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Pain > Acute Pain > Flashcards

Acute Pain Flashcards

1
Q

What is ketorolac?

A

Very potent NSAID

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2
Q

What is the onset of analgesia for ketorolac?

A

30 min

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3
Q

What is the peak effect of ketorolac?

A

2-3 hours

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4
Q

What is the duration of ketorolac?

A

4-6 hours

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5
Q

When is ketorolac contraindicated?

A

Labor and delivery

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6
Q

What do all NSAIDs increased the risk of in post-op CABG surgery?

A

MI and Stroke

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7
Q

What are the 3 IV opioids?

A

Morphine
Hydromorphone
Fetanyl

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8
Q

Which IV opioid accumulates in renal impairment?

A

Morphine

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9
Q

How does morphine cause hypotension?

A

Histamine release

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10
Q

What is a good IV alternative for morphine-intolerant pts?

A

Hydromorphone

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11
Q

What do all IV opioids cause?

A

Hypotension

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12
Q

What is similar to fentanyl in potency and PK parameters?

A

Remifentanil

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13
Q

What kind of metabolism does remifentanil show?

A

Organ-independent

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14
Q

When is meperidine used?

A

Labor and delivery

Reduce rigors associated w/amphotericin toxicity

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15
Q

What may be found PRN on a chart if the patient is receiving IV opioids?

A

Naloxone

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16
Q

Why does naloxone require repeated doses?

A

Short 1/2 life elimination compared to opioids

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17
Q

What is the onset of IV naloxone?

A

2 min

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18
Q

Who should not receive PCA?

A 
Dementia
Delirium
Cognitive deficits
H/o substance abuse
Anticipated short duration of opioid use
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19
Q

Who has an indication for PCA?

A 
Post-op pain
Severe pain
Cancer pain
Sickle cell crisis
Palliative care
Burn pts
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20
Q

What are the goals of PCA therapy?

A

Pain score 4 or less
Avg 2-3 PCA doses/hr
Maintain O2 sat and RR
Wean off PCA, decrease basal rate

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21
Q

What is the first step in adjusting PCA in opioid-naive patients?

A

Increase dose first

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22
Q

What do we do if increasing the dose of PCA is not enough for the pain?

A

Consider adding basal rate (if not prescribed already)

Start at low end of dosing range or 1/3 of average hourly usage for at least the past 12 hours

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23
Q

How do we adjust PCA doses in opioid tolerant patients?

A

Increase basal rate up to 2/3 of average hourly usage

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24
Q

How do we start PCA in a opioid tolerant patient?

A

Will likely need basal rate and higher PCA dose

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25
Q

What are ways to administer spinal opioids?

A

Epidural

Intrathecal

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26
Q

When is neuraxial analgesia indicated?

A

Post-op pain
Labor and delivery
Chronic pain

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27
Q

Where is an epidural administered?

A

Outside the dura mater
Space b/n the dura mater and ligamentum flavum
Contains fat, lymphatics, arterioles, and veins w/nerve roots

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28
Q

How does the drug that is administered via an epidural make it into the CSF?

A

Drug diffuses through the dura into the CSF

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29
Q

Where is an intrathecal opioid administered?

A

In the space under the arachnoid membrane
Intrathecal space = subarachnoid space
-B/n the arachnoid mater and pia mater
-Contains CSF

30
Q

How does the drug that is administered via an intrathecal injection make it into the CSF?

A

Drug is delivered directly into the CSF and superficial spinal cord

31
Q

What are the approximate equivalencies of morphine from an IV to epidural to intrathecal dose?

A

10mg IV = 1mg epidural = 0.1mg intrathecal

32
Q

Which opioids used in neuraxial analgesia are highly lipid soluble?

A

Fentanyl

Sufentanil

33
Q

Which opioids used in neuraxial analgesia have lower lipid solubility?

A

Morphine

Hydromorphone

34
Q

Which neuraxial analgesics have a rapid onset of analgesia?

A

Fentanyl

Sufentanil

35
Q

Which neuraxial analgesics have a delayed/slower onset of analgesia?

A

Morphine

Hydromorphone

36
Q

Which neuraxial analgesics are more rapidly cleared from the CNS?

A

Fentanyl

Sufentanil

37
Q

Which neuraxial analgesics have a prolonged half life in the CNS?

A

Morphine

Hydromorphone

38
Q

What is a serious AE of neuraxial analgesics?

A

Hematoma formation

39
Q

What increases the risk of a hematoma formation?

A

Anticoagulants

Antiplatelets

40
Q

When is the risk of a hematoma forming greatest?

A

During placement/removal of catheter

41
Q

When is neuraxial analgesia contraindicated?

A

Uncorrected coagulopathy
Infection of the lower back
Uncorrected hypovolemia
Increased intracranial pressure

42
Q

What type of solution must intrathecal and epidural agents be?

A

PF

43
Q

When is the risk of long term treatment increased in opioid-naive, non-cancer pts?

A

With each additional day of medication use after 3 days
After a second prescription/refill
700+ mg morphine equivalent cumulative dose
Exceeded 10 or 30 day supply
Initiated on a long-acting opioid
Initiated on tramadol

44
Q

What is the definition of tolerance?

A

The reduction of drug effect over time as a result of exposure to the drug

45
Q

What is the definition of dependence?

A

When an abstinence syndrome occurs following administration of an antagonist drug or abrupt dose reduction or d/c of an opioid

46
Q

What is the definition of addiction?

A

Ongoing substance use despite known harmful consequences to health or relationships

47
Q

What is the definition of pseudoaddiction?

A

Person exhibits behaviors suggestive of addiction but in reality are a reflection of unrelieved pain

48
Q

How long until a patient has physical and psychological opioid dependence?

A

Approximately 3 weeks of daily opioid use

49
Q

What are the sx of WD after 3-4 hours of non-use?

A

Drug craving
Anxiety
Fear of WD

50
Q

What are the sx of WD after 8-14 hours of non-use?

A 
Anxiety
Restlessness
Insomnia
Rhinorrhea
Lacrimation
Diaphoresis
Stomach cramps
Mydiasis
51
Q

What are the sx of WD after 1-3 days of non-use?

A 
Tremors 
Muscle spasms
Vomiting
Diarrhea
Tachycardia
Chills
52
Q

What opioids can be given to treat acute WD?

A

Any

53
Q

What is the new term for detoxification?

A

Medically supervised WD

54
Q

What drugs should be used for detox?

A

Suboxone
Buprenorphine
Methadone

55
Q

What medications can be used for sx relief in detox?

A

Clonidine
Benzo
Loperamide
Anti-emetics

56
Q

What is the length of time for drugs of abuse that can be detected in the urine?

A

About 48 hours

57
Q

How do we evaluate a urine sample?

A 
Appearance and color
Temperature
Volume
Concentration of urine
Urine pH, specific gravity, CrCl
58
Q

What are the two types of urine tests?

A

Immunoassay

Gas chromatography-mass spectrometry (GC-MS)

59
Q

What is the most common initial urine test?

A

Immunoassay

60
Q

How does immunassay work?

A

Uses antibodies to detect the presence of parent drug or metabolites

61
Q

What is a negative about immunoassays?

A

False positives can occur d/t other substances

62
Q

If a patient’s immunoassay tests positive, does that mean that they took something?

A

No, it is presumptive

63
Q

When is the GC-MS used?

A

Confirmation purposes

64
Q

Which test type is the most accurate and sensitive?

A

GC-MS

65
Q

Why is GC-MS not used as often?

A

Time-consuming and costly

66
Q

What are the s/sx of opioid overdose?

A

Decreased RR and bowel sounds
Miosis
Depressed mental status

67
Q

What opioids can cause serotonin syndromes or seizures?

A

Meperidine

Tramadol

68
Q

What opioids can cause hepatotoxicity?

A

APAP combinations

69
Q

What opioids can cause QTc prolongation?

A

Methadone

Oxycodone

70
Q

What is the management of opioid overdose?

A

ABCs
Secure airway
Administer naloxone
Tox panel, CPK, electrolytes, glucose, ECG

71
Q

What is the goal RR for naloxone administration?

A

12+ BPM

72
Q

What are preventative techniques for opioid overdose?

A

Prescription Drug Monitoring Programs
Abuse-deterant formulations (ER)
Civilian access to naloxone

Pain (5 decks)

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