Therapeutics - Pain 2

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Author:
kyleannkelsey
ID:
282529
Filename:
Therapeutics - Pain 2
Updated:
2014-09-09 15:17:28
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Therapeutics Pain
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Therapeutics - Pain 2
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Therapeutics - Pain 2
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  1. If a patient fails on one NSAID should you try a different drug class or a different NSAID?
    Try a different NSAID
  2. What is the relative bioavailability of NSAIDs?
    High
  3. To what extent are NSAIDs subject to 1st pass metabolism?
    Negligible
  4. To what extent are NSAIDs bound to albumin?
    • Tightly (except ASA)
    • Will displace Warfarin
    • Watch with Phenytoin
  5. ASA has a serious DDI with what group of drugs and how can this be coped with?
    • NSAIDs
    • Give ASA 2 hours prior to NSAIDs or 8 hours after
  6. NSAIDs may effect renal clearance of what drug?
    Methotrexate
  7. How can you alleviate GI discomfort with NSAID use?
    Take with food or milk
  8. What level of GI SEs requires DC?
    GI ulceration
  9. If GI ulceration occurs with NSAID use, what options exist for the patient?
    • DC
    • Combine with misoprostal or a PPI
    • Consider Celecoxib
  10. Due to platelet function/aggregation SEs of NSAIDs, how long prior to surgery should they be DC’d?
    7-10 days
  11. What are the risk factors for NSAID induced nephrotoxicity?
    • >60 years
    • Hx of GI events
    • Concomitant steroid therapy
  12. Due to NSAID renal effects, what concomitant disease states should be cautioned?
    • HTN
    • Renal insufficiency
  13. What level of pain is celecoxib indicated for?
    Mild to moderate
  14. What are the SE for Celecoxib?
    • GI toxicity (less than with COX-1 inhibitors)
    • Renal effects
    • Cardio effects
  15. What effect does Ibuprofen have on ASA hematologic/cardio-protection?
    IBU negates cardio-protection of ASA
  16. How do COX-2 inhibitors compare to other NSAIDs in terms of GI toxicity?
    Less with COX-2’s
  17. How do COX-2 inhibitors compare to other NSAIDs in terms of Renal toxicity?
    Same
  18. Which NSAID has not been shown to cause cardiovascular risk?
    Naproxen
  19. How should you treat a patient using an NSAID with concomitant CV issues?
    • Lowest possible dose
    • Use only when benefits outweigh risks
  20. By what mechanism do NSAIDs worsen or cause HTN?
    • Na retention
    • Vasoconstriction
  21. In what time frame does NSAID induced HTN occur?
    1 week
  22. A BP change due to NSAIDs dose dependent or independent?
    Dependent
  23. NASIDs can reduce the efficaciy of what HTN meds?
    • ARBs and ACEIs
    • Diuretics
  24. How can you work to avoid NSAID induced HTN?
    • Lowest dose possible
    • Do not take daily
  25. NSAIDs increase the risk of bleeding when combined with what other drugs?
    • Other NSAIDs
    • Warfarin
    • SSRIs/SNRIs
    • Corticosteroids
    • Alcohol
    • Tobacco
  26. Under what condition may NSAIDs decrease the efficacy of clopidegrel?
    When combined with a PPI
  27. What effect do NSAIDs have on Lithium?
    May increase Lithium level
  28. What is the adult dosing of APPA?
    500-100 mg Q4-6 hours
  29. When should you avoid APAP?
    • Liver disease
    • Alcoholics
  30. When should you avoid ASA?
    Children under 15 with a viral infection
  31. What is the adult dosing for IBU?
    200-400 mg Q6-8 hours
  32. What is the pediatric dosing for IBU?
    5-10 mg/kg Q6-8 hours
  33. What is the max dose of IBU per day?
    3200 mg
  34. When should you not use IBU?
    3rd trimester of preganancy
  35. What is the OTC IBU tablet size?
    200 mg
  36. What is the Rx IBU tablet size?
    >200 mg
  37. What is the dosing for Ketorolac?
    30-60 mg I/IM Q6H
  38. In what patient population should you reduce the Ketorolac dose?
    Elderly
  39. What is the Max dose of Ketorolac?
    • 150 mg 1st day
    • 120 mg during days 2-5
  40. What is the max days a person can receive Ketorolac?
    5
  41. What disease states should you watch for when giving Ketorolac?
    • Renal insufficiency (particularly in the elderly)
    • Dehydration
  42. What is the normal dosing for Celecoxib?
    200-400 mg Q12-24 hours
  43. What is the max dose for Celecoxib?
    400 mg

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