Term
| What is the most common type of pain? |
|
Definition
|
|
Term
| What type of pain involves conscious experience of noxious stimulus (mechanical, thermal, chemical) that has damaged nml tissue? |
|
Definition
|
|
Term
| Which stage of nociceptive pain involves tissue damage releasing sensitizing substances sucha s prostaglandins, bradykinin, substance p, and histamin, w/nn ending depolarization sending action potential to spinal cord? |
|
Definition
|
|
Term
| Which stage of nociceptive pain involves impulse to brainstem, then cortex via neurotransmitters such as substance p and glutamate? |
|
Definition
|
|
Term
| Which stage of nociceptive pain involves protective measures? |
|
Definition
|
|
Term
| Which stage of nociceptive pain involves pain impulses charged or inhibited by release of endogenous opioids, serotonin, norepinephrine, and gaba? |
|
Definition
|
|
Term
| What is one of the most difficult pains to tx? |
|
Definition
|
|
Term
| What type of pain involves healing process- adaptive mechanism to prevent contact w/, or movmt of, injured area until healing complete? This involves chemical substances produced, such as prostaglandin 32 that sensitize nociceptive nn ending and make it hypersensitive to stimuli. |
|
Definition
|
|
Term
| What type of pain is caused by damage to the ns resulting in disturbance of function? |
|
Definition
|
|
Term
| Is neuropathic pain peripheral or central? |
|
Definition
| either, depending on lesion |
|
|
Term
| diabetes, hiv, trigeminal neuralgia, and phantom limb pain can cause what type of pain? |
|
Definition
|
|
Term
| What is a catch all term for pain where no neurologic or peripheral pathology is detected? |
|
Definition
|
|
Term
| What type of pain is due to abnml responsiveness of ns? |
|
Definition
|
|
Term
| Fibromyalgia, ibs, noncardiac chest pain cause what type of pain? |
|
Definition
|
|
Term
| What are 3 types of non-opiopds? |
|
Definition
| acetaminophen, salicylates, nsaids (nonslecetive cox inhibitiors, cox-2 selective inhibitors) |
|
|
Term
| What are 3 categories of opiods? |
|
Definition
| agonists, partial agonists, antagonists |
|
|
Term
| What are 3 adjuvant agents for analgesia? |
|
Definition
| antidepressants, anticonvulsants, local anesthetics |
|
|
Term
| What are 2 alt names for acetominophen? |
|
Definition
| tylenol, paracetamol (europe) |
|
|
Term
| What is the moa of acetaminophen? |
|
Definition
|
|
Term
| What is a weak inhibitor of cox enzymes 1 and 2 in peripheray and cox-3 in brain? |
|
Definition
|
|
Term
| what is an enzyme necessary for prostaglandin synthesis? |
|
Definition
|
|
Term
| What are adrs of acetaminophen? |
|
Definition
| nmly safe in tx doses. no effect on bleeding time gi tract. potential for tubular necrosis w/chronic dosing |
|
|
Term
| When can tx doses cause acetaminophen toxicity? |
|
Definition
| tx dosing w/risk factors such as etoh- abuse, pre-existing liver disease, and other hepatotoxic drugs |
|
|
Term
| What is teh major pathway for acetaminophen toxicity? |
|
Definition
| conjugation w/metabolites and excreted in urine |
|
|
Term
| What is the minor pathway for acetaminophen? |
|
Definition
| p450 oxidation producing *toxic intermediate* which is detoxified by conjugation w/*gluthione* |
|
|
Term
| When does xs dose of acetaminophen cause toxicity? |
|
Definition
| conjugation of pathways saturated. gluthione stores in liver depleted. xs toxic metabolite binds to hepatocytes resulting in hepatic necrosis |
|
|
Term
| What is the antidote for actetaminophen od? |
|
Definition
| n-acetylcysteine (mucomyst) restores glutathione levels- best if given w/in 8 hrs of ingestion. give 140 mg/kg loading dose po diluted in juice followed by 70 mg/kg every 4 hrs x 17 doses |
|
|
Term
| What are dosage forms of acetaminophen? |
|
Definition
| capusles, tablets, suppositories, solns, drops. 80 mg, 160 mg, 325 mg, 500 mg (extra strength), 650 (arthritis strength) |
|
|
Term
| Why should parents be careful when administering acetaminophen to children? |
|
Definition
| drops versus liquid- different amts |
|
|
Term
| With what can acetaminophen be combined for perscriptions? |
|
Definition
| oxycodone (percocet, tylox), hydrocodone (vicodin) and codeine (tylenol #3) |
|
|
Term
| What doses should not be exceeded in adults, elderly, peds? |
|
Definition
| 4 gm/day. 3 gm/day. 10-15 mg/kg q 4-6 hrs |
|
|
Term
| What term comes from the gk: 'juice', and refers to morphine-like drugs, natural or synthetic, agonist or antagonis that is used interchangeably w/the term narcotic? |
|
Definition
|
|
Term
| There are 20 different alkaloids, 10% morphine of what drug? |
|
Definition
|
|
Term
| What are endogenous peptides that modulate pain perception, including enkephalins and endorphins? |
|
Definition
|
|
Term
| what are 4 types of opiod receptors? |
|
Definition
|
|
Term
| What is the range of differences w/opiod agonist's *pharmacodynamic activities*? |
|
Definition
| all have simialr pharmacodynamic activities. all stimulate mu (endorphin) receptor for analgesia. also cause respiratory depression, euphoria, constipation, and dependence. |
|
|
Term
| How are apparent differences in potency of opioid agonists explained? |
|
Definition
| by physiochemical and pharmacokinetic differences |
|
|
Term
| How can all opiods be made equianalgesic? |
|
Definition
| correcting for dose and route of administration (equianalgesic- change doses so effect is equal between 2 drugs) |
|
|
Term
| Are conversion factors for opiod agonists definitive rules or just guidelines? |
|
Definition
|
|
Term
| How does individual variation occur w/opiod agonist bioavailability? |
|
Definition
| individual variation in first pass metabolism and cross tolerance |
|
|
Term
| To what class of opioid agonist does morphine belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does oxycodone belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does oxymorphone belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does hydromorphone belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does meperidine (demerol) belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does fentanyl (duragesic) belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does methadone belong? |
|
Definition
|
|
Term
| To what class of opioid agonist does codeine belong? |
|
Definition
| moderate to weak opioid agonist |
|
|
Term
| To what class of opioid agonist does propoxyphene (darvon) belong? |
|
Definition
| moderate to weak opioid agonists |
|
|
Term
| To what class of opioid agonist does tramadol (ultram) belong? |
|
Definition
| moderate to weak opioid agonists |
|
|
Term
| What opioid agonists are used for moderate to severe pain? |
|
Definition
|
|
Term
| What opioid agonists are used for mild to moderate pain, heigher doses for severe pain will cause xs adverse effects? |
|
Definition
| moderate to weak opioid agonists |
|
|
Term
| What drug is the std that all opioids are compared to? |
|
Definition
|
|
Term
| What opiate involves 1st pass metabolism to water soluble active metabolites that are renally excreted? |
|
Definition
|
|
Term
| What is the parental: oral dose ratio for morphine for chronic v. acute pain? |
|
Definition
| 1:3 for chronic pain. 1:6 for acute pain |
|
|
Term
| By what % is it necessary to reduce morphine dose in elderly or renal failure? Why? |
|
Definition
| 25% due to accumulation of metabolites |
|
|
Term
| What opiate involves the greates variety of dosage forms? |
|
Definition
|
|
Term
| How can morphine be administered? |
|
Definition
| injection, immediate release (q4hrs)- tablets, capsules, soln, rectal suppositories, extended release |
|
|
Term
| What are the dose-lmting side effects of oxycodone? |
|
Definition
| no dose lmting side effects |
|
|
Term
| What is the potency of oxycodone relative to morphine? |
|
Definition
|
|
Term
| How is oxycodone administered? |
|
Definition
| oral dosage form. immediate release, extended release (oxycontin), combined w/tylenol (percocet) |
|
|
Term
| When might dosage of oxycodone need to be reduced? |
|
Definition
|
|
Term
| What are the problems with oxycodone? |
|
Definition
|
|
Term
| Comparing hydromorphnoe (dilaudid) and morphine, which is shorter acting? which is more potent? how is hydromorphone administered? |
|
Definition
| hydromorphone shorter acting and more potent than morphine. poor oral potency. |
|
|
Term
| What is useful if pt is morphine tolerant? how is hydromorphone administered? |
|
Definition
| hydromorphone- dilaudid-hp, 10mg/ml injection. poor oral potency- available as rectal suppository. can be given subq |
|
|
Term
| What schedule is oxycodone? |
|
Definition
|
|
Term
| What is a synthetic opioid w/low oral bioavailability that is not useful as an oral agent? |
|
Definition
|
|
Term
| Does meperidien (demerol) have a long or short half-life? |
|
Definition
|
|
Term
| What is the bioequivalence of meperidine (demerol)? |
|
Definition
| morphine 10 mg iv = demerol 75 mg iv = demerol 300mg po |
|
|
Term
| What are the adverse rxns of meperidine (demerol)? Why? |
|
Definition
| toxic metabolite (normeperidine) renaly excreted. half life 16-30 hrs.. accumulation w/oral dose, renal dysfunction. can cause neurtoxicity, seizures. |
|
|
Term
| What is the t1/2 of normeperidine? |
|
Definition
| toxic metabolite of meperidine. t1/2=16-30 hrs |
|
|
Term
| With what type of drugs can meperidine (demerol) have drug interactions? |
|
Definition
|
|
Term
| What drug was approved by the fda in an oral dose in 2006? |
|
Definition
|
|
Term
| What recently approved opiate has a black box warning? |
|
Definition
|
|
Term
| To what other opioid is oxymorphone (opana) structurally related? |
|
Definition
|
|
Term
| What percent bioavailability is involved w/oxymorphone (opana)? |
|
Definition
|
|
Term
| What is the bioequivalence between oxymorphone (opana) and morphine? |
|
Definition
|
|
Term
| How is oxymorphone (opana) administered? |
|
Definition
| available as ir tablets 5 and 10 mg and er 1 12 hrs |
|
|
Term
| What drug has the following potential danges: currently heavily marketed and very expensive. if crushed and give iv may get equivalent of 100 mg morphine iv -> od. food increases peak plasma concentration by 50% and etoh- by 200%!` |
|
Definition
|
|
Term
| What drug is 50-100x as potent as morphine? |
|
Definition
|
|
Term
| How is fentanyl (sublimaze) available for anesthesi? |
|
Definition
|
|
Term
| How can fentanyl (sublimaze) be administered oral transmucosally? |
|
Definition
| lozenge on a stick (actiq) for breakthrough cancer pain only |
|
|
Term
| What is available as an oral effervescent buccal tablet? |
|
Definition
| fentora also for breakthrough cancer pain |
|
|
Term
| What opiate involves 16 hrs for initial effect, lasts 2-3 days. calculate 24 hr morphine equivalent requirement. 60 mg/day im ms = 100 mcg/hr fentanyl. durageic-50 = $95/15 day. disposal problems? |
|
Definition
| transdermal (duragesic) for chronic pain- fentanyl |
|
|
Term
| What is the t1/2 of methadone? |
|
Definition
| synthetic opioid w/long t1/2 of up to 5 days |
|
|
Term
| What opioid is used in detox and maintentance programs- less acute withdroaw sx? |
|
Definition
|
|
Term
| What opioid has an analgesic duration only 8 hrs that accumulates w/repetitive dosing leading ot delayed side effects w/good oral potency? |
|
Definition
|
|
Term
| What is a methyl derivative of morphine? |
|
Definition
|
|
Term
| What opioid is usually combined w/non-opioid? |
|
Definition
| 60 mg codeine=650 mg tylenol in analgesia. tylenol#3=30 mg codeine+300 mg tylenol |
|
|
Term
| What is the most common opiate rx right now? |
|
Definition
|
|
Term
| Why is codeine dosing lmtd? |
|
Definition
| due to adr. n/v adn *constapation*. should not exceed 400 mg/day po |
|
|
Term
| What is the equivalence btwn codeine and morphine? |
|
Definition
| 10 mg morphine 1v = 130 mg codeine iv = 200 mg codeine po |
|
|
Term
| What opioid also has antitussive action? |
|
Definition
|
|
Term
| What drug is similar to codeine but only available orally? |
|
Definition
|
|
Term
| What is the equivalence btwn hydrocodone and codeine? |
|
Definition
| hydrocodone 5 mg = codeine 30 mg |
|
|
Term
| Which has a higher abuse potential: hydrocodone or codeine? |
|
Definition
|
|
Term
| With what drug is hydrocodone often combined? |
|
Definition
| combined w/acetaminophen. max acetaminophen (T) intake should be 4000 mg/day. vicodin, lortab. 500-750 mg T. |
|
|
Term
| What class are cough preparations of hydrocodone? |
|
Definition
|
|
Term
| What opioid is structurally related to methadone? |
|
Definition
|
|
Term
| What should be avoided w/chronic dosing of propoxyphene (darvon)? |
|
Definition
| accumulation of metabolite w/chronic dosing. t1/2=12 hrs, norproxyphene=24-36 hrs. norproxyphene is cardiotoxic. use caution in renal failure, elderly. dose ceiling due to adverse effects. |
|
|
Term
| To what opioid is propoxyphene (darvon) structurally related? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How strong of an analgesic is propoxyphene (darvon)? |
|
Definition
| mild analgesic (65mg less than or equal to 650 mg T) |
|
|
Term
| To what is propoxyphene hcl 65mg equivalent? |
|
Definition
| propoxyphene napsylate 100 mg |
|
|
Term
| What is the statistical difference in pain intensity btwn T and T/propoxyphene combinatin? |
|
Definition
|
|
Term
| What is a synthetic analog of codeine? |
|
Definition
|
|
Term
| What is the unique analgesic activity of tramadol (ultram)? |
|
Definition
| binds weakly to mu-receptor, plus, inhibits serotonin and norepinephrine reuptake |
|
|
Term
| What are common adr of tramadol (ultram)? |
|
Definition
| common: nausea, dizziness, *cns excitation*/rather than sedation. increased *risk of seizure* at high doses or in pts w/head injury or takng drugs that lower seizure threshold |
|
|
Term
| What are some drug interactions of tramadol (ultram)? |
|
Definition
| met by cyp2d6 to active metabolite (prodrug). inhibitors of cyp 2d6 can lower analgesic effect. increased risk of serotonin sx (chest pain, tachycardia, htn, agitation) when combined w/ssri antidepressants or triptan drugs for migraine |
|
|
Term
| What is the depenence potential for tramadol? |
|
Definition
| potential for dependence but no dea restrictions for now |
|
|
Term
| What is the t1/2 of tramadol (ultram)? |
|
Definition
|
|
Term
| Which is more effective for acute pain: tramadol (ultram) or vicodin? |
|
Definition
|
|
Term
| With what drug is tramadol available in combination? |
|
Definition
|
|
Term
| What opioid is a partial agonist-antagonist similar to pentazocine (talwin)? how is it delivered? for what is it indicated? How many doses per prescription? |
|
Definition
butorphanol (stadol nasal spray) Partial agonist-antagonist
Similar to pentazocine (Talwin)
Transnasal delivery with onset and duration similar to IM
Indicated for migraine and postoperative pain
15 doses per spray pump |
|
|
Term
| What drug involves *immediate reversal of opioid effect*? |
|
Definition
|
|
Term
| What drug can ppt severe withdrawal sx if opioid dependent? |
|
Definition
|
|
Term
What is a pure opioid antagonists displacing opioid from receptor site?
what is its t1/2? How is it administered? |
|
Definition
naloxone. Long acting pure opioid antagonist
Approved for treatment of alcohol dependence
Duration of action = 24 hrs
Must be opioid free
12 week course lowers alcohol craving |
|
|
Term
| What is a long acting pure opioid antagonist approved for tx of etoh- dependence? What is the duration of action? How must it be formulated? What is the course and effect? |
|
Definition
naltrexone. Long acting pure opioid antagonist
Approved for treatment of alcohol dependence
Duration of action = 24 hrs
Must be opioid free
12 week course lowers alcohol craving |
|
|
Term
| What is the most toxic effect of opioids? |
|
Definition
| respiratory depression. dose dependent, tolerance develops w/in 507 days of atc dosing |
|
|
Term
| what adverse effect of opioids precedes respiratory depression? |
|
Definition
|
|
Term
| What are 6 adrs of opioids? |
|
Definition
Respiratory depression – most toxic effect
Dose dependent
Tolerance develops within 5-7 days of ATC dosing
Sedation
precedes respiratory depression
Constipation (can increase N&V)
Nausea and vomiting (vestibular)
Itching (histamine release)
Urinary retention |
|
|
Term
| What is the aim of opioid titration? |
|
Definition
| aim is to obtain and maintain opioid level which lies inside the tx window |
|
|
Term
| When opioid levels rise above upper parameter, how do pts feel? how do they feel when opioids drop below lower parameter? |
|
Definition
| hung-over. breakthrough pain. |
|
|
Term
| Which consequences of long term opioid tx requires increased dose for same analgesic effect- develops slowly w/chornic use? |
|
Definition
| tolerance and cross tolerance |
|
|
Term
| What consequence of long term opioid x involves natrual process that develops w/chronic use and time course function of opioid t1/2? |
|
Definition
| physical dependence and withdrawl |
|
|
Term
| What consequence of long term opioid tx involves dysfunctional pattern of use for purposes other than alleviation of pain, w/tolerance and dependence not necesarily present? |
|
Definition
|
|
Term
| What consequence of long term opioid tx involves pts w/severe unrelenting pain preoccupied w/obtaining opioids? |
|
Definition
|
|
Term
| What are 8 sx of opioid physical dependence and withdraw? |
|
Definition
Begins within 6 hrs and peaks in 36-48 hrs
Rhinorrhea – runny nose
Lacrimation – tearing
Hyperthermia, chills
Myalgia – muscle aches
Emesis, diarrhea, GI cramping
Anxiety, agitation, hostility
Sleeplessness |
|
|
Term
| What is a preprogrammed basal iv dose, self-bolus dose, and lock-out period? |
|
Definition
| pt controlled analgesia (pca) |
|
|
Term
| What alt opioid delivery technique usually involves fentanyl + analgesic? |
|
Definition
|
|
Term
| What alt opioid delivery technique is for labor? |
|
Definition
| pt controlled epidural analgesia |
|
|
Term
| Mrs. Jones has been receiving hydromorphone via PCA pump at a dose of 0.5 mg/hr after surgery to correct spinal stenosis. Her pain has been well controlled on this dose and her attending physician wants to discharge her on controlled-release morphine (MS Contin). What would be an appropriate dose? |
|
Definition
HM 0.5 mg/hr IV = HM 12 mg/24 hrs IV
HM 12 mg/24 hrs IV = MS 80 mg/24 hrs IV
MS 80 mg/24 hrs IV = MS 240 mg/24 hrs PO
Recommend MS Contin 120 mg q12 hrs |
|
|
Term
| What schedule are heroin and lsd? |
|
Definition
|
|
Term
| On what are schedules of controlled substances based? |
|
Definition
| based on potential for abuse and depenence |
|
|
Term
| Which schedule of controlled substances involves morphine, codeine, oxycodone, and amphetamines? |
|
Definition
|
|
Term
| Which schedule of controlled substances involved Tw/codeine or hydrocodone? |
|
Definition
|
|
Term
| Which schedule of controlled substances involves benzodiazepines, phenobarbital, chloral hydrate, and propoxyphene? |
|
Definition
|
|
Term
| What schedule of controlled substances involves narcotic cough/antidiarrheal meds? |
|
Definition
|
|
Term
| What schedule of controlled substances involves all other rx drugs? |
|
Definition
|
|
Term
Which schedule involves the following: DEA number required.
Written prescription required, except in emergency.
Emergency prescription:
Amount to last through emergency.
Written prescription mailed to dispenser within 7 days. Otherwise DEA notified by pharmacy.
“Authorized for emergency dispensing” must be written on prescription.
No refills. Not valid after 6 months. |
|
Definition
|
|
Term
Which schedule involves the following: Refills allowed. Up to 5 refills or 6 months (whichever comes first) for schedule III-V.
DEA # required.
May be “called in” to pharmacy. |
|
Definition
|
|
Term
| What are agents that are indicated for conditions other than pain, but have analgesic properties for some painful conditions? |
|
Definition
|
|
Term
What agents are: Primarily for neuropathic pain
MOA: block Na+ and Ca+ ion channels, enhance GABA, and block NMDA receptors
Gabapentin (Neurontin)
Somnolence, dizziness, and fatigue
900-1800 mg/day? |
|
Definition
|
|
Term
| Which class of drugs involve amitryptyline (elavil)? |
|
Definition
| tricyclic antidepressants (TCA's). also ssri's |
|
|
Term
What type of drugs are the following: Injectable glucocorticoids
Topical anesthetics
Lidocaine patch (Lidoderm)
Capsaicin |
|
Definition
| adjuvant analgesic agents |
|
|
Term
| What is used as an analgesic for mild to moderate pain, antipyretic, however has no anti-inflammatory activity (not an nsaid)? |
|
Definition
|
|
Term
|
Definition
|
|
