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Pain Control II > Choosing an analgesic > Flashcards

Choosing an analgesic Flashcards

1
Q

acute pain

A

frequently has a known cause

has identifiable tissue damage

usually subsides as healing takes place
has a predictable endpoint
associated with anxiety – flight or fight and increase in pulse and respiratory rate

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2
Q

chronic pain

A

present in area for greater than 3 months

does not usually manifest the physiologic arousal as seen in acute pain

may exhibit reactive depression and decreased function

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3
Q

physiological condtiions associated with chronic pain

why?

A

high prevelance of psychological comorbitites among patients with chronic pain

presence of chronic pain may cause emoional distress and exacerabate premorbid psychological disorders

mood disorders
anxiety disorders 
somatic symptoms disorders 
personality disorders 
other conditions
  • unidentified can get in way of achieving management
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4
Q

three main minsconceptions regarding pain and analgesics

A
  1. patients who are in pain always have observable signs
  2. obvious pathology, test results, and the type of surgery determine the extence and the intensity of pain

3, patients should wait as long as possible before taking a pain medication. this period of abstinence will teach them to have a better tolerance for pain

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5
Q

three main minsconceptions regarding pain and analgesics

A
  1. patients who are in pain always have observable signs
  2. obvious pathology, test results, and the type of surgery determine the extence and the intensity of pain

3, patients should wait as long as possible before taking a pain medication. this period of abstinence will teach them to have a better tolerance for pain

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6
Q

post op pain mangament with aspirin

A

650 mg better than placebo or 30 mg codeine

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7
Q

post op pain mangament with aspirin

A

650 mg better than placebo or 30 mg codeine

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8
Q

adult ibuprofen rx

A

200-800 mg
q 6 hrs
no excees 3.2 g/day

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9
Q

downfalls of the COX -2 selective

A

resulted in increase in MI’s and strokes, especially with rofecoxib and valde

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10
Q

COX-2 on the market

A

celecoxib

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11
Q

head injuries give opoids

A

no

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12
Q

head injuries give opoids

A

no

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13
Q

combination analgesics

A

opiod with non opiod

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14
Q

amount of drug in combination analgesics determined by

A

amount of the non-opiod analgesic

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15
Q

pharmacologic control of pain can b direced at any of the three nocieptive processes

A
  1. initiation of impulses
    - free nerve endings
  2. propagation of those impulses
    - like local anesthetic
  3. perception of the painful stimuli
    - like narcotics
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16
Q

hydrocodone associated with

A

vicodine

complete agonist (opiod)

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17
Q

oxycodone associated with

A

percocet

complete agonsit - opiod

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18
Q

NSAIDs act where

A

at site of the initiation of nociceptive impulses

primarily in periphery by preventing synthesis and release of inflammatory mediators

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19
Q

aspirin like drugs effect

A

acetylsalicyclic acid moiety binds irreversibly to platalet cyclooxygenases

prevents platelet production of prostaglandins and thromboxanes - which are essential for platalet aggregation

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20
Q

6 main indications for aspirin like drugs

A
  1. mild to moderate pain
  2. fever
    3/ arthritis
    4/ thromboemolic disorders
  3. TIAs
  4. postmyocardial infarction
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21
Q

contraindications and side effects of aspirin like drugs

A
  1. alergic
  2. anti-coagulated patient
  3. gastric ulcers
  4. side effects such as
    - epigastric distress
    - nausea / vomit
    - increased bleeding time
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22
Q

reyes syndrom from

A

aspirin given to young children resulting in encephalopathy and liver disease

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23
Q

aspirin dose effetive after extraction

A

650 mg vs 30 mg of codeine or placebo

24
Q

ibuprofen is
peak?
half life?

A

motrin / advil
peal is 1-2 hr
half life 2-4

25
Q

adult vs children dose of ibuprofen

A

200-800 mg q 6 hr
- not exceed 3.2 grams / day

2-11 yrs.
7.5 mg/ kg qid
not exceed 30 mg/kg/day

26
Q

naproxen sodium

dosage?

naproxen dosage

A

safe for short use
similar to ibuprofen
slightly slower onset but longer duration

may consider before night before surgery

loading dose of 550 mg - then 275 mg q6-8 hr. not exceeding 1375 mg/day

naproxen = 250-500 mg bid
not exceed 1g/day

27
Q

prostaglandins usually used for? implication

A

responsible for producing compounds that protect gastric lining

  • so inhibiting them with NSAIDS - can see most common side effects of
  • gastrointestinal problems - dyspepsia, gastric erosions, and mucosal ulcerations
28
Q

NSAID that effects bleeding

A

ASA - only one because it IREVERSIBLY inhibits the COX pathways
- prolongs bleeding

29
Q

dosage of celecoxib aka

A

celebrex
COX-2 inhibitor

100 or 200 mg BID

30
Q

pregnency use of NSAIDs

avoid when? why?

A

APAP > ASA
apap – therapeutic doses is generally considered best choice for manging acute pain

ASA – can lead to anemia and delivery cmplications and postpartum hemorrhage

avoid ASA and NSAIDs in THIRD TRIMESTER
- inhibit prostaglandin syntheiss and can inhibit contractions in labor
- constriction of ductus arteriosis in utero – pulmonary HTN of newborn
-

31
Q

NSAIDs and alcohol - general

A

combo increases the risk of fecal blood loss associated with GI erosions and ulcers

32
Q

acetaminophen aka ?

metabolite of?

A

tylenol
metabolite of phenatecin – equipotent to ASA but fewer side effects b/c acts more centrally – weak inhibitor of the peripheral prostaglandins

33
Q

no / minimal antiinflammatory NSAID

A

APAP - acetaminophen / tylenol / panadol

34
Q

hepatic / liver toxicity in which NSAID

dose?

A

acetaminophen – induced with APA with daily dose of 4000mg is exceeded

so daily dose is 3000 mg max or 3 g / day

35
Q

acetaminophen dose with opiods

A

max of 325 mg

36
Q

indications for acetaminophen

A

mild to moderate pain

fever

37
Q

contraindications for acetaminophen /

A

hypersensitivityy

precautions

  • hepatic / liver disease
  • renal disease
  • chronic alcoholism
38
Q

acetaminophen dosage

A

325-650 mg q4 h

not to exceed 3gm / day

39
Q

LA’s working where

A

blocking propagation at peripheral site so do not reach spinal cord or brain

40
Q

opiods receptors are where

A

spinal cord, medulla, and periaqueductal grey matter (considered important areas in perception of pain)

  • decrease the perception of pain in the CNS
41
Q

contraindications for opiods

A

hypersensitivirt
CHRONIC OROFACIAL PAIN - NO
head injuries - NO

42
Q

first pass addect in centrally acting analgesics

A

50 to 90% of the absorbed drug is metabolized on the first pass through the liver – clinically this means that only one-tenth to one-half of the dose reaches the analgesic receptors in the brain

43
Q

codeine is

A

tylenol #3

44
Q

most important for choosing regimen for pain control

A

cause of pain and pain severity

45
Q

important use of LA

A

perioperative LONG ACTING LA can delay onset of post procedural pain

46
Q

long acting LA

A

bupivacaine - marcaine

exparel – liposomal bupivacaine – injected into SURGICAL site - not for use of 18 year or younger

47
Q

major differences between non-opioid and opioid

A

non opioid
- ceiling effect to anagesia (no ceiling effect on analgesic response)
-no toleranc or physical dependence built
- are antipyretic
=- posses antinflamm + analgesic (except acetaminophen )

48
Q

If use opioid should be

A

FULL agonist with minimal first pass affect

49
Q

dosing equivalaents of oxy, hydroco, codeine and tramadol

A

5mg of oxycodone = 10 mg of hydrocodone = 65 mg of codeine = 75 mg tramadol

50
Q

source of diversion

A

non used drugs - then used for nonmedical use by those around - not prescribed

51
Q

max dos of acetaminophen

A

3 grams aily

325-650 po - q4-6 hours

or 1 g po 3x day

52
Q

percocet is?

dosing?

A

5/325
acetaminophen 325 mg
oxycodone = 5mg

12 tablets usually q 6 hr

53
Q

vicodin is?

dosing?

A

acetaminophen 300 mg
hyrocodone 5 mg

15 tabs usually q 6

54
Q

vicoprofen is?

dose?

A

hydrocodone bitartrate 7.5 mg

ibuprofen 200 mg

15 tabs 4-6 hr prn pain

55
Q

potential drug interactions with motrin

A

motrin = ibuprofen

antihypertensive - may decrease effectivenes

ASA, corticosteroids - increased risk of adverse GI reactions

Digoxin, lithium , oral anti-coagulants- may incease the plasma levels or affects of these medications

methotrexate – decreased clearance and thus increased toxicity

56
Q

gastric bypass probably not giving?

A

NSAID

or esophagial reflux

Pain Control II (15 decks)

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