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Principles > Acute Pain > Flashcards

Acute Pain Flashcards

1
Q

Somatic pain types

A

Superficial; from skin, subs tissue, mucous membranes
Deep; Muscle, tendons, joints or bones

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2
Q

Visceral pain types

A

Parietal; localized to the area around the organ; sharp/ stabbing
Referred Pain; cutaneous pain resulting form patters of embryo logic developments and migration of tissues and the convergence of visceral and somatic afferent inputs into the cns

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3
Q

Red Flags of pain

A

Pain that wakes pts up
Immunosuppressive
Severe or progressive neurological deficit
Cold, pale mottled or cyanosis limb
New bowel/ bladder dysfunction
Severe and pain or signs of shock/ peritonitis

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4
Q

Who defined pain as an emotional experience rather than a sensory one

A

Plato

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5
Q

Who explained the degree of plain associated with the degree of tissue injury

A

Rene Descartes “specificity theory of pain”

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6
Q

Who came up with the gate control theory of pain

A

Ronald Melzack and Patric Wall
In the substantia gelatinousa

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7
Q

Inflammatory mediators that contribute to pain

A

Peptides = bradykinin
Lipids = prostaglandins
Neurotransmitters = serotonin

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8
Q

Four elements of pain processings

A

transduction = noxious stimuli concerted to A&P
Transmission= AP is conducted through the nervous system
Modulation = pain transmission alters afferent neural transmission (gate control)
Perception- integration of painful input into somatosensory and lambic contrices

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9
Q

Allodynia

A

Pain from a stimulus that doesn’t normally evoke pain (thermal or mechanical)

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10
Q

Hyperalgesia

A

An exaggerated response to a normal painful stimulus.

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11
Q

What medication can cause hyperalgesia

A

Remifentanil (use with ketamine because its primary treatment of hyperalgesia)

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12
Q

Neuropathic pain

A

Complete denervation of a body part does result in numbness, the hallmark ‘negative” symptom of neuropathy. Yes nerve trauma and disease are also frequently associated with ‘positive’ symomtoms and signs.
Pain coming from the nerve itself

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13
Q

My receptor responses

A

Analgesia, resp depression, euphoria, reduced GI motility

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14
Q

kappa receptors response

A

Analgesia, dysphasia, psychosis, delusion/ delirium, mitosis, resp depression

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15
Q

Delta Receptors Response

A

Analgesia

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16
Q

Codeine compared to morphine

A

More reliably absorbed orally than morphine

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17
Q

Codeine metabolism

A

Metabolized by P450 CYP 2d6 10% of admin dose is demethlated in liver to morphine
Remainder demethlyated to inactive norcodeine CYP3A4

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18
Q

Who do we avoid codeine in?

A

CHildren less than 12 lack maturity of the enzyme and can experience side effects w/out analgesia

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19
Q

COdeine adult dosing

A

15-60 mg q4 max 360/day

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20
Q

Tramadol

A

Synthetic opioid that is a combo of morphine and codeine
Use for long and short term pain when we are trying to avoid a true opioid
Receptors; mu kappa and delta

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21
Q

Tramadol metabolism

A

Cape 2d6 and 2A4 to active metabolite that is 2-4 x as potent as the OG

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22
Q

Tramadol potency and onset and T1/2

A

1/5-1/10 the potency of morphine
Onset 1-2 hrs
T1/2= 6.3 for Tramadol and 7.4 for metabolite

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23
Q

Tramadol contraindications

A

Sz pts
High incidence of n/v

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24
Q

Morphine receptors

A

Mu 1 and mu2

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25
Q

Morphine metabolism

A

Metabolism is conjugation with glucuronic acid
Lipid soluble/ highly protein bound
Active metabolite

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26
Q

Morphine onset and peak and women vs men

A

IM = 15-30 min and peak effect in 45 min

Greater analgesia and slower onset in women (give less)

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27
Q

Oxycodone

A

Synthetic derivative ‘replaced morphine’

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28
Q

Name for long acting oxycodone

A

OxyContin (controlled release)

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29
Q

Oxycodone metabolism

A

Active metabolites
Mu and Kappa receptors
Cyp 2D6; excessive first pass effect

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30
Q

Dosing and timing for oxycodone

A

10-15 mg = 10mg of morphine
1 hr onset
3 hr half life (4.5 for CR)

Cr can last 12 hrs

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31
Q

Methadone

A

treatment for opioid addiction
potent and long duration of action

sporadic effects and get wide variety of effects

32
Q

Where is methadone excreted

A

urine
metabolismed by 3A4 and 1A2 and 2D6 to inactive metabolite

33
Q

What can increase cyp450

A

carbazepine - inducer
antiretroviral and grapefreuit juice- reducers

34
Q

Dose for methadone

A

2.5-10 mg PO/IM/SC q 4-12 hr

takes awhile to get to steady state (takes about 10 days)

35
Q

Fentanyl

A

synthetic opioid
high potency
rapid onset and fast offset

36
Q

Detecting fentanyl

A

normeperidine can be detected in urine for up to 72 hrs
lungs serve as a large inactive reservoir

37
Q

Hydromorphone potency and metabolism

A

3-5 x as potent as morphine when administered orally and 8.5 times as potent parenterally

liver metabolism

38
Q

Hydrophrphone dosing

A

0.2-0.5 mg q 3-5 min

PO; 2-8 mg q4-6 hrs

39
Q

Hydrocodone potency compared to codeine

A

6-8 x as potent as codeine

40
Q

Most commonly abused perscription medications

A

oxycodone then hydrocodone

41
Q

Hydrocodone metaboilsm

A

active metabolite hydromorphone

42
Q

opioid that interacts with cardiac medications

A

hydrocodone

43
Q

Buprenorphine

A

agonist antagonist of mu kappa and delta

analgesic or weaning for those with opioid abuse

44
Q

Buprenorphine metaoblism

A

liver

can be IM or PO

45
Q

Burprenorphine dose IM

A

0.3 mg = 10 mg of morphine

long half life 20-72 hr

46
Q

Ibuprofen dose

A

200 mg 3 x daily

47
Q

Celecobix dose

A

100 mg daily

48
Q

Naproxen dose

A

220 mg twice daily

49
Q

Diclofenac dose

A

50 mg twice daily

50
Q

Anticonvulsant medications

A

Gabapentin (neurontin)
Phyenytoin (Dilantin)
Carbamazepine (tegretol)
Topiramate (topamax)

51
Q

SKm relaxants

A

Baclofen
carisoprodol
Cyclobenzaprine (flexeril)
Methocarbamol (robaxin)
Tizanidine (zanaflex)

52
Q

Morphine IV dose

A

2.5-15 mg

53
Q

Morphine IM dose

A

10-15 mg

54
Q

Morphine PO dose

A

40-60 mg

55
Q

Codeine PO dose

A

15-60 mg

56
Q

Hydromorphone IV dose

A

0.2-1 mg

57
Q

mydromorphone IM dose

A

1-4 mg

58
Q

Hydromorphone PO dose

A

1-4 mg

59
Q

Fentanyl IV dose

A

20-50 mcg

60
Q

Fent TM dose

A

200-1600 mcg

61
Q

Fent TD dose

A

12.5-100 mcg

62
Q

Hydrocodone PO dose

A

5-7.5 mg

63
Q

Oxycodone Po dose

A

5 mg

64
Q

methadone PO dose

A

2.5-10 mg

65
Q

Tramadol PO dose

A

50-100 mg

66
Q

Celecoxib PO dose

A

100 mg/d

67
Q

Diclofenac PO dose

A

50 mg BID

NSAID

68
Q

Mag sulfate dose

A

Loading 30-50 mg/kg
Maint 6-20mg/kg/hr

69
Q

Lidocaine bolus dose

A

100 mg

70
Q

Lidocaine gtt dose

A

1.3-3 mg/kg / hr

71
Q

ketamine dose

A

0.25-0.5 mg/kg

72
Q

Precedex loading dose

A

0.5mcg/kg over 10 min

73
Q

precedex gtt dose

A

0.1-0.3mcg/kg/hr

74
Q

gabapentin dose

A

200-300 mg

75
Q

nicardipine dose

A

1-5 mg

76
Q

Ephedrine dose

A

3-9mg

77
Q

neo dose

A

10-30 mcg

Principles (34 decks)

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