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PHRM 845 > 5.7 non-malignant pain pt1 > Flashcards

5.7 non-malignant pain pt1 Flashcards

1
Q

What questions would a pharmacist want to ask to SUBJECTIVELY assess a pt’s pain?

A

“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

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2
Q

What are objective ways to assess pain?

A
  • Behavioral changes
  • Physiological changes: dilated pupils (mydriasis), paleness (palor), sweating (diaphoresis), tachycardia, tachypnea
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3
Q

What are the different pain intensity scales?

A
  • Verbal
  • Numeric
  • Visual
  • Wong-Baker (faces)
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4
Q

What are non-pharmacologic therapy options?

A
  • Can be used in combo w analgesics
  • Correct the underlying cause (surgery, avoidance)
  • Exercise
  • Acupuncture
  • Physical manipulation
  • Heat or ice
  • Massage
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5
Q

What is the 1st step of WHO’s analgesic ladder?

A
  • Non opioid
  • +/- adjuvant analgesic
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6
Q

What is the 2nd step of WHO’s analgesic ladder?

A
  • Opioid for mild to moderate pain
    + non-opioid
  • +/- adjuvant analgesic
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7
Q

What is the 3rd step of WHO’s analgesic ladder?

A
  • Opioid for moderate to severe pain
    + non-opioid
  • +/- adjuvant analgesic
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8
Q

When should a pt move onto the next step of the WHO’s analgesic ladder?

A

If pain is persisting or increasing

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9
Q

When should a pt move down to a lower step of the WHO’s analgesic ladder?

A

If pain is resolving or toxicity occurs

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10
Q

What drugs are non-opioids?

A
  • Acetaminophen
  • NSAIDs
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11
Q

What drugs are adjuvant therapies?

A
  • Gabapentinoids
  • SNRIs
  • TCAs
  • Skeletal muscle relaxants
  • Anti-epileptics
  • Topical agents
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12
Q

What is acetaminophen (tylenol) used for?

A

Analgesic and antipyretic

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13
Q

What are the available formulations for acetaminophen (tylenol)?

A
  • Tablet
  • Capsule
  • Chewable tablet
  • Liquid/gel
  • IV solution
  • Suppository
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14
Q

What are the recommended dosing of acetaminophen (tylenol) for adults?

A
  • 325-1000 mg PO q4-6h PRN
  • Max dose <= 3-4 g/day
  • In liver disease, max <= 2 g/day
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15
Q

What is the recommended dosing of acetaminophen (tylenol) for pediatrics?

A
  • 10-15 mg/kg PO q4h PRN
  • Max dose 75 mg/kg/day or <= 3-4 g/day
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16
Q

What are the SEs of acetaminophen (tylenol)?

A
  • Hepatotoxicity
  • Acute liver failure most likely w >= 10 g/day
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17
Q

What drugs are NSAIDs?

A
  • Aspirin
  • Ibuprofen (Advil, Motrin)
  • Diclofenac (Voltaren)
  • Naproxen (Aleve, Naprosyn)
  • Ketorolac (Toradol)
  • Celecoxib (Celebrex)
18
Q

What are NSAIDs used for?

A

Analgesic, antipyretic, anti-inflammatory

19
Q

What are SEs of NSAIDs?

A
  • GI bleeding (black box warning)
  • Nephrotoxicity
  • Fluid retention
  • Increase CV events (black box warning)
20
Q

What are clinical pearls for NSAIDs?

A
  • 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
21
Q

What are available formulations for aspirin?

A
  • Chewable tablet
  • Tablet
  • EC tablet
  • Capsule
  • ER capsule
  • Suppository
22
Q

What is the recommended dosing of aspirin for adults?

A
  • 325-1000 mg q4-6h PRN
  • Max 4 g/day
23
Q

Can aspirin be used in pediatric pts?

A

AVOID due to Reye’s syndrome

24
Q

What is Reye’s syndrome?

A
  • 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
24
Q

What are the available formulations of Ibuprofen (Motrin, Advil)?

A
  • Capsule
  • Tablet
  • Chewable tablet
  • Suspension
  • IV solution
25
Q

What is the recommended dosing of ibuprofen (advil, motrin) in adults?

A
  • 200-800 mg PO q4-6h PRN
  • Max 3200 mg/day
26
Q

What is the recommended dosing of ibuprofen (advil, motrin) in pediatrics?

A
  • 5-10 mg/kg PO q4-6h PRN
  • Max 40 mg/kg/day or 2400 mg, whichever is less
27
Q

What are available formulations of diclofenac (voltaren)?

A
  • Capsule
  • Tablet
  • IV solution
  • Suppository
  • Topical gel and solution
  • Ophthalmic solution
  • Patch
28
Q

What is the recommended dosing of diclofenac (voltaren) in adults?

A

50 mg PO q8h or 2-4 g applied topically 4x/day

29
Q

What is a clinical pearl for diclofenac (voltaren)?

A

Minimal systemic SEs w topical gel

30
Q

What are available formulations of naproxen (aleve, naprosyn)?

A
  • Capsule
  • Tablet
  • DR/ER tablet
  • Suspension
31
Q

What is the recommended dosing of naproxen (aleve, naprosyn) in adults?

A
  • 220-500 mg PO q6-12h
  • Max 1000 mg/day
32
Q

What are available formulations of ketorolac (toradol)?

A
  • Tablet
  • IV/IM solution
  • Nasal spray
  • Ophthalmic solution
33
Q

What is the recommended dosing of ketorolac (toradol) in adults?

A
  • 15-30 mg IV q6h prn or
  • 10 mg PO q6h prn
34
Q

What is the recommended dosing of ketorolac (toradol) in pediatrics?

A

0.5 mg/kg/dose IM/IV q6h prn

35
Q

What is the max duration of ketorolac (toradol) use?

A

5 days (parenteral + oral)

36
Q

What is a risk if ketorolac (toradol) is used for longer than 5 days?

A

Increased risk of GI bleed when used longer

37
Q

What is the oral form of ketorolac (toradol) used as?

A

Oral dosing is intended as a continuation of IM or IV therapy

38
Q

What are the available formulations of celecoxib (celebrex)?

A
  • Capsule
  • Oral solution
39
Q

What is the recommended dosing of celecoxib (celebrex) in adults?

A

200 mg PO BID

PHRM 845 (48 decks)

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