10 - pain Flashcards
def. nociceptive pain
due to damaged tissue
- aching and burning
def. neuropathic pain
due to damaged nerves
- sharp and burning
def chronic pain
> 6mos beyond point of expected resolution
what is clinically signigicant reduciton in pain
3/10
Phx for pain
- point tenderness
- hyperalgesia
- allodynia
4 principles of good pain mgmt
- treat underlying source
- manage preventatively
- analgesics before doing painful things - use a multimodal approach
- manage pain continuosly
meds for nociceptive pain
- tylenol
- nsaid
- opioid
- local
meds for neuro
- opioids
- TCA
- anti convulsants
tylenol dose for acute pain
1g qid
- reduce in alcohol
only IV NSAID
ketrolac
risk with NSAIDS
- ulcer
- perfs
- bleeds
- HT
- ## Pulmonary edema
contraindications to NSAID use
- allergy
- asthma
- rhinitis or urticaria
- ulcer
- IBD
adv and disadv of COX-2
same pain effect
adv - less GI and ulcer
dis - more CV such as MI and stroke
preferable route for opioids
IV
what is mophine excretion
renal - get higher dose with impairment
power of hydromorphone
5-8x
basic dosing of morphine for acute pain
2-3mg boluses every 5 minutes prn
or .25-.5mg hydromorph
opioid to avoid
merperidine
when to use fentanyl
no metabolites and rapidly out of system
- for short procedures
- 0.5ug/kg
3 drugs for morphine N/V
- dimenhydrinate
- odansetron
- prochloroperazine
use for codeine and tramadol
mild to moderate pain for discharge
use for oxycodone
moderate to severe pain or those unresponsive to codeine
- most commonly compounded - percocet
what to ask about with oxy
drug and alcohol abuse
how to adjust with elderly
lower dosing
4 steps to look out for drug seeking behaviour
- ask for ID
- verify objectively the presenting complaint
- attempt to contact the regular prescriber
- only give smallest number to treat presenting complaint
2 other Tx for pain
- calcitonin - good for osteopriotic vert. fractures
2. local and topical anesthetic
mgmt of arthritis
- NSAIDS, opioids, steroids
chronic pain
try to get consult
herpes zoster
- topical ASA
- oral NSAIDS
- opiods
- acyclovir within 72 hours
- amytriptyline
- pregabalin for post-herpeti neuralgia
mgmt sickle crisis
- IV opioids
- NSAIDS
mgmt of ureteral colic
- opioids
- renal specific NSAID
- tamulosin
mgmt of vertebral compression fractures
- calcitonin
