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Pharmacotherapy > Acute Pain > Flashcards

Acute Pain Flashcards

1
Q

What is meant by pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

True/False: pain report is the most reliable indicator of pain

A

True

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3
Q

Tie/False: pain remains the most inadequately or mapproprantely treated issue

A

True

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4
Q

True/False: it requires a multidisciplinary team to address pain management needs

A

True

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5
Q

What are the two types of pain

A

Nociceptive

Pathophysiologic

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6
Q

Which pain type occurs due to protection and is physiologic in nature

A

Nociceptive

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7
Q

Which pain is harmful

A

Pathophysiologic

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8
Q

Chronic pain for example neuropathic pain is what type of pain?

A

Pathophysiologic

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9
Q

What are the two types of nociceptive pain?

A

Somatic

Visceral

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10
Q

Pain arising from skin, bone, joint, muscle or any type of connective tissue is called

A

Somatic nociceptive pain

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11
Q

How is somatic nociveptive pain described

A

Throbbing, well localized

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12
Q

What type of pain arise from internal organ such as large intestine, pancreas etc or pain coming from other structures

A

Visceral nociceptive pain

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13
Q

Nociceptive pain is usually what category of pain

A

Acute pain

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14
Q

List examples of conditions that can give rise to acute pain

A

Surgery

Acute illness

Trauma

Labor

Medical procedures

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15
Q

What can unrelieved pain cause

A

Tachycardia

Chronic pain

Hyper-coagulable

Increased myocardial oxygen consumption

Immuno-suppression

Catabolism

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16
Q

For each characteristic describe if is for acute and chronic pain

Relief of pain

A

Highly desirable for both

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17
Q

For each characteristic describe if it is for acute and chronic pain

Dependence/Tolerance

A

Acute: unusual

Chronic: common

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18
Q

For each characteristic describe if it is for acute and chronic pain

Physiologic component

A

Acute: rare

Chronic: often

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19
Q

For each characteristic describe if it is for acute and chronic pain

Organic cause

A

Acute: common

Chronic: may not be present

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20
Q

For each characteristic describe if it is for acute and chronic pain

Environmental or Social issues

A

Acute: small

Chronic: significant

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21
Q

For each characteristic describe if it is for acute and chronic pain

Insomnia

A

Acute: unusual

Chronic: common

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22
Q

For each characteristic describe if it is for acute and chronic pain

Treatment goal

A

Acute: pain reduction

Chronic: functionality and qualify of life

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23
Q

For each characteristic describe if it is for acute and chronic pain

Depression

A

Acute: uncommon

Chronic: common

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24
Q

What is the A in ABC’s of pain management

A

Assess pain systematically

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25
Q

What is the B in ABC’s of pain management

A

Baseline medication utilization

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26
Q

What is the C in ABC’s of pain management

A

Choose most appropriate medication

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27
Q

What is the D in ABC’s of pain management

A

Determine adjuncts /supportive care as well as follow ups and monitoring plans

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28
Q

What is the E in ABC’s of pain management

A

Educate the patient

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29
Q

When a patient present to the clinic how do you best assess them for therapy recommendation

A

Comprehensive patient history and physical exam

Patient report is the best tool

Look for other indicators of pain but not used as a diagnostic of pain

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30
Q

What can be indicator of a patient is in pain

A

Changes in eating habit

Agitation

Hypertension

Tachycardia

Diaphoresis (Sweatingexcessively)

Mydriasis (pupil dilation)

Pallor (pale appearance)

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31
Q

What Assessment tools can guide you to identify how much pain a patient is experiences

A

PQRST-U

VAS- visual analog scales ( no pain - worst possible pain)

Graphic scale (emoji faces)

Verbal pain (on a scale of one - ten)

Functional pain scale (on a scale of one-five how does the pain limit your activity)

Word descriptor scale

Critical care pain observation tool

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32
Q

0

A

No pain

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33
Q

1-2

A

Mild pain

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34
Q

3-5

A

Moderate pain

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35
Q

6-7

A

Severe pain

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36
Q

8-9

A

Very severe pain

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37
Q

10

A

Worst possible pain

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38
Q

What ‘s the primary goal of acute pain relief

A

Rapid pain relief or reduction in pain intensity

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39
Q

What are the non-pharmacologic therapy that may provide some benefit

A

Physical manipulation

Topical application of heat or cold

Massage

Exercise

Acupuncture

Biofeedback

Cognitive behavioral therapy

Relaxation

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40
Q

What is the cornerstone of acute pain management

A

Pharmacologic treatment

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41
Q

What is the best thing to look for when prescribing pharmacological pain therapy

A

Most effective pain analgesic with the fewest side effect

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42
Q

Therapy for mild-moderate pain

A

Acetaminophen or NSAIDs

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43
Q

Therapy for moderate-severe pain

A

Opioids

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44
Q

Choice of particular agent depends on what factor

A

Availability

Cost

PK

Pharmacologic characteristics

ADR

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45
Q

What is the preferred route of analgesic administration

A

Oral

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46
Q

When is onset via oral administration seen

A

45 minutes

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47
Q

What is the preferred rout for immediate relief

A

Parenteral route

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48
Q

When it comes to dosing frequency what should be considered

A

Initial around the clock or as needed

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49
Q

Easier to prevent pain than to treat once it occurs

• As needed regimens rely on patient to ask for pain medications each dose (negative connotations) and produce wide swings in
drug concentrations

• May require escalating doses to relieve pain with PRN dosing
which may precipitate side effects

A

Just know this

50
Q

What is the use of acetaminophen

A

Antipyretic

Antianalgesic

No anti-inflammatory properties

51
Q

Acetaminophen MOA

A

Prostaglandin synthesis inhibition in CNS to block pain impulse generation

52
Q

Acetaminophen usual dose

A

325-1000 mg q 4-6hours

53
Q

Acetaminophen max dose

54
Q

Which patient should maximum acetaminophen dose be 2g daily

A

Hepatic dysfunction

Alcohol use

Poor nutritional intake

55
Q

What is the major toxicity of acetaminophen

A

Hepatotoxicity

56
Q

What is a good monitoring parameter for acetaminophen dosing

A

Monitor total close of APAP utilized in all OTC or prescribed medication

57
Q

When is IV acetaminophen (ofirmev) used

A

In postoperative pain

58
Q

What is the use of NSAIDs

A

Antipyretic

Analgesic

Anti-inflammatory

59
Q

NSAIDs MOA

A

Reversible inhibition a COX 1 and2 enzymes which decrease formation of prostaglandin precursors

60
Q

What does the higher dose of NSAIDs have more effect on

A

Inflammation. Ceiling effect exist for the analgesic effect of NSAIDs.

61
Q

True or false: NSAIDs have dependence or tolerance

62
Q

What are the most Common NSAIDs for acute pain

A

Ibuprofen

Naproxen

Ketorolac

63
Q

What’s the initial dose of ibuprofen

A

200-800 mg every 4-6 hours

64
Q

What is the Max dose for ibuprofen

A

3200 mg daily

65
Q

What is the initial dose of naproxen

A

275-550mg every 6-12 hours; variable by product

66
Q

What is the max dose of naproxen

A

1100 mg daily

67
Q

What is the route of administration for ketorolac

68
Q

What is the initial dose of ketorolac

A

15-30mg IV or 60-120mg daily

1M-60 mg

Every 6 hours

69
Q

Holy is the maximum daily use of ketolorolac 5 days

A

To reduce risk of GI bleeding

70
Q

Which patient should lower dose be given

A

Elderly ≥ 65 years

Mild to moderate renal impairment

71
Q

For which patient is ketorolac contraindicated

A

Several renal impairment

Low body weight < 50 kg due to increased risk of bleeding

72
Q

What is the GI ADR of NSAID

A

Acute GI: irritation, abdominal pain

Chronic GI: bleeding

73
Q

What are the risk factors for GI problem with NSAID use

A

Prior history of GI bleeding

Corticosteroid use

Anticoagulants

Alcoholism

Older age

Chronic NSAID use

Smoking

H-Pylori

74
Q

Which is the order for which GI problem is higher in NSAID use

A

Ibuprofen - least

Aspirin

Naproxen

Ketorolac - most

75
Q

What should you counsel patient an hour to reduce GI bleeding

A

Take with food or milk

76
Q

For patient with high risk of GI bleeding or history of gastric ulcer what medication can be given to decrease their risk of developing GI ADR

77
Q

What is the Hematologic ADR for NSAIDs use

A

Decreased platelet aggregation

It is reversible depending on the drug half life

78
Q

Who are at risk of developing Hematologic ADR with NSAIDs use

A

Anticoagulant

Thrombocytopenia

Prior GI bleed

Elective surgery

79
Q

What is the renal ADR for NSAID use

A

Decreased glomerular filtration ratel

80
Q

Who are at risk for renal ADR from NSAID use.

A

Chronic or dual NSAID use

Dehydration

CHF

Hepatic disease

Concomitant use with ACEi

81
Q

Which medication is reserved for moderate to severe pain

82
Q

Opioid MOA

A

Analgesic effect through central and peripheral opioid receptors ( mu receptors)

83
Q

Is pain a ways eliminated in opioid use

A

No, however unpleasantness decreases meaning that they feel pain but it no longer bothers them

84
Q

What is the GI ADR of opioid use

A

Decreased GI motility leading to constipation

Nausea and vomiting

85
Q

How is this constipation relieved in patients taking opioid

A

prescibe stool softener with or without a stimulant

86
Q

How is nausea and vomiting in patients taking opioids managed

A

Antiemetic

87
Q

What CNS effect might opioid have

88
Q

Why can opioid use cause rash

A

Some activate the release of histamine from mast cells

89
Q

How is opioid induced rash managed

A

Antihistamine but may contribute to sedation

90
Q

What effect does opioid have On un’ne output and why this not worrisome

A

Urinary retention but patient will develop tolerance over time

91
Q

How does opioid induce respiratory depression and how does it manifest

A

Respiratory Center becomes less responsive to Carbon dioxide causing progressive respiratory depression that manifest as decreased respiratory rate.

This effect is dose dependent

92
Q

What effect does opioid have On cough reflex

A

Opioids depresses it

93
Q

What is the antidote for opioid induced respiratory depression

A

Naloxone - increase patient’s respiratory rate

94
Q

True/ false: naloxone can precipitate withdrawl sx

95
Q

What is the natural occuring opioid

96
Q

What is the gold standard for severe pain

97
Q

Activate histamine release the most

A

Morphine

Meperidine

98
Q

Precipitate histamine release at a lesser degree

A

Hydromorphone

Oxycodone

Fentanyl

99
Q

Does not precipitate histamine release

A

Hydrocodone

100
Q

What effect can morphine induce

A

Vasodilation

Decrease myocardial oxygen demand

Sphincter of Oddi spasms

101
Q

Why should morphine be dosed cautiously m patient with renal impairment

A

Active metabolite are cleared really and can accumulate

102
Q

What are the semi synthetic opioids

A

Hydromorphone

Hydrocodone

Oxycodone

103
Q

Which have similar effect as morphine but with fewer side effect

A

Hydromorphone

104
Q

Which is available as combination product only

A

Hydrocodone

105
Q

Which comes as a single or combination drug

106
Q

Used for moderate to severe pain

A

Hydrocodone

Oxycodone

107
Q

Which have similar effect to morphine but is less potent and have shorter duration of action

A

Meperidine

108
Q

Caution in elderly and renal impaired patient

A

Meperidine

109
Q

Which has a metabolite that is venally cleared and accumulation and can cause CNS excitability such as tremor, myoclonus, seizures

A

Meperidine

110
Q

Which opioid has no analgesic advantage

A

Meperidine

111
Q

Which opioid is the most potent, lipophilic and shorter acting

112
Q

Gold standard for ICU or OR

113
Q

Caution in dosing errors but safe for renal impairment

A

Hydromorphone

Fentanyl

114
Q

Severe pain opioid

A

Morphine

Hydromorphone

Meperidine

Fentanyl

115
Q

By mouth only closed at 5-10mg every 4-6hours

A

Hydrocodone

Oxycodone

116
Q

IM only dosed at 50-150mg every 3-4hours

A

Meperidine

117
Q

IV and IM only dosed in micrograms

118
Q

Steps 1 of WHO analgesic ladder for mild pain

A

Non-opioids with or without adjuvants for neuropathic or bone pain

119
Q

Step 2 of WHO analgesic ladder for mild to moderate pain

A

As needed opioid

Codeine

Combination opioids with acetaminophine or ibuprofen

Tramadol

120
Q

Step 3 of WHO analgesic ladder for moderate to severe pain

A

Around the clock dosing

Morphine

Oxycodone

Hydrocodone

Fentanyl

Hydromorphone

Pharmacotherapy (12 decks)

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