Assessment of Pain/Non-opioid Flashcards

1
Q

what questions should be asked to assess subjective pain

A

PQRSTU
(palliative/precipitating, quality, region, severity, time related, impact on U)

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2
Q

what objective information should you collect to assess pain

A

behavior changes
physiological changes

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3
Q

what are the goals of therapy with pain

A

correct underlying pain
minimize pain and symptoms
improve QOL
limit drug side effects

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4
Q

non-pharm therapy options

A

correct underlying cause
exercise
acupuncture
physical manipulation
heat or ice
massage

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5
Q

WHO step 1 treatment

A

non-opioid +/- adjuvant analgesic

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6
Q

WHO step 2 treatment

A

opioid for mild to moderate pain
+ non opioid
+/- adjuvant analgesic

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7
Q

WHO step 3 treatment

A

opioid for moderate to severe main
+ non opioid
+/- adjuvant analgesic

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8
Q

when to step up in treatment

A

pain is persisting or increasing

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9
Q

when to step down in treatment

A

pain is resolving or toxicity occurs

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10
Q

what are examples of adjuvant therapy

A

gabapentinoids
SNRIs
TCAs
muscle relaxants
antiepileptics
topical agents

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11
Q

what are the non-opioid pain options

A

APAP
NSAIDs

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12
Q

acetaminophen uses

A

analgesic and antipyretic

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13
Q

acetaminophen formulations

A

tablet
capsule
chewable
liquid/gel
IV
suppository

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14
Q

acetaminophen recommended dosing for adults

A

325-1000mg PO q4-6h prn

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15
Q

acetaminophen max dose adults

A

3-4 g/day

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16
Q

acetaminophen max dose liver disease

A

2 g/day

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17
Q

acetaminophen dosing peds

A

10-15 mg/kg PO Q4H prn

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18
Q

acetaminophen max dose peds

A

75 mg/kg/day or 3-4 g/day

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19
Q

acetaminophen side effects

A

hepatotoxicity (greater than 10g dose)

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20
Q

what is acetaminophen the gold standard for

A

osteoarthritic in geriatric patients due to fewer side effects

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21
Q

education points for acetaminophen

A

max daily doses
combo products

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22
Q

what are NSAIDs used for

A

analgesic, antipyretic, anti-inflammatory

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23
Q

NSAID side effects

A

GI bleeding (black box warning)
nephrotoxicity
fluid retention
increase CV events

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24
Q

NSAID education points

A

take with food

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25
Q

who should avoid NSAIDs

A

geriatric patients
patients with cardiac history
severe liver or kidney disease

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26
Q

aspirin formulations

A

chewable
tablet
EC tablet
capsule
ER capsule
suppository

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27
Q

aspirin adult dosing

A

325-1000mg PO q4-6h PRN

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28
Q

aspirin adult max dose

A

4g/day

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29
Q

aspirin peds dosing

A

AVOID (reye’s syndrome)

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30
Q

what is reye’s syndrome

A

rare serious condition that causes swelling in the brain and liver

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31
Q

Ibuprofen formulations

A

capsule
tablet (200mg)
chewable
suspension
IV solution

32
Q

ibuprofen adult dosing

A

200-800mg PO q6-8h PRN

33
Q

ibuprofen adult max dose

A

3200mg/day

34
Q

ibuprofen peds dosing

A

5-10mg/kg PO q4-6h PRN

35
Q

ibuprofen peds max dose

A

40mg/day or 2400mg whichever is less

36
Q

how old do kids have to be to take ibuprofen

A

> 6 months

37
Q

diclofenac formulations

A

capsule
tablet
IV solution
suppository
topical gel/solution
eye solution
patch

38
Q

diclofenac adult dose

A

50mg PO q8h or 2-4g topically 4 times/day

39
Q

clinical pearls of diclofenal

A

minimal side effects with gel

40
Q

naproxen formulations

A

capsule
tablet
DR/ER tablet
suspension

41
Q

naproxen adult dosing

A

220-500mg PO q6-12h

42
Q

naproxen adult max dose

A

1000mg/day

43
Q

ketorolac formulations

A

tablet
iv/im solution
nasal spray
eye solution

44
Q

ketorolac adult dosing

A

15-30 IM/IV q6h prn or 10mg q6h prn

45
Q

ketorolac peds dosing

A

0.5mg/kg/dose IM/IV q6h prn

46
Q

max duration of ketorolac

A

5 days (increased risk of GI bleed when used longer)

47
Q

celecoxib adult dosing

A

200mg PO BID

48
Q

celecoxib clinical pearl

A

cox 2 selective – less GI toxicity

49
Q

gabapentinoid uses

A

fibromyalgia
neuropathies
post-op pain

50
Q

gabapentin dosing

A

100-300mg PO TID (max 3600mg/day)

51
Q

pregabalin dosing

A

75mg PO BID (max 600mg/day)

52
Q

gabapentinoid side effects

A

sedation, dizziness, peripheral edema

53
Q

gabapentinoid clinical pearls

A

renally dose adjusted
titrate up dose
use in combo to decrease dose requirements
pregabalin is schedule V

54
Q

SNRI uses

A

fibromyalgia
neuropathy

55
Q

venlafaxine dosing

A

37.5-75mg PO daily (max 225mg/day)

56
Q

duloxetine dosing

A

30mg PO daily x 1 week then increase to 60mg PO daily (max)

57
Q

SNRI side effects

A

nausea
headache
HTN
sedation
weakenss

58
Q

SNRI clinical pearls

A

start low and titrate slow
renally dose adjust venlafaxine and avoid duloxetine for CrCl < 30 mL/min

59
Q

TCA uses

A

fibromyalgia
neuropathy
migraine prophylaxis

60
Q

amitriptyline or nortriptyline dosing

A

10mg PO qhs (max 150mg/day)

61
Q

TCA side effects

A

anti-cholinergic side effects
sedation

62
Q

TCA clinical pearls

A

last line for neuropathy and fibromyalgia due to side effects

63
Q

muscle relaxant side effects

A

sedation/drowsiness
dizziness
dry mouth
vision changes

64
Q

muscle relaxant pearls

A

short term use (<3 weeks)
carisoprodol is schedule IV

65
Q

carbamazepine clinical pearls

A

increased risk of hypersensitivity reactions in patients with HLA-B*1502
autoinduction of hepatic enzymes

66
Q

lidocaine side effects

A

hypotension
arrythmia

67
Q

lidocaine clinical pearls

A

tachyphylaxis with continued use
12 hour break between patches
local affect so apply to where pain is

68
Q

capsacian uses

A

muscle/joint pain
neuropathic pain

69
Q

capsaician side effects

A

skin irritation and pain

70
Q

capsaician clinical pearls

A

do not get in eyes
wash hands after applying

71
Q

non cox-2 selective NSAIDs in geriatric patients

A

avoid chronic use
avoid short term schedule use when used in combo

72
Q

indomethacin and ketorolac in geriatric patients

A

avoid

73
Q

skeletal muscle relaxants in geriatric patients

A

avoid

74
Q

SNRIs, TCAs, Carbamazepine in geriatric patients

A

use with caution

75
Q

opioids and benzos in geriatric patients

A

avoid