Assessment of Pain/Non-opioid Flashcards
what questions should be asked to assess subjective pain
PQRSTU
(palliative/precipitating, quality, region, severity, time related, impact on U)
what objective information should you collect to assess pain
behavior changes
physiological changes
what are the goals of therapy with pain
correct underlying pain
minimize pain and symptoms
improve QOL
limit drug side effects
non-pharm therapy options
correct underlying cause
exercise
acupuncture
physical manipulation
heat or ice
massage
WHO step 1 treatment
non-opioid +/- adjuvant analgesic
WHO step 2 treatment
opioid for mild to moderate pain
+ non opioid
+/- adjuvant analgesic
WHO step 3 treatment
opioid for moderate to severe main
+ non opioid
+/- adjuvant analgesic
when to step up in treatment
pain is persisting or increasing
when to step down in treatment
pain is resolving or toxicity occurs
what are examples of adjuvant therapy
gabapentinoids
SNRIs
TCAs
muscle relaxants
antiepileptics
topical agents
what are the non-opioid pain options
APAP
NSAIDs
acetaminophen uses
analgesic and antipyretic
acetaminophen formulations
tablet
capsule
chewable
liquid/gel
IV
suppository
acetaminophen recommended dosing for adults
325-1000mg PO q4-6h prn
acetaminophen max dose adults
3-4 g/day
acetaminophen max dose liver disease
2 g/day
acetaminophen dosing peds
10-15 mg/kg PO Q4H prn
acetaminophen max dose peds
75 mg/kg/day or 3-4 g/day
acetaminophen side effects
hepatotoxicity (greater than 10g dose)
what is acetaminophen the gold standard for
osteoarthritic in geriatric patients due to fewer side effects
education points for acetaminophen
max daily doses
combo products
what are NSAIDs used for
analgesic, antipyretic, anti-inflammatory
NSAID side effects
GI bleeding (black box warning)
nephrotoxicity
fluid retention
increase CV events
NSAID education points
take with food
who should avoid NSAIDs
geriatric patients
patients with cardiac history
severe liver or kidney disease
aspirin formulations
chewable
tablet
EC tablet
capsule
ER capsule
suppository
aspirin adult dosing
325-1000mg PO q4-6h PRN
aspirin adult max dose
4g/day
aspirin peds dosing
AVOID (reye’s syndrome)
what is reye’s syndrome
rare serious condition that causes swelling in the brain and liver