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Arocena Exam ??s

Dr. Arocena review questions

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