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Arocena Exam ??s
Dr. Arocena review questions
| Question | Answer |
|---|---|
| Incomplete cross tolerance is when drug A has the potential to still have more of an effect on a patient than drugB even after we gave the patient an equianalgesic dose. We account for this by doing what??? | Decreasing dose by 25% |
| Tingling or burning is _____ pain that is neuropathic. It is created by the ___ nervous system. | Non-nociceptive; sympathetic |
| Patient complains of impotence. What would you test first with him? | Testosterone FSH LH levels (not always drug) |
| What is the first thing you must do before starting a patient on Methadone?? | Check their QT interval/length by ordering an EKG |
| Why is there no maximum dose for most opioids? What is the exception to this and why? | Because tolerance will build up. Exception..Percocet b/c APAP which has ceiling dose (4g QD) |
| What must be given to ALL opioid naive patients? | Stool softener!!! |
| When beginning a patient on opioids, what is one important thing to remember when choosing their opioid? | NEVER begin on a long acting opioid for opioid naive patients |
| When beginning a patient on opioids, what are some lab tests you should order? | Kidney function tests (eliminated here) LFT (metabolized here) EKG (inc. QT interval) |
| Patient who are allergic to ___ CAN NOT take morphine. | CODEINE |
| Why does morphine negatively effect patients with renal dysfunction? | Morphine's M6G metabolite could increase respiratory depression risk and M3G could cause neurotoxicity |
| Which medicine for NON-NOCICEPTIVE pain must be renally adjusted? | Gabapentin |
| Which drugs should never be used in patients with seizures?? | Tramadol Nucentya Demerol Darvocet(propoxyphene) |
| Fentanyl comes as a patch which should be used in ___ patients, usually keep in post-op procedures. Add on to patients previous opioid with ___ given as well. Keep the patch on for __ at a time. Put it on ___ body area and rotate with each use | NON-Naive opioid patients Old opioid dose given for 6-12hrs 72 hrs at a time clean shaven, dry area |
| Patient X comes to you complaining that she can't use her fentanyl patch b/c she got a rash when she tried it for the first time. What will you tell her? | Probably not allergic to the medication, skin reaction to the adhesive and will decrease over repeated use |
| All NSAIDs can worsen ___, ___ and cause ___ | HTN, CHF, edema |
| NSAIDs __ local PG that promote vasodilation of renal blood vessels | inhibit |
| Direct toxicity to kidneys caused by NSAIDs, symptoms include: | hyperkalemia, HTN, inc. SCr adn BUN, peripheral edema, weight gain |
| Age __, volume depletion, diuretic use, cirrhosis, renal disease are cautioned in patients using NSAIDs | >65yo |
| Caution for GI toxicity with NSAID use in patients w/: | peptic ulcer, EtOH abuse and major organ dysfunction |
| To avoid GI toxicity with NSAIDs you can discontinue the medication, add ___ or ___, switch to COX-2 | PPI or antacids |
| Hematologic toxicity with NSAIDs is caused by ___ platelet aggregation | decreased |
Created by:
csucop2014
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