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Drug lit/Pain

Pharm II - Fall 2011

QuestionAnswer
Criteria to evaluate a source? CARS = Credibility, Accuracy, Reasonableness, Support
Duration of acute pain? Hours/days
Duration of chronic (non-CA) pain? Months/yrs
Duration of chronic malignant pain? Unpredictable
Leukotrienes, prostaglandins, histamine stimulate? Nocicepters
Pain goes to the nociceptors, then the spinal cord, then to the where/what in the brain? Endogenous opiate system
Enkephalins, dynorphins, B-endorphins are all what? Endogenous endorphins
What are the predictors of inadequate pain management? Age, non-caucasion, low cognitive performance, multiple other meds
MILD PAIN: 1-3/10 +non-opioid -/+adjuvants
MOD PAIN: 4-6/10 ~Weak opioid +non-opioid +/-Adjuvants
SEVERE PAIN: 7-10/10 ~Strong opioid +Non-opioid +/-adjuvants
Analgesic MOA of ASA? Inhibs prostaglandin synthesis in CNS and peripherally blocks pain impulse gen
the analgesic effect of APAP is comparable to? ASA
MOA of acetaminophen? Inhibits PG synthesis in CNS; periph blocks pain impulse generation
Max daily dose for APAP? 4000mg
Max daily dose of APAP for elderly? 3000mg
What are COX-1 and COX-2? 1=GI protec/renal, platelet fxn 2=pain and fever
What is NAPQI? Some of APAP is metabolized into this hepatotoxic metabolite
NAPQI and glutathione? Usually glutathione binds to NAPQI to allow excretion of nontoxic conjugates, but misuse or OD depletes the glutathione and NAPQI is not detoxified
Analgesic vs anti-inflamm dose of NSAIDS? Analgesic: 200-400mg Anti-in: 600-800mg
What is the mechanism that NSAIDS injure the GI mucosal lining? Direct/topical irritation, inhibition of protective prostaglandins
Most and Least toxic NSAID to GI? Most=ketorolac; Least=Ibuprofen
What is the NSAID effect on kidneys? Decrsd renal blood flow
Effect of NSAIDS on platelets? Anti-platelet (may prolong bleeding time)
ASA and platelets? ASA inhibits platelet aggregation for the lifetme of the platelet (7-10 days)
Selective inhib of COX2 may have what effect? Cardiotox.
When taking ASA and an NSAID? Take a non-enteric coated ASA 1 hr before Ibu/Naproxen
NSAIDS may ^BP, why? Bc decrs renal blood flow = compensate by water and Na+ retention = ^BP
Max ASA dose/day? 5400mg
Reye's sx is assoc w/? ASA use in kids (salicylate) - esp w/ varicella, influenza
Ibuprofen max/day? 3200mg
Which opiod receptor's only fxn is dealing with analgesia? Delta
Agonist/antag opioids deal with which receptors in brain? Mu agonist, Kappa antag
Codeine in usual doses efficacy? Same as APAP/ASA
Phenanthrenes means? Agents related to morphine
What is tylenol #3? APAP + Codeine
What is Percocet? Oxycodone/APAP
Which are the CYP3A4 substrates? Hydro and Oxycodone, Tramadol, Fentanyl
Which opioid must only be used short-term d/t szr risk? Meperidine
What has a similar efficacy to codeine/APAP? Tramadol
What may the reason to take tapentadol? Less N/V/Constip than oxycodone
Gold std opioid? Morphine
What can happen with morphine that you may need to pre treat for? Histamine release - pretreat w/ benadryl/antihist...bc NOT a true drug allergy
What drug is useful for terminal pain syndromes? Hydromorphone (dilaudid)
What may be the advantage of hydromorphone over morphine? Less gastritis
What is important to remember with oxymorphone? NO alcohol; take on an EMPTY stomach!
Which opioid is commonly used in narcotic maint programs/weaning protocols? Methadone (long t1/2 = good for chronic use)
What are some pain adjuvants? Caffeine, Hydroxyzine, Corticosteroids
What med is good for bone pain? NSAIDS
Adjuvants for persistent pain? TCAs, AEDs, SSRIs, SNRIs
SNRIs help with what kind of persistent pain? Low back pain, OA, diabetic neuropathy, chronic MS
Created by: ferrier.kath
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