Chapter 9 Pain

Question 1

How do you get the most information about a patient’s pain?

Answer 1

ask patient to explain using descriptive words.

Question 2

What types of meds are given as adjuvants? What are some of the most common ones?

Answer 2

corticosteroids, antidepressants, antiseizure drugs, GABA receptor agonists, alpha adrenergic agonists, local anesthetics

Question 3

What is the purpose of adjuvant meds? How do you know they have been effective?

Answer 3

a

Question 4

What is the focus (goal) of treatment for chronic pain?

Answer 4

Control pain to the extent possible, focus on enhancing function and quality of life.

Question 5

What do you do if a patient on a PCA is waking up every night with pain?

Answer 5

Consider switching to a different medication in the PCA.

Question 6

What pain meds should rarely ever be used, especially for chronic pain?

Answer 6

Darvon, Darvocet

Question 7

When do you choose to give a rapid-acting IV opioid?

Answer 7

Breakthrough pain

Question 8

What is the best medication to give an elderly patient with complaints of mild pain? Why?

Answer 8

Tylenol, less effect on GI

Question 9

When should you withhold pain medicine in a terminal patient with severe pain?

Answer 9

Never

Question 10

What concerns should you have about OTC pain meds?

Answer 10

GI problems, bleeding, analgesic ceiling, drug interactions, side effects

Question 11

What is breakthrough pain and how do you manage it?

Answer 11

Transient, mild to severe pain that occurs in pts whose baseline persistent pain is otherwise mild to moderate and fairly well controlled. Peak 3-5 minutes, can last 30 minutes

Question 12

What is the focus (goal) of treatment for chronic pain?

Answer 12

a

Question 13

What do you do if a patient on a PCA is waking up every night with pain?

Answer 13

a

Question 14

What pain meds should rarely ever be used, especially for chronic pain?

Answer 14

a

Question 15

When do you choose to give a rapid-acting IV opioid?

Answer 15

a

Question 16

What is the best medication to give an elderly patient with complaints of mild pain? Why?

Answer 16

a

Question 17

When should you withhold pain medicine in a terminal patient with severe pain?

Answer 17

a

Question 18

What concerns should you have about OTC pain meds?

Answer 18

a

Question 19

What is breakthrough pain and how do you manage it?

Answer 19

a

Question 20

Adjuvants: Corticosteroids

Answer 20

(Prednisone, Dexamethasone) Inflammation. best for cancer pain, spinal cord compression, inflammatory joint pain, many side effects, don’t give with NSAIDS

Question 21

Adjuvants: Antidepressants

Answer 21

(Elavil, Cymbalta) Neuropathic pain. Increases serotonin and norepinephrine, promotes sleep, don’t give if hx of seizures or cardiac disease, bad for older adults (long half life), many side effects,

Question 22

Adjuvants: Antiseizure Drugs

Answer 22

(Lamictal, Neurotonin, Lyrica) Neuropathic pain, Multimodal therapy for acute pain, Fibromyalagia. Affect peripheral nerves and CNS

Question 23

Adjuvants: GABA Receptor Agonists

Answer 23

(Baclofen) Nueropathic pain, Muscle spasms. Inhibits pain transmission, used for muscle spasms, best used intrathecally

Question 24

Adjuvants: Alpha Adrenergic Agonists

Answer 24

(Clonidine, Zanaflex) Used for chronic headaches, neuropathic pain

Question 25

Adjuvants: Local Anesthetics

Answer 25

(Lidocaine, Zostrix) Interrupts transmission of pain signals to the brain, works for types of neuropathic pain