48 Questions
What are the primary classes of analgesics mentioned in the text?
Acetaminophen, NSAIDs, opioids, medications for neuropathic pain
What is MAT in the context of opioid use disorder management?
The use of medications to treat persons with opiate use disorder
What are the characteristic pharmacologic effects of different opioid receptors?
Analgesia, respiratory depression, sedation, and euphoria
What is the goal of pain management according to the text?
To alleviate pain and improve quality of life
What is the correct dosing strategy for managing breakthrough pain during around the clock (ATC) opioid dosing?
Increase the dose or decrease the interval of the scheduled pain medicine
What is the recommended approach for managing end-of-dose pain during opioid medication?
Increasing the dose or decreasing the interval of the scheduled opioid medication
What is the effect of parenteral administration of opioids within 2-4 hours of delivery on the neonate?
May lead to transient respiratory depression in the neonate
What is the recommended approach for managing predictable incident pain in patients?
Using a short-acting opioid 30 to 45 minutes prior to activity
Which medication is considered a first-line treatment for neuropathic pain?
Amitriptyline
Which medication is considered a second-tier guideline therapy for neuropathic pain?
Carbamazepine
What is the recommended approach for managing breakthrough pain with a neuropathic origin?
Consider nonopioid analgesics such as anticonvulsants
What is the correct strategy for managing breakthrough pain in opioid-tolerant patients?
Start with the lowest dose and only use in opioid tolerant patients
Which opioid receptor do opiate agonists primarily bind to?
Mu opioid receptor
What is the main physiological effect of opiate/opioid agonists?
Respiratory depression
Which opioid is derived from the opium poppy plant and is considered a prototypical full mu agonist?
Morphine
What is the active metabolite of morphine that is formed in the liver?
Morphine 6-glucuronide
Which opioid is known for its potency, being more potent than morphine?
Hydromorphone
Which opioid is associated with the risk of accumulation of its active metabolite, normeperidine, leading to neuro excitation and seizures?
Meperidine
Which opioid is a controlled-release formulation of oxycodone, dosed every 12 hours?
Oxycontin
What is the main physiological effect of opioid overdose?
Respiratory depression
What is the peak onset time for intrathecal administration of morphine?
90 minutes
Which opioid is known for its potency and is available as a transdermal patch for continuous pain management?
Fentanyl
What is the primary mechanism of action of opiate agonists in exerting analgesic effects?
Binding to mu opioid receptors
Which opioid is commonly used for the treatment of diarrhea due to its antidiarrheal effects?
Loperamide
Which type of pain is caused by nerve damage or persistent stimulation?
Neuropathic pain
What is the main site of painful stimuli in nociceptive pain?
Peripheral nociceptive receptors
What is the primary organ for the metabolism of acetaminophen?
Liver
What is the mechanism of action of NSAIDs?
Decreasing prostaglandin synthesis
What is a potential adverse effect of NSAIDs on the gastrointestinal system?
Gastritis
Which receptors do opioids act on to provide analgesia?
Mu, delta, and kappa receptors
What is the term for natural opioids such as heroin, morphine, and codeine?
Opiates
What is the primary use of opioids in pain management?
Providing analgesia
Which type of pain has different physiological and psychological components for acute and chronic forms?
Chronic pain
What is the primary class of drugs used for severe pain in pain management?
Opioids
What is the potential consequence of high doses of acetaminophen?
Hepatotoxicity
What is a characteristic of chronic nociceptive pain?
Often caused by nerve damage
What is the long half-life of methadone?
24 hours
Which opioid is used for acute pain but increases cardiac work, requiring caution in CHF patients?
Butorphanol
What are Sublocade and Probuphine?
Long-acting buprenorphine products for OUD
What is the main use of naloxone and naltrexone?
Opioid dependence treatment
What are abuse deterrent formulations of opioids designed to deter?
Misuse
What is a potential consequence of high doses of acetaminophen?
Hepatotoxicity
What are the distinct phenomena related to opioids?
Tolerance, dependence, and addiction
What is the primary goal of NPs and PAs prescribing buprenorphine for OUD?
Prescribe for up to 30 patients
What is the main concern with recent use of buprenorphine as Suboxone?
Dental decay and cavities
What are the potential adverse effects of opioids?
Respiratory depression and opioid-induced constipation
What is the primary use of tramadol, tapentadol, and dextromethorphan?
Analgesia and antitussive purposes
What are the primary uses of naloxone and naltrexone?
Opioid overdose and addiction treatment
Study Notes
Pain Management Overview
- Types of pain include nociceptive, neuropathic, acute, and chronic
- Nociceptive pain can be somatic or visceral, with painful stimuli at the site of injury stimulating peripheral nociceptive receptors
- Neuropathic pain is difficult to treat and often chronic, caused by nerve damage or persistent stimulation
- Acute and chronic pain have different physiological and psychological components
- Pain management involves the use of analgesics, including nonopioids like acetaminophen and NSAIDs, as well as opioids for severe pain
- Acetaminophen is metabolized in the liver, has a ceiling dose for analgesia, and can cause hepatotoxicity in high doses
- NSAIDs decrease prostaglandin synthesis and are used for multiple types of pain, with various drugs and dosages available
- NSAIDs have adverse effects including gastritis, ulceration, and decreased renal blood flow, and can interact with other medications
- NSAIDs carry FDA warnings for potential serious adverse cardiovascular and gastrointestinal events
- Opioids act on mu, delta, and kappa receptors, providing analgesia, euphoria, and respiratory depression
- Opioids include natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors
- Opiates refer to natural opioids such as heroin, morphine, and codeine, while opioids encompass natural, synthetic, and semi-synthetic chemicals
Opioids Overview
- Fentanyl is 100 times more potent than morphine and is a leading cause of opioid overdose deaths.
- Sufentanil, 1000 times more potent than morphine, is used in anesthesia and peaks quicker than meperidine/morphine.
- Methadone is used for opioid use disorder (OUD) and pain management, with a long half-life of 23hrs and potential for drug interactions.
- Butorphanol, available in nasal, IM, and IV formulations, is used for acute pain but increases cardiac work, requiring caution in CHF patients.
- Buprenorphine, used for opioid dependence, is available alone or in combination with naloxone as Suboxone, with recent issues of dental decay and cavities.
- NPs and PAs can now prescribe buprenorphine for OUD after completing the required training and can apply to prescribe for up to 30 patients.
- Sublocade, a once-monthly subcutaneous injection, and Probuphine, a 6-month implant, are long-acting buprenorphine products for OUD.
- Naloxone and Naltrexone are opiate antagonists used for the treatment of opioid overdosage and addiction.
- Abuse deterrent formulations of opioids, such as oxycodone and hydrocodone, are designed to deter misuse through physical or chemical barriers.
- Opioids have dose-limiting adverse effects, including respiratory depression, and can cause opioid-induced constipation (OIC), managed with stool softeners and other interventions.
- Opioid tolerance, dependence, and addiction are distinct phenomena with different implications for medication management and patient outcomes.
- Tramadol, tapentadol, and dextromethorphan are opioids used for analgesia and antitussive purposes, with their own unique properties and indications.
Test your knowledge of pain management and opioids with this comprehensive quiz. Explore different types of pain, analgesic medications, opioid classifications, and the use of opioids in pain management and opioid use disorder. This quiz covers important concepts and considerations for healthcare professionals involved in pain management and opioid prescribing.
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