Pain meds

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  1. Chronic pain is...
    pain not associated with cancer or other medical conditions that persists for more than 3 to 6 months

    pain lasting more than 1 month beyond the course of an acute illness or injury

    or pain recurring at intervals of months or years.
  2. What enzyme converts Archaidonic acid to prostaglandins?
  3. Which COX is responsible for stomach lining, stomach mucus production?
    Cox 1
  4. Which cox in the blood, thromboxane promotes platelet aggregation and vasoconstriction

    In lungs prostaglandins have anti-inflammatory effect and anti asthmatic?
    COX 1
  5. Which COX is ramped up during injury, increase vasodialation and vascular permeability which causes swelling?
    COX 2
  6. Which cox increases production of osteoblasts? and pain?
    Cox 2
  7. Which has a prostacycline that inhibits platelet aggregation, allowing the body to keep clot formation isolated to area of injury?
    Cox 2
  8. Which cox is ramped up in response to pathogens and have prostaglandins that work on the hypothalamus to increase body temperature by peripheral vasoconstriction. activated by pathogen
    cox 3
  9. what are released from the cells in response to chemical stimuli or trauma?
  10. What are some selective cox 2 inhibitors?
    Naproxen, meloxicam, celecoxib
  11. NSAIDS decrease COX by __________
    competitive inhibition
  12. NSAIDS can be used as a sole agent or in conjunction with...
    Narcotics, muscle relaxants, acetaminophen
  13. how do NSAIDS cause a decrease in renal perfusion?
    inhibits prostaglandins ability to vasodialate blood vessels
  14. Prostaglandins help maintain the ______of the glomerulus
    lumen of the afferent
  15. Fast acting NSAIDS should be limited to...
    5 days
  16. Why arent NSAIDS indicated during fractures?
    May inhibit osteoblasts
  17. How do NSAIDS work with blood thinners
    Potentiate the effects
  18. What are some names for motrin?
    Advil, Nuprin Midol
  19. What are indications for motrin?
    Mild to moderate pain


    inflammatory diease
  20. What are contraindications to ibuprofen?
    • HX of allergy to aspirin or other NSAIDS
    • penetrating trauma
    • Head injury or ICP
    • Bronchiospasm
    • Angioedema
    • Pain control before surgery
  21. Naproxens indications?
    • Mild to moderate pain
    • Inflammatory diease
  22. contraindications
    liver functions test for long term use!

    HX of allergy to aspirin or other NSAIDSpenetrating traumaHead injury or ICPBronchiospasmAngioedemaPain control before surgery
  23. Meloxicam indications
    Inflammatory Disease

    mild to moderate pain

    once a day dosing Cox 2 inhibitor
  24. Contraindications for Mobic?
    • HX of allergy to aspirin or other NSAIDS
    • penetrating trauma
    • Head injury or ICP
    • Bronchiospasm
    • Angioedema
    • Pain control before surgery
  25. Celexobid or celebrex Category? and benefit?
    Cox 2 inhibitor

    once a day dosing
  26. Ketorlac or toridol indications

    Primary benefits?
    • moderately acute severe pain not requiring opiods
    • Injectable
  27. Time for IV bolus?
    How long should ketorolac be given for?
    15 seconds

    5 days
  28. Aspirin indications

    • fever
    • mild to moderate pain

    • Thromboembolytic disorders
    • Reduce risk of TIA MI or unstable angina
  29. common NSAID Contraindications
    • HX of allergy to aspirin or other NSAIDS
    • penetrating trauma
    • Head injury or ICP
    • BronchiospasmAngioedema
    • Pain control before surgery
  30. Contraindications for ASA
    • bleeding/gi disorders
    • Patients under 19
    • Asthma
  31. How long does permanent platelet inhibition last for Acetl Sylic acid
    7-10 days
  32. Aspirin side effects
    • GI symptoms and bleeding
    • Stomach PN
    • Nausea vomiting
  33. How to Identify Reyes syndrome.
    A hallmark is a red rash on the palms and soles with in 3 weeks of a viral illness (chicken pox, mono, or URI) accompanied by nausea and vomiting, fever, and other flu-like symptoms.
  34. Other names for Tylenol
    Acetaminophen, APAP, paracetmol
  35. Contraindications for tylenol?
    • Hepatitis, renal disorders
    • Anemia, cardiac, pulm, renal disease
    • alcoholics due to high risk of hepatoxicity
  36. Where is APAP metabolized and how many MG causes hepatoxicity?
    Liver, 7500mg
  37. Early signs of Paracetamol toxicity are...
    Diaphoresis, anorexia, nausea and fatigue
  38. What is the antidote for tylenol poisoning?

    How fast should it be given?
    N-acytlecystine or Mucomist

    Within 24 hours
  39. Indications for NARCS
    • Moderate to severe acute/chronic pain
    • Anesthesia
    • coughing
  40. How do opiods work?
    Inhibits cAMP, not allowing calcium channels to open and slows transmission
  41. This type of opiod receptor has an effect of
    respiratory depression
    Reduced GI motility
    physical dependence
  42. Kappa opiod receptors do what?
    • Analgesia
    • Sedation
    • Miosis
    • Dysphoria
  43. What kind of effects does the delta receptor have?
    • analgesia
    • antidepression
    • physical dependence
  44. What opiod receptor causes these effects?
    Tolerance to Mu
  45. Why is a closed head injury contraindicated with opioid?
    Respiratory depression can cause the brain to sense high CO2 levels and release more blood increasing ICP
  46. Other names for morphine?
    MS contin, Roxanol, Duramorph
  47. What are some narcotic contraindications?
    • Respiratory depression
    • Hypotension
    • head injury/ICP
  48. What type of patients are at risk to overdose of MS Contin?
    Circulatory impairment (Burn or shock) due to slower absorption
  49. What are some CV effects morphine has?
    • peripheral arterial dialation
    • decreases systemic resistance of afterload in the heart
    • decreases myocardial oxygen demand
  50. What is meperidine?
    Demerol a synthetic opiod
  51. What are some uses for meperidine?
    • Moderate to severe pain,
    • anasthesia adjunct for preoperative sedation
  52. what are some other names for fentanyl?
    Actiq, duragesic
  53. What are some indications for fentanyl
    Synthetic and highly potent for acute or chronic severe pain
  54. SOCM recommendation for a fentanyl lollipop is
    800 mcg
  55. Oxycodone combined with APA is?
    with ASA is?
    Percocet, tylox

  56. The 12 hour sustained release tablet of oxycodone is?
    Oxycontin (no ASA or APAP)
  57. Tramadol does what with serotonin?
    Increases the release and decreases the reuptake of nE, mitigating opiod side effects
  58. What are some indications of hydrocodone and codeine?
    • Moderate pain
    • cough
  59. Hydrocodone 5mg + APAP 500mg are known as?
    Lortab or vicodin
  60. Codeine 30mg and 300mg APAP are?
    Tylenol 3
  61. Hydrocodone 5mg and guaifenesin 100mg/5ml is?
    Kwelcof, codiclear
  62. What are signs of opiod toxicity?
    • Respiratory depression
    • Unconsciousness, coma, decreases LOC
    • Miosis
  63. Why does tolerance occur?
    Liver gets used to it and builds up enzyme which metabolizes the drug faster
  64. a compulsive, drug seeking behavior, it is not when a person develops tolerance to opioid’s analgesic effects is
  65. after giving an opiod there may be wheezing due to a histamine reaction, how can an operator differentiate between anaphylaxis?
    listen to the lungs for wheezing and check blood pressure, as well as signs of urticaria.
  66. people with renal disease require what kind of opiod dose?
  67. Minimum BP for opiod?
    100 mmhg
  68. what are some agonist/antagonist opiods?
    Butorphanol (Stadol) and Nalbuphine (Nubain)
  69. how does nubain decrease euphoria and resp depression and maintain analgesia?
    Nubain does this by competitively antagonizing the opioid off the mu receptor site while providing analgesia on the kappa receptor site.
  70. What is a common compettitive opiod antagonist?
    Naloxone, narcan
  71. Narcan is included in oral narcotics to prevent the crushing of the pill and IV abuse, whats this called
    (aversion technology)
  72. Dosage for narcan?
    .4-2mg IV repeat 2-3 min PRN
  73. How long does narcan last?
    20-40 min
  74. Narcan dose for children?
    0.01 mg/kg IV/SQ/IM q2-3 min
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Pain meds
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