35. Opioids and Principles of Pain Management

Question 1

What drug should NOT be used in patients with end-stage renal disease?

Answer 1

morphine (hepatically metabolized but renally cleared)

Question 2

opioids work primarily by altering which step in the nociceptive process?

Answer 2

modulation (not transduction, transmission, or perception)

Question 3

Which of the following opioids is best used in patients with renal impairment?

Answer 3

Fentanyl. (doesn’t get metabolized at all, just out through feces)

Question 4

Which of the following is most likely to be predictive of the development of chronic pain after lumpectomy and axillary node dissection for breast cancer?

Answer 4

High level of anxiety and depression preoperatively.

Question 5

You are treating an 80 year old patient with excruciating pain from post-herpetic neuralgia. Which of the following is true?

Answer 5

Treatment should include a short acting opioid

Question 6

With regard to the “Gate Control” theory of pain, which of the following is true?

Answer 6

Stimulation of large myelinated fibers can help “Close the Gate”