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445- Pain and Mental Health > Acute Pain > Flashcards

Acute Pain Flashcards

1
Q

list some physical consequences of poor pain management

A

tachycardia, HPTN, increased cardiac workload, respiratory muscle spasm, atelectasis, hypoxia, post operative ileus, increased risk of oliguria and urinary retention, increased risk of thromboembolism, impaired immune function, muscle weakness and fatigue, anxiety, fear, frustration, poor pt satisfaction

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2
Q

assessment of acute pain should include

A

SCHOLAR, inquire about prior workup, diagnostic lab tests, prior self treatment, medical history (including allergies), current medications, physical exam

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3
Q

acute pain red flags

A

NIFTI
neurological, inflammatory, fracture, tumor, infection

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4
Q

nonpharm tx for acute pain is

A

PRICE
activity as tolerated, physio, external supports, cold/head therapy, massage, support

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5
Q

how long to rest and ice after an injury?

A

48hrs

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6
Q

benefits of nonopioid analgesia

A

readily available
efficacious
may eliminate need for opioids
may enhance opioid analgesia
varied MOA from opioids

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7
Q

what does the analgesic ladder say to use for mild pain

A

nonopioid +/- adjuvant therapy

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8
Q

what does the analgesic ladder say to use for mild-mod pain

A

weak opioid (codeine) +/- nonopioid +/- adjuvant therapy

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9
Q

what does the analgesic ladder say to use for severe pain

A

strong opioid +/- nonopioid +/- adjuvant therapy

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10
Q

acetaminophen CI and interactions

A

ethanol
warfarin (increased INR)
phenytoin
isoniazid

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11
Q

what is one function of NSAIDs that acetaminophen doesn’t have

A

antiinflammatory

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12
Q

NSAIDs are __ effective and ____ toxic than tylenol

A

more
more

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13
Q

COX1 inhibition prevents

A

production of protective mucosal prostaglandins

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14
Q

T or F: COX2i may still block COX1 at clinically used doses, but lower risk of GI bleeds compared to nonselective (still higher than placebo)

A

T

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15
Q

what NSAID should you use if you have CV concerns?

A

naproxen

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16
Q

T or F: ibuprofen is the worst for all cause mortality

A

F- all NSAIDs about the same

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17
Q

what 2 NSAIDs should be used if upper GI concerns

A

celecoxib and diclofenac

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18
Q

what NSAID should you use if pt has 1-2 GI RF

A

Celecoxib or nonselective NSAID with GI protection (PPI or misoprostol)

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19
Q

what NSAID should you use if pt has >2 Gi RF

A

celecoxib + PPI or misoprostol

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20
Q

how to prevent NSAID related CV toxicity in chronic use

A

naproxen preferred
avoid high dose diclo and ibu if on low dose aspirin
caution with other nonselective NSAIDs
avoid COX2 selective NSAIDs

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21
Q

how to prevent NSAID related toxicity in those with increased renal risk

A

avoid NSAIDs, use tylenol

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22
Q

___ causes steric hinderance of ASA binding

A

ibuprofen

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23
Q

in those with high CV risk, not taking ASA - ____ is associated with a lower CV risk than ibuprofen and lumiracoxib

A

naproxen

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24
Q

in those with high CV risk, taking ASA - _____associated with greater CV risk at 1 yr than lumiracoxib and naproxen

A

ibuprofen

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25
Q

when should you consider opioid analgesics

A

when persistent pain despite reasonable trial of nonopioid analgesics
mod-severe pain
CI to other analgesics
benefits > risks

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26
Q

pain adjuvants may include

A

gabapentinoids
skeletal muscle relaxants
cannabinoids

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27
Q

how do skeletal muscle relaxants like baclofen, cyclobenzaprine, and methocarbamol work for pain? what duration?

A

causes CNS sedation, might not actually be muscle relaxation
most benefit in first week

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28
Q

is there a role for cannabinoids in acute pain

A

some, but much- may cause more pain + not v effective

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29
Q

___ is a a common cause of delirium in the ICU

A

pain

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30
Q

predisposing factors for pain in the ICU

A

recent acute pain
hx of chronic pain, arthritis, fibromyalgia, traumatic injuries
thermal injuries
post op surgical site pain
infection or malignancy causing inflammation

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31
Q

precipitating factors for pain in the ICU

A

device placement
repositioning
diagnostic procedures
dressing changes
mobilization, physio
ET suctioning
prolonged immobility

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32
Q

prolonged immobility is a ____ factor

A

precipitating

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33
Q

traumatic injuries is a ______ factor

A

predisposing

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34
Q

validated ICU pain assessment scales are shown to (5 things)

A

improve pain management
decrease use of sedatives
decrase length of ventilation and ICU stay
decrease mortality
decrease use of opioids in noncommunicative pts

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35
Q

what opioid is a safer option in renal dysfunction and causes less histamine release

A

hydromorphone

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36
Q

which opioid needs consideration about renal function

A

morphine

37
Q

which opioid has the least hemodynamic effects and histamine release

A

fentanyl

38
Q

___ route is most commonly used for opioids in the ICU

A

IV

39
Q

why is the PO route not often used for opioids in the ICU

A

pts often have GI dysfunction resulting in altered absorption

40
Q

why is the SQ/IM route not often used for opioids in the ICU

A

altered absorption due to regional hypoperfusion

41
Q

which opioid is highly lipophilic and can accumulate and cause prolonged sedation

A

fentanyl

42
Q

what are some important points for preoperative pt eval

A

surgery type
expected postop pain type, severity, duration
past med hx and allergies
risk benefit ratio for available techniques
pt preference and previous pain experience

43
Q

what are some persistent post op pain risk factors

A

severe preop pain
repeat surgery
high risk of nerve damage
severe post op pain

44
Q

analgesic techniques can be __ or _______

A

single modality of multimodal (preferred)

45
Q

postop analgesic strategy may be (4 options)

A

ATC analgesia for 48-72hrs
nonpharm measures
nonopioid analgesics (acetaminophen or NSAIDs)
opioids (use short acting, oral opioids)

46
Q

what is PCA

A

pt controlled analgesia- analgesic admin on pt demand

47
Q

most common PCA is

A

IV via an infusion pump

48
Q

T or F: routine continuous infusion doses are typically not required on top of PCA for opioid naive pts

A

T

49
Q

PCA bolus doses have the following safety mechs build in

A

fixed bolus dose
predefined lockout intervals
recording of number of doses used

50
Q

which maintains more consistent plasma opioid concentrations
1. PCA
2. PRN boluses

A

PCA

51
Q

3 points on how to use PCA

A

educate pt- must understand + willing to use
ensure appropriate efficacy and safety parameters
adjust as needed for pain score of 1-3/10

52
Q

when to avoid PCA

A

not opioid naive or on opioids for chronic pain

53
Q

what is the only opioid available as injection

A

ketorolac

54
Q

which of the following is true about ketorolac (select all that apply)
1. it is the only NSAID available as injection
2. it can be used PO F5D for post op pain and 7 days for MSK
3. it can be used max 2 days IV/IM
4. it has greater analgesic effect to equipotent PO NSAIDs

A

1,2,3

55
Q

what is incidental pain

A

ST pain with predictable cause (bathing, dressing changse, movement)

56
Q

how to treat incidental pain

A

avoid precipitating event
multidisc approach
opioid or other analgesic 30-60min before activity

57
Q

ketorolac can be used PO for max ___ days for post op pain and __ days for MSK

A

5, 7

58
Q

ketorolac can be used IV/IM max ___ days in pts who can not tolerate PO

A

2

59
Q

when can you use acetaminophen in pregnancy

A

low risk at all stages, routine use not recommended

60
Q

when can you use NSAIDs in pregnancy

A

with caution, generally avoid at 20wks, contraindicated in 3rd trimester

61
Q

why are NSAIDs CI in 3rd trimster

A

premature closure of ductus arteriosus

62
Q

what opioids may be taken breastfeeding

A

morphine, fentanyl, hydromorphone

63
Q

which opioids should be avoided breastfeeding

A

meperidine, codeine, oxycodone, hydrocodone

64
Q

to convert codeine to morphine PO equivalent, multiply by

A

0.15

65
Q

to convert oxycodone to morphine PO eq, multiply by

A

1.5

66
Q

to convert hydromorphone to morphine PO eq, multiply by

A

5

67
Q

adjuvants to opioids include

A

gabapentinoids, skeletal muscle relaxants, cannabinoids

68
Q

what is the least effective option in acute pain
1. fentanyl patch
2. cannabinoids
3. opioids
4. tylenol

A

2

69
Q

T or F: pain in ICUs is a common cause of delirium

A

T

70
Q

T or F: pain in ICUs should be managed after giving sedation

A

F- manage pain, then give sedation

71
Q

predisposing factors of pain in ICU

A

recent acute pain, hx chronic pain, arthritis, fibromyalgia, traumatic injuries, thermal injury, post op surgical site pain, infection or malignancy causing infection

72
Q

implementation of pain assessment scales is shown to (5 things)

A

improve pain management, decrease use of sedatives, decrease length of ventilation and ICU stay, decrease mortality, decrease use of opioids in noncommunicative pts

73
Q

which is safer in renal dysfunction
1. morphine
2. hydromorphone
3. fentanyl
4. codeine

A

2

74
Q

which has the shortest onset and duration
1. morphine
2. hydromorphone
3. fentanyl
4. codeine

A

3: onset <2min, duration 1-2hrs

75
Q

which has the least histamine release
1. morphine
2. hydromorphone
3. fentanyl
4. codeine

A

3

76
Q

why is the IV route most commonly used for opioid admin in ICU pts

A

PO- pts often have GI dysfunction, leading to altered absorption
SQ/IM- may have altered absorption due to regional hypoperfusion

77
Q

________ is highly lipophilic and can accumulate and cause prolonged sedation

A

fentanyl

78
Q

what is prefered for analgesics
1. single modality
2. mutlimodal

A

2- use of =>2 drugs with variable MOA associated with superior pain relief and decreased opioid use

79
Q

what is a general postop analgesia strategy

A

ATC analgesics for 48-72hrs
nonpharm measures
nonopioid analgesics + consider gabapentinoids
opioids- short activg, oral

80
Q

if parenteral opioids are required for more than a few hours, consider ______ instead of PRN intermittent boluses

A

PCA

81
Q

which of the following is false about PCA
1. has predefined doses and lockout intervals
2. is better at maintaining constant plasma opioid concentrations compared to conventional IM breakthrough doses
3. allows individualization of dose
4. routine continuous infusion is not required in addition to PCA in opioid naive patients
5. should not be used for patients that are opioid naive

A

5- should not be used on those that are NOT opioid naive

81
Q

which of the following is false about PCA
1. has predefined doses and lockout intervals
2. is better at maintaining constant plasma opioid concentrations compared to conventional IM breakthrough doses
3. allows individualization of dose
4. routine continuous infusion is not required in addition to PCA in opioid naive patients
5. should not be used for patients taht have used opioids before

A

5- shou;d not be used on opioid naive

82
Q

when to avoid PCA

A

not opioid naive or on opioids for chronic pain

83
Q

what is the only NSAID available as an injection

A

ketorolac

84
Q

ketorolax PO max ____ days for post op pain and ____ days for MSK

A

5 days for post op
7 days for MSK

85
Q

ketorolac IV/ IM max ___ days in pts who can not tolerate PO

A

2 days

86
Q

what is incidental pain

A

short term pain with predictable cause

87
Q

how to treat incidental pain

A

opioid or other analgesics 30-60min before activity

445- Pain and Mental Health (21 decks)

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