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SECTION 5: Analgesia, Anesthesia, and Procedural Sedation > CHAPTER 35: Acute Pain Management > Flashcards

CHAPTER 35: Acute Pain Management Flashcards

1
Q

Is the most common presenting symptom for patients coming to the ED

A

Pain (70% to 80%)

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2
Q

Undertreatment of pain

A

Oligoanalgesia

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3
Q

Ethnicity, gender, age (very young, very old)
Diminished cognitive function
Fear of meds: addiction, side effects
Acceptance of pain as being inevitable
Unwillingness to bother healthcare providers

A

Patient related barriers to adequate ED pain control (Table 35-1 p. 230)

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4
Q

Is the physiologic response to a noxious stimulus

A

Pain

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5
Q

Is the expression of pain, it is modified by the complex interaction of cognitive, behavioral, and sociocultural dimension

A

Suffering

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6
Q

Is considered the gold standard for quantifying the severity of a patient’s pain

A

Self-reporting

The patient’s subjective reporting of pain, not the healthcare provider’s impression, is the basis for pain assessment and treatment.

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7
Q

Easily localized pain

A

Somatic pain

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8
Q

Visceral pain

A

Poorly localized pain

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9
Q

Opioid receptor with significant structural homology

A

Nociceptin

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10
Q

Opioid receptor produces supraspinal analgesia

A

Mu-1 (μ1) receptor

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11
Q

Opioid receptor results in euphoria, miosis, respiratory depression, and depressed GI motility

GERM:
GI motility depression
Euphoria
Resp depression
Miosis
A

Mu-2 (μ2) receptor

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12
Q

Opioid receptor produces analgesia and also exerts an antidepressant effect

A

Delta (δ) receptor

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13
Q

Opioid receptor produces Dysphoria, along with Dissociation, Delirium, and Diuresis

4Ds

A

Kappa (κ) receptor

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14
Q

TRUE or FALSE?

Opioid receptors are linked to addiction

A

FALSE

Opioid receptors are NOT linked to addiction, which is much more closely linked to the cannabinoid-1 receptor

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15
Q

TRUE or FALSE?

There’s a weak correlation bet nonverbal signs & px’s report of pain

A

TRUE

There is a weak correlation between nonverbal signs and the px’s report of pain, so DO NOT rely on these to det the seve of a px’s pain

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16
Q

Quantitate pain severity, guide the selection and administration of an analgesic agent, and reassess the pain response to determine the need for repeated doses or alternative analgesics

A

Pain scales

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17
Q

Is the preferred pain assessment tool when there are language difficulties or cross-cultural differences because it is the least affected by these factors

A

Visual Analog Scale (VAS)

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18
Q

Is the mainstay of acute pain management

A

Administration of pharmacologic agents

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19
Q

Pain reliever that should be considered for mild to moderate pain or when targeting severe pain originating from smooth muscle spasm such as renal or biliary coli

A

NSAIDs

In specific instances such as renal and biliary colic, although parenteral NSAIDs may control severe pain, combination therapy with an opioid is usually superior.

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20
Q

Pain Scale method (Table 35-2 p. 230):
Ordered list of pain descriptors (no pain to worst possible pain)
Easy to administer

A

Adjective rating scale

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21
Q

Pain Scale method (Table 35-2 p. 230):
10-cm linear scale
Measured in millimeters

A

Visual analog scale (VAS)

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22
Q

Is the minimum clinically significant change noticeable by patients in VAS

A

13mm

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23
Q

Is the average decrease of change as the minimum acceptable change for pain control

A

30 mm

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24
Q

Pain Scale method (Table 35-2 p. 230):
Scale of 0 to 10 WITH descriptors
Used in patients with visual, speech, or manual dexterity difficulties by using upheld fingers

A

Numeric rating scale

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25
Q

Pain Scale method (Table 35-2 p. 230):
Rates pain as:0 = none1 = a little2 = some3 = a lot4 = worst possible
Decrease of 1 point is a large change

A

5-Point global scale

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26
Q

Pain Scale method (Table 35-2 p. 230):
Sccale of 0 to 10 WITHOUT descriptors

Most commonly used scale

A

Verbal quantitative scale

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27
Q

Are the cornerstone of pharmacologic management of moderate to severe acute pain

A

Opioid analgesics

28
Q

Refers to agents that are structurally related to natural alkaloids found in opium, the dried resin of the opium poppy

A

Opiate

29
Q

Describes any compound with pharmacologic activity similar to an opiate, regardless of chemical structure

A

Opioid

30
Q

TRUE or FALSE?

Variation in pain reduction is related to body mass and gender

A

FALSE
Variation in pain reduction is related to age, initial pain severity, and previous or chronic exposure to opioids, but NOT body mass or gender

31
Q

TRUE or FALSE?

Opioid hypersensitivity is uncommon

A

TRUE

Opioid hypersensitivity is uncommon, and true allergic reactions are extremely rare

32
Q

There is minimal evidence of clinical cross-sensitivity within opioid classes EXCEPT among the —?—

A

Phenylpiperidines:
Fentanyl
Alfentanil
Sufentanil

33
Q

Not a reliable analgesic, and it produces more nausea, vomiting, and dysphoria than other opioids

A

Codeine

34
Q

Opioid which is extensively metabolized by cytochrome P450 enzymes

A

Tramadol

35
Q

Opioid which is considered to produce more elation than other opioids

A

Meperidine (Pethidine)

36
Q

Metabolite of meperidine which has neuroexcitatory properties and a long elimination half-life (24 to 48 hours)
Seizures in elderly or CKD: >48 hrs or >600mg/day

A

Normeperidine

37
Q

Opioid with histamine may produce transient hypotension or nausea and emesis (neither requires routine adjunctive treatment)
Table 35-4 page 232

A

Morphine

38
Q

Opioid more euphoria inducing than morphine

Table 35-4 page 232

A

Hydromorphone

39
Q

Opioid less cardiovascular depression than morphine

Table 35-4 page 232

A

Fentanyl

40
Q

Dose of Fentanyl that can cause chest wall rigidity

A

High doses (>5 micrograms/kg IV)

41
Q

Opioid used for breakthrough pain in opioid-tolerant cancer patients
Table 35-4 page 232

A

Fentanyl (nasal spray & buccal mucosa tablet)

42
Q

Opioid contraindicated when patient has taken a monoamine oxidase inhibitor within the past 14 d to avoid precipitating serotonin syndrome
Table 35-4 page 232

A

Meperidine (Pethidine)

43
Q

Opioid with lower incidence of nausea than others

Table 35-4 page 232

A

Oxycodone & Hydrocodone/acetaminophen

44
Q

Opioid with high incidence of GI side effects

Table 35-4 page 232

A

Codeine

45
Q

Opioid with common CNS side effects

Table 35-4 page 232b

A

Tramadol

46
Q

Medications that are sometimes used to enhance the analgesic effect, reduce the amount of opioid required, and prevent side effects

A

Adjuncts

47
Q

Medications that are used to minimize some of the adverse effects of pure opioid agonists and have major benefit of ceiling on respiratory depression but may precipitate withdrawal symptoms in opioid-addicted patients

A

Opioid agonists-antagonists

48
Q

Is an effective analgesic for acute mild to moderate pain

No dosage change is required for renal or mild hepatic impairment

A

Acetaminophen (Paracetamol)

49
Q

Are both anti-inflammatory agents and analgesics

Have significant opioid dose-sparing effects

A

Aspirin & NSAIDs

50
Q

A phencyclidine derivative produces analgesia and/ or dissociative anesthesia with the advantage of causing minimal respiratory depression at usual doses

A

Ketamine

51
Q

Is a fast-onset, short-acting analgesic and sedative inhalational agent

A

Nitrous Oxide

52
Q

Nitrous oxide/oxygen mixture that is consistently effective

A

70/30

53
Q

Nitrous oxide is contraindicated in patients with —?—

A

Perforated abdominal viscus
Altered mental status
Suspected pneumothorax
Head injury

54
Q

Topical analgesic effective for treating acute soft tissue injuries such as sprains and strains and also for treating chronic joint pain from osteoarthritis

A

Topical NSAIDs

55
Q

Topical analgesic effective for patients with postherpetic neuralgia and diabetic neuropathy

A

Topical lidocaine

56
Q

Topical analgesic effective for postherpetic neuralgia, but requires professional application and removal to minimize side effects

A

Topical capsaicin (8% capsaicin topical patch)

57
Q

The primary adverse reaction of topical medications

A

Local burning

58
Q

Hypotension effect of opioids is almost always due to —?— release with the first dose of medication

A

Histamine

59
Q

Is the misuse of a medication or drug to the detriment of the patient’s well-being

A

Addiction

60
Q

Infers that abrupt cessation of a medication will result in acute withdrawal symptoms
Requires regular daily usage for 4 to 6 weeks

A

Dependence

61
Q

Are the preferred opioids in patients with renal failure

A

Hydromorphone & Fentanyl

62
Q

Drugs contraindicated when patient has taken a monoamine oxidase inhibitor within the past 14 d to avoid precipitating serotonin syndrom

A

Monoamine Oxidase Inhibitors (MAOIs)

63
Q

Cyclic antidepressants that may increase morphine levels and potentiate the opioid effects

A

Clomipramine & Amitriptyline

CA = Cyclic antidepressants

64
Q

Medications when combined with opioids carries a high risk of central sleep apnea and should be used with caution

A

Benzodiazepines

65
Q

The opioid of choice in trauma patients

A

Fentanyl

SECTION 5: Analgesia, Anesthesia, and Procedural Sedation (4 decks)

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