4. Pain Management

Question 1

When should be be evaluated and documented

Answer 1

every appointment

Question 2

What considerations should be kept in mind when deciding what pain management meds should be used

Answer 2

• Individual patient/familt
• Extent of treatment
• Duration of procedure
• Psychological factors
• Medical history/ physiologic factors (bleeding disorders, liver, and kidney problems)

Question 3

What are the first line drug therapy for pre and post op pain

Answer 3

non-opiod analgesics (esp. NSAIDs)

Question 4

Which have anti-inflammatory properties

• Tylenol
• Motrin
• Codeine
• Advil

Answer 4

Motrin and advil (also ibprophen)– only NSAIDs

Question 5

Why should caution be used with opiods

Answer 5

respiratory depression- most common cause of death with opiod use

Question 6

Properties of NSAIDs

Answer 6

Antipyretic
Anti-inflammatory
Analgesic

Question 7

Dosing for children less than 12 (ibprofen)

Answer 7

4-10 mg/kg/dose every 6-8 hrs

Max= 40 mg/kg/24 hrs

Question 8

Dosing for children >12 Ibprofen

Answer 8

200 mg every 4-6 hrs

Max=1.2g/24 hr

Question 9

Dosing for adult ibprofen

Answer 9

200-400mg every 4-6 hr

Max=1.2 g/24hr

Question 10

MOA of NSAIDs

Answer 10

• Inhibition of COX (cyclooxygenase) enzymes

- Prevents the formation of prostaglandins

Question 11

Caution should be used with NSAIDs in what patients

Answer 11

• GI disease
• Bleeding disorders (affects platelet aggregation- increases bleeding time)
• Impaired renal function

Question 12

Why is aspirin avoided in kids

Answer 12

linked to reye’s syndrome

Question 13

Properties of acetaminophen

Answer 13

antipyretic and analgesic

Question 14

Dosing for tylenol in kids <12

Answer 14

10-15 mg/kg every 4-6hr

Max= 90mg/kg/24 hr – not exceeded 2.6g/24hr

Question 15

Dosing for tylenol in kids <12

Answer 15

325-650mg every 4-6 hr or 1000mg 3-4 times a day

Max= 4g/24hrs

Question 16

MOA of tylenol

Answer 16

not fully understood (thought to act through COX inhibition

Question 17

T/F Caution should be taken when using tylenol in kids with bleeding disorders

Answer 17

F- tylenol doesn’t disrubte platelet aggregation and clotting time

Question 18

OD of tylenol can lead to

Answer 18

acute liver failure

Question 19

Name the metabolic substrate that causes acetaminophen toxicity

Answer 19

NAPQI

Question 20

When detoxifies NAPQI

Answer 20

glutithione

Question 21

What is the antidote for tylenol OD and how does it work

Answer 21

NAC (N-acetylcysteine) acts by bumping up glutithione

Question 22

Initial symptoms of acetaminophen toxicity are

Answer 22

• Nausea
• Vomiting
• Drowsniness
• Lethargy
• Malaise

Question 23

progression of tylenol toxicity can lead to

Answer 23

• Upper right quadrant pain
• Tachycardia
• Hypotension
• Hepatic disfunction
• Multi-organ failure

Question 24

Look at chart on slide 11

Answer 24

ok

Question 25

State the amount of acetaminophen in #2,3, and 4 acetaminopen with codeine

Answer 25

``` 2= 300 mg acetaminophen and 15mg codeine 3= 300mg acetaminophen and 30 mg codeine 4= 300 mg acetaminopen and 60 mg codeine ```

Question 26

How much acetaminophen and codeine present in liquid tylenol and codeine

Answer 26

120mg acetaminophen +12 mg codeine (5mL suspension)

Question 27

Dosing for child <12 for tylenol with codeine

Answer 27

0.5-1mg codeine/kg/dose every 4-6 hrs 10-15mg acetaminophen/kg/dose every 4-6 hr Max -90 mg/kg acetaminophen in 24 hr (not to exceed 2.6 mg acetaminophen in 24 hrs)

Question 28

Codeine has the potential for _ if OD

Answer 28

respiratory depression (it's a narcotic)

Question 29

Codeine is metabolized into what by what organ

Answer 29

morphine by the liver

Question 30

Describe ultra-fast and slow metabolizers

Answer 30

Ultra-fast -Require higher doses for effect (easy to OD) Slow -Takes a long time for effect to kick in (impatience --> OD)

Question 31

Why is there little potential for addiction with codeine

Answer 31

short course of administration

Question 32

Analgesics for mild/moderate pain should recommend

Answer 32

OTC

Question 33

Moderate/Severe pain- recommend what analgesics

Answer 33

acetaminophen and ibprofen - Don't exceed to max dose per day for each - As one med wears off the other is peaking

Question 34

What should you do if you expect there to be post op pain

Answer 34

- I.e exo or SSC | - Give pre-op analgesics or recommend dose before anesthesia wears off.

Question 35

Antibiotics should be used when

Answer 35

Acute infection - Facial swelling - Tooth painful to palpation - Pain wakes kid up at night

Question 36

Perscribe AB for acute infection then ask to return how long later for exo

Answer 36

5-10 days

Question 37

Purpose of perscribing AB then Exo

Answer 37

- May not be able to get tissue fully numb | - Get child out of acute pain (better cooperation for exo)

Question 38

T/F analgesics can be used with ABs

Answer 38

t

Question 39

Dosing of amoxicillin in kids <12 or <40 kg

Answer 39

20-40 mg/kg/day Dosing every 8 hrs 25-45mg/kg/day divided into doses every 12 hrs

Question 40

Dosing for kids >12 amoxicillin or >40kg

Answer 40

250-450mg every 8 hr OR 500-875mg every 12 hr

Question 41

Forms of amoxicillin

Answer 41

Liquid (250 mg.5mL) or (125mg/5mL) Chewable tab (250mg) Tab (500mg)

Question 42

Dosing for child clindamycin

Answer 42

8-20 mg/kg/day in 3-4 doses

Question 43

Dosing for adults clindamycin

Answer 43

150-450 mg every 6 hrs

Question 44

Forms of clindamycin

Answer 44

Liquid (75mg/5mL) | Capsule (150mg and 300 mg)

Question 45

dosing for kids is based on (age/weight)

Answer 45

age- not every kid falls in average weights

Question 46

1 tsp= _mL

Answer 46

5

Question 47

Most meds given to kids are in (liquid/tab) form

Answer 47

liquid

Question 48

Review calculations and script writing

Answer 48

ok