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Pain Management

Pharmacology Exam 1

QuestionAnswer
Acetaminophen (APAP): - Class - Indication - Non-opioid analgesic - Analgesia, antipyretic, NO anti-inflammatory effects
Acetaminophen (MOA): Inhibits synthesis of p___ in the CNS and peripherally ___ pain impulse generation. Inhibits hypothalamic __-regulated center prostaglandins, blocks, heat
Acetaminophen (Pharmacokinetics): Metabolism of the ___ enzymes to sulfates and glucuronides. Small amount metab via CYP450 to a _ metabolite, then inactivated by glutathione. Alcohol is an __of p450 pathway leading to _ production of toxic metabolites. hepatic, toxic, INDUCER, increased.
Acetaminophen: G___ stores are depleted by ___ and APAP overdose. Eliminated in ___. Glutathione, alcohol. Urine.
Acetaminophen OVERDOSE results in h__ n__. Antidotal tx is a____. MAX dose: __gm/dose, __gm/day. Black Box: ___ injury. hepatic necrosis. ACETYLCYSTEINE. 1gm/dose, 4gm/day. Liver.
Acetaminophen (Adverse Effects): __sensitivity rxns, ___toxicity, __ tubular necrosis. (Drug Interactions): W___, A___, ____ of APAP metabolism (ex. phenobarb, carbamazepine, phenytoin, rifampin) HYPERsensitivity, hepatotoxicity, Renal. Warfarin, Alcohol, INDUCERS.
Acetaminophen (Dosing) Adults: ___-___ mg PO/PR q_-q_ prn: Max: __g/dose, __g/24hr. Peds: __-__mg/kg PO/PR q_-q_ prn; MAX: __doses/24h. Dose adjust in __/__ impairment. Preg Categ: __ . __ during lactation. 325-1000mg, 4h-6h, 1g, 4g. 10-15mg, 4h-6h, 5 doses. Renal and hepatic, B, Safe.
Aspirin (ASA): - Class - Chemical Family - Indication - Cyclooxygenase (COX) Inhibitor - Salicylates - Antipyretic, analgesia, ANTI-INFLAMMATORY
Aspirin (MOA): n__, i___ inhibits cyclooxygenase (Cox 1 + 2), blocking synthesis of thrombaxane A2 and prostaglandins. Metabolized via g__ and p__ and l__. Highly __ bound. Excreted ___. Contraindicated in ____. Non-selective, irreversibly, gut, plasma, liver. protein. renally. Bleeding disorders
Aspirin (Adverse Effects): G__, R__ impairment, __sensitivity rxn, R__ syndrome thus should not be used in __- w.out healthcare approval and never used when they have __ or __ symptoms. GI, renal, HYPERsensitivity, Reye's, children, chickenpox, flu
Aspirin (Drug Interactions): drugs that increase ___ risk, a__, g__, a__/a__, L__. bleeding, alcohol, glucocorticoids, ACE/ARB, Lithium
NSAIDs - Class - (MOA): Cause ___ inhibition of Cox-1 and Cox-2. Black Box: C__ Risk and G__ Risk. Some NSAIDs contain s___. Do not give to allergic pts. Pts that are hypersensitive to A___ are likely sensitive to NSAIDs. - Cox Inhibitors - Reversible, Cardiac, GI, sulfonamide, ASA
NSAIDs (Adverse Effects): H__, G__, B__, R__ impairment, Fluid ___, R__ syndrome thus avoid s___, Inhibits P___ aggregation and prolongs B___ time. Drug Interaction: drugs that increase bleeding risk, A__, G__, __/__, L__. Headache, GI, Bleeding, Renal, Retention, Reyes, Salicylates, platelete, bleeding, alcohol, Glucocorticoids, ACE/ARB, Lithium.
ASA & NSAID (Considerations): Avoid in pts with p__ u__ dz or g__ bleed. Avoid if low p___, r__ or h__ impairment. Avoid in pts sensitive to __ intake or edema. Preg __? if breast feeding use ___. Administer with ___. Caution with a__ and allergies to s__ peptic ulcer, GI, platelets, renal or hepatic, sodium, not recommended, APAP, food. asthma, sulfonamides.
Celecoxib (Celbrex): - Type of Drug - Class - (MOA): ___ inhibition of cox 2. Metabolized ___ and Excreted ___. Preg __? Contraindicated with _____ allergy and post ___. BLACK BOX: C__ risk and G__ risk. - second generation NSAID - COX inhibitor - Selective, hepatically, renally, Not recommended, sulfonamide, CABG. Cardiovascular risk and GI risk
Celecoxib (Celebrex) (Adverse Effects): G__, ___ toxicity, etc same as NSAIDs. Drug interactions: increases effects of W___, A___, G__, __/__, L__. GI, renal, Warfarin, Alcohol, Glucocorticoids, ARB/ACE, Lithium
Morphine and Codine - Opioid receptor activity - Pure opioid AGONISTS
Pentazocine, Nalbuphine, Butorphanol, Buprenorphine: - Opioid receptor activity - Agonist-Antagonist Opioids
Naloxone (Narcan) + Naltrexone: - Opioid recep activity -Nalox: Rev of opioid __, post__ effects, induced neonatal r__ depress. - Naltrex: Prevent relapse to opioid _ following opioid detox, _ depen, Comb w/ m_ to tx chronic severe pain. BLACK BOX: _to - Pure opioid ANTAGONISTS - Overdose, post-OPERATIVE, respiratory - Dependence, Alcohol, Morphine sulfate, Black Box HEPATOTOXICITY
Equianalgesic dosing: The degree of pain relief achieved in analgesic equivalants, which is the dose of an analgesic required to produce the same analgesic effect as a ___mg dose of m___ (standard measure of pain relief. 10mg, Morphine
Opioids (Adverse Effects): R___ depression, U__/P__, C___, U__ retention, C__ suppression, ___ of intracranial pressure, ___ if abrupt D/C Respiratory, Urticaria/Pruritis, Constipation, Urinary, Cough, Elevated, Withdrawal
Opioids (Drug Interactions): CNS ___, ___tensive drugs, M___ and L___(abx) biggest offenders (meperidine, methadone, tramadol, tapentadol, sufentanil, remifentanil, propxyphene, pentazocin, fentanyl). Anti-___ drugs, ___/___ of metabolism. depressants, HYPOtensive, MAOIs, Linezolid (abx), Anti-cholinergic, inhibitors/inducers
Opioids (Drug Interactions) Cont: Herbals: St. __ ___, K__ K__, V___. A__/A__ opioids, Opioid A___. St. John's wort, Kava Kava, Valerian, Agonist/Antagonist, Antagonists
Tapentadol (Nucynta): - Opioid receptor activity? - Indication: moderate to moderately severe acute ___. - Metabolized ___, eliminated ___. Drug Interaction same with all opioids (TCA, SNRI *antidepressants) - Central Opioid Agonist - Pain - Hepatically, Renally
Tramadol (Ultram): * - Opioid receptor activity? - Indication: moderate to moderately severe ___ - Metabolized ___ eliminated ___. Drug Interactions: same as for Tapentadol and other Opioids but include SSRI with SNRI * non-narcotic option - Nonopioid centrally acting Analgesic - Pain - Hepatically, Renally
Opioid (Considerations): H___ is important, F__ patches avoid f__ patient, broken __, r___ sites. Instruct patients not to take __ or __ in combination therapy. Mindful dosing max APAP __gm/day. Avoid __ cessation. Proper drug d___ is imperative! Hydration, Fentanyl, Febrile, Skin, Rotate, APAP, NSAIDS, 4, Abrupt, Disposal
Created by: mnc8
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