Other than cardiac events, what is the main s/e of NSAIDS (ibuprofen, naproxen, meloxicam)? What is given to help with those s/e?
GI: risk reduced by adding:
- PPI (Prilosec)
- H2 Blocker (Zantac)
- Gastric cytoprotection (Cytotec)
- COX-2 selective inhibitor (Mobic)
Ibuprofens, naproxen, Meloxicams are:
a. Opioids
b. NSAIDS
c. Adjuvant
Both B and C
Which of these NSAIDS are better for the GI?
B.
How can NSAIDS lead to cardiac events? Which one is best to use with someone who has HF?
Sodium retention which can lead to volume overload
ASA
T or F: Opioids are useful for Neuropathic pain
False
List 3 classes of drugs that can treat neuropathic pain. How can they do this?
TCA, SNRI, Anticonvulsants
Modulate pain at brain by allowing brain to increase serotonin's ability to inhibit painful stimuli
Fill in: The anticonvulsant, Gabapentin, is used to treat ___a__ pain. When first administering it, it is best to give at __b__(AM/HS) at a low dose, then titrating higher. The effective and max dose is __c__ mg/d.
a. Neuropathic
b. HS
c. 900 mg/d
Why is it best to give gabapentin for neuropathy at night time in the beginning?
s/e include drowsiness, dizziness in initial dosing. Tolerance develops within days.
This adjuvant is used to treat for pain, but has a s/e of damaging bones.
Corticosteroids
T or F: You should give corticosteroids at HS
false: has a s/e of wakefulness
Select all s/e of corticosteroids:
a. wakefulness
b. sleepiness
c. HTN
d. GI burning
e. fluid retention
f. bone damage
a. wakefulness
b. sleepiness
c. HTN
d. GI burning
e. fluid retention
f. bone damage
How much, in percentage, would you adjust pain dosage for patients in this pain:
a. moderate pain (4-6) _____
b. severe pain (7-10) _____
a. 25-50%
b. 50-100%
The typical immediate-release dose of a sustained release dose is:
C.
When a patient is on a sustained-release dose that is 24h, what is also given with it (if needed)
An immediate-release opioids that is 1/6 of the sustained release dose PRN
If a patient is receiving 300mg PO BID of sustained-release morphine, what is the proportional and appropriate dose for immediate-release morphine PRN for breakthrough pain?
D. 100mg q4h
SRD: 300mg BID = 600mg/day
IRD = 1/6 of SRD = 600mg/6 = 100mg
How much APAP is = to 2mg of Morphine?
2 tabs of 325mg APAP (tylenol)
What s/s will you see of Morphine toxicity from Metabolite?
twitchiness
Hydrocodone (vicodin, norco) is more expensive than Morphine, but is ___ in strength.
C.
Can hydrocodones be combined with APAP?
Yes: Hydrocodone + APAP = Norco
What dosing consideration will you watch for when giving Norco?
Watch for APAP dose limit
Oxycodone (Percodan, Oxcontin) is ____ potency of morphine.
A.
Oxycodone + APAP is:
B.
T or F: Oxycontin CR cannot be crushed
truew
Hydromorphone (Dilaudid) is ____ strength of Morphine:
A.
This med needs subcutaneous fat to be absorbed and won't work with skinny, malnourished patients
Fentanyl patch
This pain med is equaianalgesic to morphine and treats both neuropathic and nociceptive pain:
A.
What two GI drugs are usually given when giving opioids?
Senna: GI stimulant
Colace: Stool softener
What drug is given when n/v s/e occurs from pain meds?
Reglan or zofran
Marinol is the active ingredient in marijuana. It is used for :
B. n/v but can also relieve pain
List medical uses for THC MJ?
suppresses nausea
increases appetiite
may lessen inflammation, pain and MS
What 2 meds are often in PCAs for severe pain?
Morphine
Hydromorphone (dilaudid)
If a pt's RR <8-10/min, list interventions and drug that must be given
Stimulate pt for response
Give O2
Titrate Naloxone
Fill in:
Give _a__ mL increments of Naloxone when indicated by slow IV push at __b_ minute intervas up to __c_ times and continue as needed.
