Therapeutics - Pain 5

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Therapeutics - Pain 5
2014-09-09 15:20:13
Therapeutics Pain
Therapeutics - Pain 5
Therapeutics - Pain 5
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  1. How can you ease Opioid SEs?
    Dose related = Start low and go slow
  2. What is the most common Opioid SE?
  3. Do patients become tolerant to Opioid induced constipation?
  4. What type of laxative is preferred for Opioid induced constipation?
  5. What type of laxative should be cautioned for Opioid induced constipation and why?
    • Fiber laxatives may worsen problem if taken with inadequate fluid
    • Docusate does nothing for peristalsis
  6. What is the max time period a patient should go without a Bowel movement?
    3 days
  7. When you increase opioids, what other medication should you potentially also increase?
  8. If constipation develops and a patient is already on a laxative, what suggestions can you make?
    • Titrate to max laxative dose
    • Consider co-analgesic to reduce opioid dose
    • Add another agent adjunctively
  9. Do Opioid antagonists provide analgesia, anti-inflammatory effects or fever reduction?
  10. What class of drug is Alvimopan (Entereg)?
    Opioid antagonist
  11. What is the brand name for Alvimopan?
  12. What situation is CI for Alvimopan (Entereg)?
    Having taken opioids more than 7 days
  13. How long can you use Alvimopan (Entereg)?
    15 days max
  14. What risks are there to taking Alvimopan (Entereg)?
    Increaseed MI risk
  15. What is the brand name for Methylnaltrexone?
  16. What is Methylnaltrexone (Relistor) used for?
    • Opioid induced constipation
    • (Opioid antagonist)
  17. Do patients become tolerant to opioid induced nausea?
    Yes, most patients
  18. Ho can you treat Opioid induced nausea?
    • Antiemetics: Phenothiazines:
    • Prochlorperazine 10 mg
    • Promethazine 25 mg
  19. How can you prevent opioid induced nausea?
    • Send patients with medication when starting opiods
    • Antiemetics: Phenothiazines:
    • Prochlorperazine 10 mg
    • Promethazine 25 mg
  20. When would you expect patients to develop opioid induced sedation?
    With initiation of therapy
  21. Do patients develop tolerance to opioid induced sedation?
    Yes, usually
  22. How can you treat opioid induced sedation?
    Stimulants like Modafenil or methylfenidate
  23. How can you prevent opioid induced sedation?
    Start low and go slow
  24. What constitutes respiratory depression?
    < 8 breaths/minute
  25. When should you give opioid antagonistswith respiratory depression?
    When unarousable
  26. What are the opiod antagonists used to treat respiratory depression?
    • Naloxone (Narcan)
    • Naltrexone
    • Nalmefene
  27. How can you treat Opioid allergies?
    • Switch classes
    • Reduce dose
    • Give an antihistamine
  28. How can caffeine be used in the treatment of pain?
    Reduce total dose of NSAIDs or opioids
  29. Cn you cut lidocaine patches?
  30. Can you cut Fntanyl patches?
  31. Bupivicaine comes in what dosage form?
    ER liposomal
  32. What classes of drugs serve as Pan adjuvants?
    • TCAs
    • SSNRIs
    • Anticonvulsants
    • Corticosteroids
    • Anesthetics
  33. Under what situation would you use antidepressants as an adjunct to pain medication?
    Chronic and neuropathic pain
  34. What situation warrants the use of adjunctive SNRIs, Duloxetine and Venlafaxine for pain treatment?
    • Fibromyalgia
    • Diabetic neuropathy
  35. What are the precautions and CIs for TCA adjunctive therapy in pain treatment?
    CI: coronary disease/ventricular arrhythmias, get an EKG before starting
  36. Would you use a higher or lower dose to treat pain with a TCA than you would use to treat depression?
  37. What type of pain are TCAs good at treating?
    Neuropathic pain
  38. What anticonvulsants can be used for pain?
    • Gabapentin
    • Pregabalin
    • Carbemazepine
    • Divalpoate
  39. What is the MOA of anticonvulsants in treating pain?
    Reduce membrane excitability, but not completely understood
  40. What type of pain would you treat with anticonvulsants?
    • Neuropathic and Chronic
    • Trigeminal neuralgia
    • Postherpetic neuropathy
    • Diabetic and peripheral neuropathy
  41. What types of pain can be treated by local anesthetics?
    acute and chronic localized pain