorphine/naloxone

________ combination products are used as alternatives to methadone for opioid use disorder.

buprenorphine; naloxone

(Buprenorphine/Naloxone) suppresses withdrawal symptoms and (buprenorphine/naloxone) helps prevent misuse in opioid use disorder.

III

Buprenorphine is a schedule ________ drug.

Suboxone

What's the brand name for buprenorphine + naloxone sublingual films?

Zubsolv

What's the brand name for buprenorphine + naloxone sublingual tablets?

Belbuca

What's the brand name for buprenorphine buccal films?

Butrans

What's the brand name for buprenorphine patches?

weekly

How often should buprenorphine patches be changed?

fold sticky sides together and flush down toilet

How should buprenorphine patches be disposed of?

dizziness

What's a side effect of buprenorphine?

application site reaction, nausea

What are 2 side effects of buprenorphine patches?

Bioclusive, Tegaderm

What 2 adhesive coverings are approved for covering Butrans?

buprenorphine/naloxone, methadone

What are 2 drugs used for the treatment of opioid use disorder?

fibromyalgia, neuropathy, postherpetic neuralgia

In what 3 conditions are adjuvants commonly used?

adjuvants

________ are useful in pain management though they are not classified as analgesics.

clonidine; epidural

________ injection can be added to opioids in ________ pain infusion pumps for patients with cancer pain when other agents are insufficient.

carbamazepine, gabapentin, pregabalin

What 3 antiepileptic drugs are adjuvants?

Neurontin

What's the brand name for gabapentin?

postherpetic neuralgia, restless legs syndrome

In what 2 conditions is gabapentin enacarbil ER tablets used as an adjuvant?

dizziness, peripheral edema, somnolence, weight gain

What are 4 side effects of gabapentin?

Lyrica

What's the brand name for pregabalin?

V

Pregabalin is a schedule ________ drug.

dizziness,

peripheral edema,

somnolence,

weight gain

mild anxiolytic

What are 5 side effects of pregabalin?

fibromyalgia, neuropathic pain, postherpetic neuralgia

Pregabalin is approved for use as an adjuvant in what 3 conditions?

Tegretol

What's the brand name for carbamazepine?

trigeminal neuralgia

In what condition is carbamazepine FDA-approved for use as an adjuvant?

amitriptyline

What TCA is used as an adjuvant?

duloxetine

What SNRI is used as an adjuvant?

Cymbalta

What's the brand name for duloxetine?

amitriptyline, carbamazepine, duloxetine, gabapentin, pregabalin

What drugs are used as oral adjuvants for neuropathic pain?

baclofen, carisoprodol, cyclobenzaprine, methocarbamol, tizanidine

What 5 drugs are used as oral adjuvants for musculoskeletal pain/spasms?

baclofen, cyclobenzaprine, tizanidine

What are 3 antispasmodics with analgesic effects that are used as adjuvants?

Lioresal

What's the brand name for baclofen?

asthenia, confusion, dizziness, sedation

What are 4 side effects of all muscle relaxants?

asthenia

muscle weakness

Amrix, Fexmid

What are 2 brand names for cyclobenzaprine?

dry mouth

What's a side effect of cyclobenzaprine?

c

Which antispasmodic is serotonergic?

a) baclofen

b) carisoprodol

c) cyclobenzaprine

d) methocarbamol

e) tizanidine

muscle relaxer

What's another term for antispasmodic?

Zanaflex

What's the brand name for tizanidine?

dry mouth, hypotension

What are 2 side effects of tizanidine?

carisoprodol, methocarbamol

What are 2 antispasmodics that exert their effects by sedation and are used as adjuvants?

Soma

What's the brand name for carisoprodol?

IV

Carisoprodol is a schedule ________ drug.

2C19

Poor CYP________ metabolizers will have increased carisoprodol concentrations.

b

Which antispasmodic is a controlled medication?

a) baclofen

b) carisoprodol

c) cyclobenzaprine

d) methocarbamol

e) tizanidine

Robaxin

What's the brand name for methocarbamol?

dantrolene

What is a muscle relaxant that's rarely used as an adjuvant?

Dantrium

What's the brand name for dantrolene?

malignant hyperthermia

Dantrolene is typically used for ________.

capsaicin, lidocaine, methyl salicylate, trolamine

What are 4 topical adjuvants?

Lidoderm

What's the brand name for the lidocaine 5% topical patch?

gel

What formulation does prescription-only viscous lidocaine come in?

painful area

Where is Lidoderm applied?

12

Lidoderm patches may be worn for up to ________ hour(s)/day.

postherpetic neuralgia

What is topical lidocaine approved as an adjuvant for?

false

True or False: Lidoderm patches should not be cut into smaller pieces.

3

Do not apply more than ________ Lidoderm patch(es) at one time.

Zostrix

What's the brand name for topical capsaicin 0.025%?

Zostrix HP

What's the brand name for topical capsaicin 0.075%?

TID-QID

How often is topical capsaicin applied?

substance P

Capsaicin decreases ________.

a

With what topical adjuvant should you wash your hands immediately after application, avoiding contact with genitals, nasal area, mouth, and eyes?

a) capsaicin

b) lidocaine

c) methyl salicylate

d) trolamine

BenGay, IcyHot, Salonpas

What are 3 brand names for topical methyl salicylate?

Aspercreme

What's the brand name for topical trolamine?