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 |