Term
| Acetaminophen (Tylenol) dosing |
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Definition
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Term
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Definition
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Term
| Ibuprofen (Motrin) dosing |
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Definition
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Term
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Definition
| 200-250 mg PO q 8-12 hours |
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Term
| What is the role of Cox-2 inhibitors like Celebrex? |
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Definition
-no role in acute pain
-only play a role in chronic pain because their advantage is they decrease side effects OVER TIME
-Celebrex: 200 mg po once daily |
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Term
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Definition
-GI intolerance
-GI ulcers
-renal dysfunction
-increase risk of bleeding in some patients
-compromise treatment of HTN and CHF
-risks with chronic use are much greater |
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Term
| What does Dr. Scott think of the new diclofenac patch, Flector? |
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Definition
-not much benefit over NSAIDs, unless you get a severe upset stomach with NSAIDs
-very expensive $$$
-1 patch BID
-little systemic absorbance, absorbed locally
-indicated for acute pain d/t strains and sprains |
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Term
| Which enzyme is responsible for converting codeine to morphine? |
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Definition
-CYP2D6
-7-10% of Caucasians produce limited CYP2D6, so codeine will be ineffective for them because no analgesic effect will occur because no morphine is produced
-CYP2D6 inhibitors will inhibit analgesic activity: benadryl, duloxetine, fluoxetine |
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Term
| What strengths of codeine/APAP are available? |
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Definition
-tablet: 30/325
-elixir: 12 mg/5 mL |
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Term
| What strengths of hydrocodone/APAP are available? |
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Definition
-2.5/325, 5/325, 7.5/325, 10/325
-now restricting APAP to 325 mg/tablet
-max APAP dose is 4 g/day |
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Term
| What strengths of hydrocodone/ibuprofen are available? |
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Definition
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Term
| What strengths of Oxycodone/APAP are available? |
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Definition
-2.5/325, 5/325, 7.5/325, 10/325
-C2 -> no refills; doctors and patients prefer hydrocodone |
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Term
| What strengths of oxycodone/ibuprofen are available? |
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Definition
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Term
| What strengths of Tramadol are available? |
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Definition
-Ultram: 50 mg tramadol
-Ultracet: 50 mg tramadol/ 325 mg APAP |
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Term
| Describe the MOA for tramadol |
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Definition
| -centrally-acting synthetic analgesic with dual MOA: weak mu agonist & inhibition of 5HT and NE reuptake |
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Term
| Describe the SE profile of tramadol |
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Definition
-lower occurrence than with other centrally-acting analgesics
-N/V, dizziness, somnolence, drowsiness, constipation, restlessness, sweating, HA
-may increase risk of seizures in at risk patients |
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Term
|
Definition
50-100 mg q 4-6 hours; max 400 mg/day
-max of 300 mg/day in pts >75 yo
-in pts with CrCl <30, extend dosing interval to q 12 hours |
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Term
| Options for moderate to severe acute pain (trauma, post-op, breakthrough pain, procedures) |
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Definition
-opioids (morphine, meperidine, hydromorphone, fentanyl)
-Ketorlac injectable
-Ibuprofen injectable
-Butorphanol Nasal Spray
-Ketorlac Nasal Spray
-Narcotic Agonists/Antagonists (Buprenorphine, Butorphanol, Nalbuphine, Pentazocine) |
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Term
| Which narcotic agonists/antagonists are used primarily in detox programs? |
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Definition
-Suboxone (buprenorphine and naloxone SL) and Subutex (buprenorphine SL)
-C IIIs
-MD restrictions
-Subutex is used first for several days, followed by Suboxone |
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Term
| What are some advantages of PCA? |
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Definition
-gets the patient involved
-often decreases the amount of medication needed
-every patient's pain threshold is different
-patients know best when they hurt
-usually provides better outcomes than standard IM injection |
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Term
| What are some potential risks of PCA? |
|
Definition
-programming errors
-pump failures
-PCA by proxy
-not an option for cognitively impaired/ very young children |
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Term
| What is the loading dose for PCA? |
|
Definition
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Term
| What are some advantages of using fentanyl over morphine for PCA? |
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Definition
-fentanyl has shorter duration of action -> beneficial if patient overshoots
-less N/V, urinary retention, and sedation |
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Term
| What types of patients will benefit from a basal rate with PCA? |
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Definition
Patients who:
-undergo major surgery
-hit the limit every hour
-have high dosing requirements during first 24-48 hours
-wake up frequently at night |
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Term
| How do you increase the dose in PCA pumps? |
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Definition
-increase dose by 50% plus hour and 4 hour limit
-if this doesn't work, increase by 50% of the first increase
-ALWAYS ASSESS IF PATIENT NEEDS TO BE RELOADED
-if patient waits too long in between injections, rebolus |
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Term
| Management of mild to moderate chronic pain (arthritis, neuropathies, fibromyalgia, low back pain) |
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Definition
-STEP 1: APAP, NSAIDS, Tramadol
-STEP 2: SR forms of step 1; Ultram SR & Ryzolt
-STEP 3: non-pcol therapy in addition to step 1 or step 2 agents |
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Term
| True or false: people with low back pain should rest and avoid exercise. |
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Definition
| FALSE! Exercise/activity has been shown to help lower back pain |
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Term
|
Definition
-Extreme sensitivity to touch or temperature, as seen in shingles/herpes zoster
-feeling of clothing against skin results in severe pain
-condition can last for months
-occurs on ONE side of body |
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Term
| What are some treatment options for neuropathic chronic pain? |
|
Definition
-Antidepressants with NE and 5-HT activity (Duloxetine, amitriptylline, nortriptylline, desipramine, Effexor XR)
-Anticonvulsants (Gabapentin*, Pregabalin*, Carbamazepine, Phenytoin, Topiramate, Lamotrigine)
-Capsaicin Topical Cream - Zostrix 0.025%
-Capsacin 8% patch
-Lidocaine patches 5%
-Muscle relaxants/anti-spasmodics (Tizanidine and Baclofen)
-Lidocaine injections/Alcohol injections
-Clonidine
-Ketamine injection or 5% gel
-Botox injections |
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Term
| What are some general principles for treating neuropathic pain? |
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Definition
-initiate one drug at a time
-use drugs with lower SE profiles
-taper dose up
-for therapeutic failures, be willing to try alternative agents within the same class
-educate patient that full benefit may take days to weeks
-educated patient that full pain relief should not be expected
-continue tx if pain reduction is ≥ 30% and functional improvement is observed |
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Term
| What are the common symptoms of fibromyalgia? |
|
Definition
-achiness all over
-inability to sleep
-stiffness on awakening
-tiredness during the day |
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Term
| What are the criteria for classification of fibromyalgia? |
|
Definition
-pain left/right side; above/below the waist
-pain for > 3 months
-palpable pain at 11 of 18 identified tender point sites |
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Term
| What are some treatments for fibromyalgia? |
|
Definition
-Amitriptyline
-Cyclobenzaprine
-Duloxetine
-Venlafaxine
-Tramadol
-Exercise and muscle strengthening
-Cognitive behavioral therapy
-Patient education
-Milnacipran (Savella) |
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