NR 565 ADVANCED PHARMACOLOGY FUNDAMENTALS
What are 3 types of acute pain?
- Somatic
- Visceral
- Referred
What is referred pain?
Pain that is present in an area removed or distant from its point of origin.
What is acute somatic pain?
Arises from connective tissue, muscle, bone and skin.
Sharp and localized or dull and non-localized
What does acute somatic pain respond best to? **7
acetaminophen, corticosteroids, NSAIDs, opiates, local anesthetics, ice, massage
What is acute visceral pain?
Pain in the internal organs and abdomen
Poorly localized (C-fibers)
Radiates
What do you use to treat acute visceral pain?
Most responsive to opiates
May also use corticosteroids, NSAIDs
Heroin, Lysergic Acid Diethylamide (LSD), marijuana (cannabis), 3, 4- Methylenedioxymethamphetamine (ecstasy), Methaqualone, and Peyote are in what drug class?
Schedule I — Substances or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.
Name some schedule II drugs **
Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (oxycontin) fentanyl, Dexedrine, Adderall and Ritalin.
Alfentanil
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine
Opium tincture
Oxycodone
Oxymorphone
Remifentanil
Sufentanil
Psychostimulants
Amphetamine
Cocaine
Dextroamphetamine
Methamphetamine
Methylphenidate
Phenmetrazine
Barbiturates
Amobarbital
Pentobarbital
Secobarbital
Miscellaneous Depressants
Glutethimide
Substances or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence refers to what drug class?
schedule II
Products containing less than 90 milligrams of codeine per dosage unit (Tylenol and codeine), ketamine, anabolic steroids, testosterone refers to what drug class?
schedule III — Substances or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than schedule I and Schedule II drugs but more than schedule IV.
Name some schedule IV drugs
Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol
Substances or chemicals are defined as drugs with a low potential for abuse and low risk of dependence refers to what drug class?
Schedule IV drugs
Name some Schedule V drugs
Cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Pregabalin (Lyrica), parepectolin
Schedule V drugs, substances, or chemicals are defined as drugs with a _ __ for abuse than schedule IV and consists of preparations containing limited quantities of certain narcotics. Schedule __ drugs are generally used for antidiarrheal, antitussive and analgesic purposes.
- lower potential 2.V
What are examples of pure opioid agonists?
Morphine, codeine, meperidine, and others
Pure opioid agonists produce analgesia, euphoria, __, respiratory ___, physical dependence, ____, and other effects
- sedation
- depression
- constipation
The pure agonists can be subdivided into two groups: strong opioid agonists and moderate to strong opioid agonists. _____ is the prototype of the strong agonists. _______ is the prototype of the moderate to strong agonists.
- morphine
- codeine
What is used to calculate a patient’s overdose risk?
Calculating MME/ day Determine the total daily amount of each opioid the patient takes.
Convert each opioid to MMEs by multiplying the daily dosage for each opioid by its conversion factor.
Add all opioid MMEs together.
NIDA-Modified Assist
What are the side effects of opioid agonists? (6)
Sedation, respiratory depression, constipation, GI upset, hypotension, urinary retention
How would you know when to refer someone to a pain specialist for pain management?
What is a Prescription Drug Monitoring Program (PDMP) and why is it important?
These electronic databases enable providers to access information regarding a patient’s prescription history of controlled substances. Nearly all states have implemented PDMPs, and some states require providers to check the PDMP before prescribing controlled substances. According to the CDC (2020), PDMPs have shown promising results in changing prescribing behaviors, decreasing the use of multiple providers by patients, and decreasing substance abuse treatment admissions.
How renal and hepatic function impact medication levels in the body?
Patients with renal or hepatic insufficiency can experience greater peak effect and longer duration of action for medications, thereby reducing the dose at which respiratory depression and overdose may occur. Similarly, for patients ages 65 years and older, reduced renal function and medication clearance due to age can result in a smaller therapeutic window between safe dosages and dosages associated with respiratory depression and overdose.
How do you assess someone for possible drug diversion?
Routine urine drug tests
In general, the medicine being prescribed, should be in the urine. If it is not in the urine, there should be a clear reason why it is not. Additionally, UDT allow for providers to see if there are illicit drugs present as well that could complicate treatment and would need to be discussed.
*** Black box warning for methadone
Methadone prolongs the _ __ and hence may pose a risk for potentially fatal ____. __ _ ___ has developed in patients taking 65 to 400 mg/day. To reduce risk, methadone should be used with great caution—if at all—in patients with existing QT prolongation or a family history of long QT syndrome and in those taking other QT-prolonging drugs. In addition, methadone causes severe respiratory depression that can be potentially fatal.
- QT interval
- dysrhythmia
- Torsades de pointes
Benefits of METHADONE in opioid use disorder
In addition to its role in facilitating opioid withdrawal, methadone (Methadose, Diskets) can be used for maintenance therapy and suppressive therapy. These strategies are used to modify drug-using behavior in patients who are not ready to try withdrawal.
By taking methadone, the addict avoids both withdrawal and the need to procure illegal drugs.
Suppressive therapy is done to prevent the reinforcing effects of opioid-induced euphoria. After the patient is tolerant to methadone, taking street drugs, even in high doses, cannot produce significant desirable effects. As a result, individuals made tolerant with methadone will be less likely to seek out illicit opioids.
Buprenorphine (Suboxone) and Naloxone — Benefit of using this combination
The naloxone in Suboxone is there to discourage IV abuse. If taken intravenously, the naloxone in Suboxone will precipitate withdrawal. However, with sublingual administration, very little naloxone is absorbed, and hence when the drug is administered as intended, the risk for withdrawal is low.
When should naloxone be prescribed for a patient?
history of overdose
history of substance use disorder, higher opioid dosages (≥50 MME/day)
concurrent benzodiazepine use
risk factors for opioid use disorder
a pattern of use that leads to significant impairment or distress. Typically, this disorder is marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school, or home responsibilities.
· Guiding principles for prescribers (6)
Using opioids only after nonopioid analgesics or more conservative methods have failed
- Discussing the benefits and risks of long-term opioids with the patient
- When possible, using only one prescriber and one pharmacy
- Ensuring comprehensive follow-up to assess efficacy and side effects of treatment and to monitor for signs of opioid abuse
- Stopping opioids after an attempt at opioid rotation has produced inadequate benefit
- Fully documenting the entire process
Download the full exam here https://learnexams.com/