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63 Cards in this Set
- Front
- Back
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JMC requires pain be treated as..
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a vital sign
health care professionals must inquire and treat it as if it were BP |
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patients taking opioids and tramadol will develop
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physiological adaptation
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diff between physiological adaptation and addiction
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all patients, including addicts are physiologically adapted
addicts- involves a strong desire or compulsion to take the drug |
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what is pseudo addiction
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pt takes more of meds so seems like addiction, but takes more cause not on proper meds to help with pain
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DOC for pain in pregnancy
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Tylenol
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Antidote for tylenol
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acetylcysteine -restores intracellular glutathione
acetadote is IV form |
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childrens Tylenol dosing
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10-15 mg/kg q 4-6 h MAX 5 doses!
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aspirin/NSAIDs MOA
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inhibit COX- which normally activates PG, causing inflammation
aspirin binds irreversibly, NSAIDs bind reversibly |
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compare Tylenol to NSAIDs
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both treat pain and fever
NSAIDs can help with inflammation, Tylenol can't |
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difference between COX1 inhib and COX2
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COX1- increases bleeding risk
COX2 selective agents have lower risk |
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NSAID BBW
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GI bleeds
increased risk of thrombosis CI for pre-op CABG pain |
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what are the GI risk factors for NSAID use
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elderly, previous bleed, chronic or high dose use
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common NSAID SE
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dyspepsia, heartburn, GI bleeding
-take with food to decrease nausea -may increase BP |
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what are the meds in Vimovo
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Naproxen + esomeprazole
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whats in arthrotec
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diclofenac and misoprostol (cat X)
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Toradol
generic med? dosing? when to never give |
ketorolac
give IV or IM 1st then switch to PO x Max 5 days!! in adults NEVER give pre-OP |
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celecoxib
brand? MOA risks and CI |
Celebrex- COX 2 selective inhibitor
avoid use in CVD risk patients, especially high doses CI- sulfa allergy |
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name 3 other COX2 inhibitors
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etodolac-lodine
meloxicam- Mobic Nabumetone- Relafen |
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NSAID counseling
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take w/ food
do not use with anything that can cause bleeding don't use if prego raises BP causes photosensitivity |
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opioids in combo with APAP are used to tx?
opioids solo are used to tx... |
combo- moderate pain
solo-severe pain |
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example of pure opioid meds
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codeine
fentanyl hydromorphone hydrocodone oxycodone-oxymorphone |
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primary receptor for pain relief is..
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mu receptor
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primary component of REMS?
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its a program to eval ER meds
1) Educate prescribers 2) Prescribes must counsel patients |
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morphine long acting brands
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MS Contin
Avinza Kadian Oramorph SR Roxanol |
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Avinza dosing points
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no alcohol, can shorten ER duration
can be sprinkled into applesauce |
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Kadian dosing points
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can be opened and sprinkled into NG tube and applesauce
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embenda
drug components? used for? |
morphine + naltrexone
cant be adulterated cause the opioid blocker best for drug abusers |
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if morphine allergy, which pain meds can be used...
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fentanyl, meperidine, methadone
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what is a morphine allergy
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NOT NAUSEA!!
drop in BP, swelling of face/lips difficulty breathing |
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fentanyl
brand? strengths? indicated for how to use |
duragesic
12.5 mcg, 25 mcg, 50 mcg, 75 mcg, and 100 mcg/H use for chronic pain only press in place x 30sec, do not cover with bandage or heating pad |
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hydromorphone
brand dose for niave pt |
dilaudid
1 to 2 mg q 4-6 H |
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oxymorphone
brands? dosing directions |
Opana, opana ER
take on an empty stomach no alcohol with ER formulation-sorry Craig |
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methadone
used for? not used for? other clinical actions |
used for opioid addicts-relieves craving without the euphoria
not FDA-approved for pain, but sometimes used had serotonergic properties-watch for SS |
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Meperidine
brad? dosing? used for? caution in |
Demerol-has serotonergic properties
short duration, max of 3 h pain control-so not for chronic pain CI- renal impairment. elderly at risk for CNS toxicity |
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hydrocodone and APAP
strengths |
2.5,5,7.5,10 in combo with APAP
new APAP strengths will be 300mg in brands and 325mg in generic combos as of 2012 |
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tramadol
brand? w/ APAP brand? MOA CI |
ultram
ultracet MOA- opioid against/NE reuptake inhibitors CI-increased seizure risk/ serotonin syndrome CIV |
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tapentadol
brand? class? |
nucynta
opioid/NE reuptake inhib CII less GI effects than opioids NO ALCOHOL |
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IF switching to morphine and pat has renal insuff. do what to the dose
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decrease daily dose by 50%
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a 25mcg/h patch is equiv to how much morphine
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morphine 60mg
make sure to switch to mcg and then divide by 24 hours |
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if pain relief med works, but the meds analgesic effect doesn't last long do what...
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decrease the interval
DO NOT increase the dose...may cause respiratory depression |
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what is morphines IV and PO conversions
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10mg IV 30mg PO
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what is hydromorphones IV and PO conversions
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1.5 7.5
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what is oxycodones IV and PO conversion
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only 20mg PO
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Hydrocodones IV and PO conversion
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30mg PO only
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Codeines IV and PO conversion
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130 mg IV and 300mg PO
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Fentanyls IV and PO conversion
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0.1 IV only
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Meperidine IV and PO conversion
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75mg IV and 300mg PO
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STEPS to convert doses
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1st calc 24 hour dose
2nd use a ratio of conversions 3rd calc dose of new drug for 24 H 4th usually reduce new dose by 25% |
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naloxone
use? dosing? SE? |
opioid antagonist used for respiratory depression rescue
repeat dosing may be required (opioid longer t1/2 than naloxone) will cause acute withdrawl symptom-pain,anxiety |
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buprenorphine
class? MOA what do docs need to prescribe |
its an opioid AGONIST, CIII
docs need a addiction tx act waiver-if have it, DEA starts with an X |
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butrans BBW
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only 1 patch of 20mcg/h or risk QT prolongation
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carisprodol
class? brand? |
SOMA
muscle relaxant- CIV |
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Baclofen
brand? class? |
not a control, muscle relaxant
Lioresal |
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Cyclobenzaprine
brand? SE |
flexeril
anti-cholinergic |
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Metaxalone
brand? SE |
Skelaxin
SE- decreased cognitive effects |
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Tizanidine
class dosing? |
not a control
muscle relaxant MAX 3 tabs/day |
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pregabalin
brand? class indication |
lyrica
C-V neuropathy agent |
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amitriptyline
brand? commonly used for... SE |
Elavil
its a TCA- but clinical evidence and comm used for neuropathy SE-anti-cholinergic |
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meds that tx fibromyalgia
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basically same ones that tx neuropathy
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lidocaine 5% patch
brand? use Dosing notes |
Lidoderm
localized pain-shingles can cut into smaller pieces, do not apply more than 3 patches at one time 1 up to 12 h/day |
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capsaicin
brands |
zostrix
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diclofenac patch
brands |
voltaren gel
flector patch Apply BID |
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what is methylnaltrexone
brand? what needs to be done prior to use |
laxative for constipation from opioids
blocks opiod receptors in gut must have failed docusate and laxative |
