10 - pain

Question 1

def. nociceptive pain

Answer 1

due to damaged tissue

- aching and burning

Question 2

def. neuropathic pain

Answer 2

due to damaged nerves

- sharp and burning

Question 3

def chronic pain

Answer 3

> 6mos beyond point of expected resolution

Question 4

what is clinically signigicant reduciton in pain

Answer 4

3/10

Question 5

Phx for pain

Answer 5

• point tenderness
• hyperalgesia
• allodynia

Question 6

4 principles of good pain mgmt

Answer 6

1. treat underlying source
2. manage preventatively
   - analgesics before doing painful things
3. use a multimodal approach
4. manage pain continuosly

Question 7

meds for nociceptive pain

Answer 7

• tylenol
• nsaid
• opioid
• local

Question 8

meds for neuro

Answer 8

• opioids
• TCA
• anti convulsants

Question 9

tylenol dose for acute pain

Answer 9

1g qid

- reduce in alcohol

Question 10

only IV NSAID

Answer 10

ketrolac

Question 11

risk with NSAIDS

Answer 11

• ulcer
• perfs
• bleeds
• HT
• ## Pulmonary edema

Question 12

contraindications to NSAID use

Answer 12

• allergy
• asthma
• rhinitis or urticaria
• ulcer
• IBD

Question 13

adv and disadv of COX-2

Answer 13

same pain effect
adv - less GI and ulcer
dis - more CV such as MI and stroke

Question 14

preferable route for opioids

Answer 14

IV

Question 15

what is mophine excretion

Answer 15

renal - get higher dose with impairment

Question 16

power of hydromorphone

Answer 16

5-8x

Question 17

basic dosing of morphine for acute pain

Answer 17

2-3mg boluses every 5 minutes prn

or .25-.5mg hydromorph

Question 18

opioid to avoid

Answer 18

merperidine

Question 19

when to use fentanyl

Answer 19

no metabolites and rapidly out of system

• for short procedures
• 0.5ug/kg

Question 20

3 drugs for morphine N/V

Answer 20

• dimenhydrinate
• odansetron
• prochloroperazine

Question 21

use for codeine and tramadol

Answer 21

mild to moderate pain for discharge

Question 22

use for oxycodone

Answer 22

moderate to severe pain or those unresponsive to codeine

- most commonly compounded - percocet

Question 23

what to ask about with oxy

Answer 23

drug and alcohol abuse

Question 24

how to adjust with elderly

Answer 24

lower dosing

Question 25

4 steps to look out for drug seeking behaviour

Answer 25

1. ask for ID
2. verify objectively the presenting complaint
3. attempt to contact the regular prescriber
4. only give smallest number to treat presenting complaint

Question 26

2 other Tx for pain

Answer 26

1. calcitonin - good for osteopriotic vert. fractures

2. local and topical anesthetic

Question 27

mgmt of arthritis

Answer 27

• NSAIDS, opioids, steroids

Question 28

chronic pain

Answer 28

try to get consult

Question 29

herpes zoster

Answer 29

• topical ASA
• oral NSAIDS
• opiods
• acyclovir within 72 hours
• amytriptyline
• pregabalin for post-herpeti neuralgia

Question 30

mgmt sickle crisis

Answer 30

• IV opioids

- NSAIDS

Question 31

mgmt of ureteral colic

Answer 31

• opioids
• renal specific NSAID
• tamulosin

Question 32

mgmt of vertebral compression fractures

Answer 32

• calcitonin