Acute pain therapeutics

Question 1

frequent signs associated with acute pain

Answer 1

• tachycardia
• hypertension
• diaphoresis
• dilated pupils
• pallor

Question 2

acute pain definition

Answer 2

pain that occurs with bodily injury and usually disappears when injury heals

Question 3

3 principles of acute pain management

Answer 3

1. start with most effective agent with least ADRs
2. try to prevent pain instead of treat
3. assume pain in critically ill patients

Question 4

critically aligned pain assessment (CAPA)

Answer 4

healthcare providers gather information about pain through conversation with patients rather than rating it on a scale

Question 5

things to observe to assess pain in non-communicative patients

Answer 5

• facial expressions
• body movement
• muscle tension
• ventilator compliance

Question 6

options for mild pain

Answer 6

• acetaminophen

- NSAIDs

Question 7

NSAID used for moderately severe pain

Answer 7

IV ketorolac

Question 8

side effects of NSAIDs

Answer 8

• GI issues
• bleeding
• AKI
• hypertension

Question 9

ibuprofen PO dosing

Answer 9

200-800 mg PO q4-8 hours

Question 10

ibuprofen IV dosing

Answer 10

400-800 mg IV q6 hours

Question 11

ketorolac IV dosing

Answer 11

15-30 q6 hours

Question 12

how long can ketorolac be used

Answer 12

no more than 5 days

Question 13

ketorolac contraindications

Answer 13

• patient is receiving other NSAIDs

- severe renal impairment

Question 14

who gets minimum ketorolac dose (15 mg)

Answer 14

• weight <50 kg
• age >65
• mild renal impairment

Question 15

morphine standard doses for equivalency calculations

Answer 15

• IV = 10 mg

- PO = 30

Question 16

hydromorphone morphine equivalencies

Answer 16

• IV = 1.5 mg

- PO = 7.5 mg

Question 17

fentanyl morphine equivalent

Answer 17

IV = 0.1 mg

Question 18

oxycodone morphine equivalent

Answer 18

PO = 20 mg

Question 19

hydrocodone morphine equivalent

Answer 19

PO = 30 mg

Question 20

oxymorphone morphine equivalents

Answer 20

• IV = 1 mg

- PO = 10 mg

Question 21

rules for calculating opioid conversions

Answer 21

1. determine total opioid used in 24 hrs
2. calculate equianalgesic dose
3. If pain is already controlled reduce dose by 25-50%
4. If pain is not controlled already begin with 100-125% of new opioid
5. divide total dose of new opioid by number of doses per day

Question 22

avoid morphine in who

Answer 22

renally impaired

Question 23

consequences of morphine metabolite accumulation

Answer 23

• respiratory depression
• excessive sedation
• muscle spasms
• N/V

Question 24

opioids to use in cirrhosis

Answer 24

• fentanyl

- oxycodone

Question 25

opioid adverse reactions

Answer 25

- sedation - N/V - hypotension - constipation - repiratory depression

Question 26

respiratory depression symptoms

Answer 26

-fewer than 8 breaths/min

Question 27

respiratory depression risk factors

Answer 27

- age - obesity - opioid naive patient - sleep apnea - serious illness

Question 28

naloxone dose

Answer 28

0.4-2 mg IV q2-3 minutes