Basics of Pain Mgmt Flashcards
How many identified neurotransmitters?
21
What cannot pass through the blood brain barrier (size, properties)?
Protein bound highly ionized drugs cannot pass thru the BBB
Which population is more sensitive to CNS medications due to the state of their BBB?
Infants b/c it is less developed
How long does chronic dosing take to have effect? why?
- weeks for optimal outcome
- ADAPTIVE changes in brain have to occur in response to the drug
ex: psych meds
Why do you need to start low and go slow with CNS meds?
side effects can be intense initially but can subside as tolerance increases
What is it called when you need an increase amount of CNS drug to get the same response?
Tolerance
What is it called when an abrupt discontinuation of CNS meds causes withdrawal sxs?
Dependence
The 1-10 pain scale can be used for chronic or acute pain?
both!
How do you treat mild pain 1-3?
non-opioids (NSAID, acetaminophen .,adjuvants)
How do you treat moderate pain (4-6)?
moderate to strong opioids
- codeine, hydrocodone, oxycodone + tylenol
- oxycontin extended release
- adjuvants
How do you treat severe pain 7-10?
strong opioids
-morphine, hydrocodone, fentanyl, methadone, meperidine, adjuvants
Which medication can be used to treat every level of pain?
adjuvants!
What is an adjuvant?
- drugs that are medications that were not initially created for pain management but can treat pain
- drug of choice for neuropathic pain
What is the drug of choice for neuropathic pain?
adjuvants
Examples of Adjuvants
- Tricyclic antidepressants (amitryptine/Elavil)
- Antiseizure (gabapentin/Neurotonin)
- Topical anesthetic (lidocaine patch)
- CNS stimulant (methylphenidate/Ritalin)
- Glucocorticoids (dexamethason/Decadron)
- Biophosphates (pamidronate/Aredia)
Which adjuvant can treat cancer pain from SOLID tumor?
-Glucocorticoids like dexmathasone/Decadron
Which adjuvant can treat cancer BONE pain?
Biophospate like pamidronate(Aredia)
What is the purpose of a multimodal pain protocol?
-use adjuvants and non-opioids to decrease opioid use
Which do you use more of to achieve results- oral or iv medication?
Oral
What is equianalgesic dosing?
administering a dose that is equivalent in pain relieving ability to another dose (change route or med)
What is the preferred route of medication for chronic pain? why?
Oral
- easy to take
- lasts longer (less peaks and trough)
What is onset time of an oral analgesic?
30 minutes
Why is oral dose larger then IV dose?
First pass effect
Do you ever give intramuscular pain meds? why or why not?
not recommended b/c of administration pain and variable rates of absorption
What is onset time for IV analgesics?
within minutes
How quickly do you push opioids?
slowly
What happens if push opioid too fast?
-hypotension, vomiting, rep depression
What does PCA stand for? How does it work?
Patient Controlled Analgesia
- patient controls rate of delivery by pressing button
- dosage/frequency limitations and lockouts preset in order by provider
Advantages of PCA pump
- use less drug
- immediate relief
- less variation to drug levels
- less side effects
- less time for nurse
Which patients cannot use PCA pump?
-confused, sedated
What is the role of an End Tidal CO2 monitor?
detects amount of CO2 coming out of nose
- measures respiratory depression
- if CO2 too low = sedation –> pump pauses and alarm rings
If you are hypo-ventilating what is your O2 sat?
O2 can still be high if hypoventilating so need end tidal CO2 monitor
3 different PCA pump settings
- continuous- drip
- PCA- only get med when pt push
- Continuous with PCA- combo!
What must be included on PCA order?
(loading dose maybe)
- setting: continuous, PCA, combo
- med name
- lockout time: amount of time b/w doses
- # /hour limit
- PCA dose amount
What is an important patient teaching with PCA pump?
- only patient can push
- lockout time/max dose
- will hear nouse after hit button which means dose is happening
What kind of pain is treated with transdermal patch?
-chronic, consistent, or cancer pain
duration of time transdermal med is released over? how long can it continue to work for? why do i care?
24 hours
- can work up to 72 hours
- always remove the old patch before putting a new one on!
Transdermal analgesics are contraindicated for what type of pain?
- postop
- post op pain meds should decrease over time
- when used with post op or acute pain it can cause death
What can increase rate of transdermal absorption?
fever, heating pad
Considerations for handling transdermal patches?
- nurse wear gloves
- dispose where no one can touch it
- –>NOT in a trash can
Rectal suppositories are not effected by ______
first pass effect
Onset of action for rectal suppositories?
slow onset of action
Considerations for administering rectal suppository analgesics?
-make sure not pressed against stool which would decrease absorption
Sublingual/Buccal are not effected by ______
first pass effect
Onset of sublingual/buccal analgesic?
-quickly: 5-7 minutes
Who should not use sublingual/buccal opioid analgesics?
opioid naive
Which patient population would benefit from sublingual?
cancer**, chronic
Tell me everything you know about intranasal cns analgesics?
- agonist/antagonist drug
- not used often
- treat migraines
What is around the clock dosing?
- preferred way to treat cancer, chronic, 1st 24 hour post op pain
- creates steady state pain
What is breakthrough pain?
-transient episodes of severe pain treated with breakthrough dose
What is a breakthrough dose?
- rapid onset, short duration of pain medication used with breakthrough pain
ex: po morphine, buccal, fentanyl nasal spray
3 things to consider for pain med scheduling?
- assess/reassess frequently
- dose individually
- premedicate for painful procedure/activities
