5.7 non-malignant pain pt1 Flashcards
What questions would a pharmacist want to ask to SUBJECTIVELY assess a pt’s pain?
“PQRSTU”:
- Palliative or precipitating factors
- Quality of pain
- Region of pain location
- Severity (pain assessment instruments)
- Time related nature of pain
- impact of pain on yoU
What are objective ways to assess pain?
- Behavioral changes
- Physiological changes: dilated pupils (mydriasis), paleness (palor), sweating (diaphoresis), tachycardia, tachypnea
What are the different pain intensity scales?
- Verbal
- Numeric
- Visual
- Wong-Baker (faces)
What are non-pharmacologic therapy options?
- Can be used in combo w analgesics
- Correct the underlying cause (surgery, avoidance)
- Exercise
- Acupuncture
- Physical manipulation
- Heat or ice
- Massage
What is the 1st step of WHO’s analgesic ladder?
- Non opioid
- +/- adjuvant analgesic
What is the 2nd step of WHO’s analgesic ladder?
- Opioid for mild to moderate pain
+ non-opioid - +/- adjuvant analgesic
What is the 3rd step of WHO’s analgesic ladder?
- Opioid for moderate to severe pain
+ non-opioid - +/- adjuvant analgesic
When should a pt move onto the next step of the WHO’s analgesic ladder?
If pain is persisting or increasing
When should a pt move down to a lower step of the WHO’s analgesic ladder?
If pain is resolving or toxicity occurs
What drugs are non-opioids?
- Acetaminophen
- NSAIDs
What drugs are adjuvant therapies?
- Gabapentinoids
- SNRIs
- TCAs
- Skeletal muscle relaxants
- Anti-epileptics
- Topical agents
What is acetaminophen (tylenol) used for?
Analgesic and antipyretic
What are the available formulations for acetaminophen (tylenol)?
- Tablet
- Capsule
- Chewable tablet
- Liquid/gel
- IV solution
- Suppository
What are the recommended dosing of acetaminophen (tylenol) for adults?
- 325-1000 mg PO q4-6h PRN
- Max dose <= 3-4 g/day
- In liver disease, max <= 2 g/day
What is the recommended dosing of acetaminophen (tylenol) for pediatrics?
- 10-15 mg/kg PO q4h PRN
- Max dose 75 mg/kg/day or <= 3-4 g/day
What are the SEs of acetaminophen (tylenol)?
- Hepatotoxicity
- Acute liver failure most likely w >= 10 g/day
What drugs are NSAIDs?
- Aspirin
- Ibuprofen (Advil, Motrin)
- Diclofenac (Voltaren)
- Naproxen (Aleve, Naprosyn)
- Ketorolac (Toradol)
- Celecoxib (Celebrex)
What are NSAIDs used for?
Analgesic, antipyretic, anti-inflammatory
What are SEs of NSAIDs?
- GI bleeding (black box warning)
- Nephrotoxicity
- Fluid retention
- Increase CV events (black box warning)
What are clinical pearls for NSAIDs?
- Take w food
- Caution in geriatrics due to increased SEs
- Avoid systemic NSAIDs in pts w cardiac hx (can use topical NSAIDs)
- Avoid in severe liver or chronic kidney disease
What are available formulations for aspirin?
- Chewable tablet
- Tablet
- EC tablet
- Capsule
- ER capsule
- Suppository
What is the recommended dosing of aspirin for adults?
- 325-1000 mg q4-6h PRN
- Max 4 g/day
Can aspirin be used in pediatric pts?
AVOID due to Reye’s syndrome
What is Reye’s syndrome?
- Rare but serious condition that causes - swelling in the brain and liver
- Associated w children/teens using aspirin when they have had a viral infection
