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Pharm 313 > Basics of Pain Mgmt > Flashcards

Basics of Pain Mgmt Flashcards

1
Q

How many identified neurotransmitters?

A

21

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2
Q

What cannot pass through the blood brain barrier (size, properties)?

A

Protein bound highly ionized drugs cannot pass thru the BBB

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3
Q

Which population is more sensitive to CNS medications due to the state of their BBB?

A

Infants b/c it is less developed

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4
Q

How long does chronic dosing take to have effect? why?

A
  • weeks for optimal outcome
  • ADAPTIVE changes in brain have to occur in response to the drug
    ex: psych meds
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5
Q

Why do you need to start low and go slow with CNS meds?

A

side effects can be intense initially but can subside as tolerance increases

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6
Q

What is it called when you need an increase amount of CNS drug to get the same response?

A

Tolerance

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7
Q

What is it called when an abrupt discontinuation of CNS meds causes withdrawal sxs?

A

Dependence

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8
Q

The 1-10 pain scale can be used for chronic or acute pain?

A

both!

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9
Q

How do you treat mild pain 1-3?

A

non-opioids (NSAID, acetaminophen .,adjuvants)

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10
Q

How do you treat moderate pain (4-6)?

A

moderate to strong opioids

  • codeine, hydrocodone, oxycodone + tylenol
  • oxycontin extended release
  • adjuvants
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11
Q

How do you treat severe pain 7-10?

A

strong opioids

-morphine, hydrocodone, fentanyl, methadone, meperidine, adjuvants

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12
Q

Which medication can be used to treat every level of pain?

A

adjuvants!

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13
Q

What is an adjuvant?

A
  • drugs that are medications that were not initially created for pain management but can treat pain
  • drug of choice for neuropathic pain
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14
Q

What is the drug of choice for neuropathic pain?

A

adjuvants

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15
Q

Examples of Adjuvants

A
  • Tricyclic antidepressants (amitryptine/Elavil)
  • Antiseizure (gabapentin/Neurotonin)
  • Topical anesthetic (lidocaine patch)
  • CNS stimulant (methylphenidate/Ritalin)
  • Glucocorticoids (dexamethason/Decadron)
  • Biophosphates (pamidronate/Aredia)
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16
Q

Which adjuvant can treat cancer pain from SOLID tumor?

A

-Glucocorticoids like dexmathasone/Decadron

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17
Q

Which adjuvant can treat cancer BONE pain?

A

Biophospate like pamidronate(Aredia)

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18
Q

What is the purpose of a multimodal pain protocol?

A

-use adjuvants and non-opioids to decrease opioid use

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19
Q

Which do you use more of to achieve results- oral or iv medication?

A

Oral

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20
Q

What is equianalgesic dosing?

A

administering a dose that is equivalent in pain relieving ability to another dose (change route or med)

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21
Q

What is the preferred route of medication for chronic pain? why?

A

Oral

  1. easy to take
  2. lasts longer (less peaks and trough)
22
Q

What is onset time of an oral analgesic?

A

30 minutes

23
Q

Why is oral dose larger then IV dose?

A

First pass effect

24
Q

Do you ever give intramuscular pain meds? why or why not?

A

not recommended b/c of administration pain and variable rates of absorption

25
Q

What is onset time for IV analgesics?

A

within minutes

26
Q

How quickly do you push opioids?

A

slowly

27
Q

What happens if push opioid too fast?

A

-hypotension, vomiting, rep depression

28
Q

What does PCA stand for? How does it work?

A

Patient Controlled Analgesia

  • patient controls rate of delivery by pressing button
  • dosage/frequency limitations and lockouts preset in order by provider
29
Q

Advantages of PCA pump

A
  1. use less drug
  2. immediate relief
  3. less variation to drug levels
  4. less side effects
  5. less time for nurse
30
Q

Which patients cannot use PCA pump?

A

-confused, sedated

31
Q

What is the role of an End Tidal CO2 monitor?

A

detects amount of CO2 coming out of nose

  • measures respiratory depression
  • if CO2 too low = sedation –> pump pauses and alarm rings
32
Q

If you are hypo-ventilating what is your O2 sat?

A

O2 can still be high if hypoventilating so need end tidal CO2 monitor

33
Q

3 different PCA pump settings

A
  1. continuous- drip
  2. PCA- only get med when pt push
  3. Continuous with PCA- combo!
34
Q

What must be included on PCA order?

A

(loading dose maybe)

  • setting: continuous, PCA, combo
  • med name
  • lockout time: amount of time b/w doses
  • # /hour limit
  • PCA dose amount
35
Q

What is an important patient teaching with PCA pump?

A
  • only patient can push
  • lockout time/max dose
  • will hear nouse after hit button which means dose is happening
36
Q

What kind of pain is treated with transdermal patch?

A

-chronic, consistent, or cancer pain

37
Q

duration of time transdermal med is released over? how long can it continue to work for? why do i care?

A

24 hours

  • can work up to 72 hours
  • always remove the old patch before putting a new one on!
38
Q

Transdermal analgesics are contraindicated for what type of pain?

A
  • postop
  • post op pain meds should decrease over time
  • when used with post op or acute pain it can cause death
39
Q

What can increase rate of transdermal absorption?

A

fever, heating pad

40
Q

Considerations for handling transdermal patches?

A
  • nurse wear gloves
  • dispose where no one can touch it
  • –>NOT in a trash can
41
Q

Rectal suppositories are not effected by ______

A

first pass effect

42
Q

Onset of action for rectal suppositories?

A

slow onset of action

43
Q

Considerations for administering rectal suppository analgesics?

A

-make sure not pressed against stool which would decrease absorption

44
Q

Sublingual/Buccal are not effected by ______

A

first pass effect

45
Q

Onset of sublingual/buccal analgesic?

A

-quickly: 5-7 minutes

46
Q

Who should not use sublingual/buccal opioid analgesics?

A

opioid naive

47
Q

Which patient population would benefit from sublingual?

A

cancer**, chronic

48
Q

Tell me everything you know about intranasal cns analgesics?

A
  • agonist/antagonist drug
  • not used often
  • treat migraines
49
Q

What is around the clock dosing?

A
  • preferred way to treat cancer, chronic, 1st 24 hour post op pain
  • creates steady state pain
50
Q

What is breakthrough pain?

A

-transient episodes of severe pain treated with breakthrough dose

51
Q

What is a breakthrough dose?

A
  • rapid onset, short duration of pain medication used with breakthrough pain
    ex: po morphine, buccal, fentanyl nasal spray
52
Q

3 things to consider for pain med scheduling?

A
  • assess/reassess frequently
  • dose individually
  • premedicate for painful procedure/activities

Pharm 313 (26 decks)

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