Chronic pain Flashcards

1
Q

Meds for neuropathic pain

A

Pregabalin
Gabapentin
SNRI
Capsaicin

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2
Q

How to mitigate diversion/ abuse when prescribing meds w/ potential for this

A

limit doses
document reasons
check for double doctoring
Use written treatment contract with realistic consequences
limiting prescribed quantities or carries
when pt breaches contract, manage your own emotions, address impact on staff, apply or judiciously amend contract

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3
Q

Indication for cannabis

A

Refractory severe neuropathic pain or palliative pain, has tried >3 neuropathic pain meds

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4
Q

CI to cannabis

A

<25y/o
Fam hx psychosis
Cannabis or SUD
CV/ resp dz
Pregnant

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5
Q

Safety education for cannabis

A

No driving 6 hrs after smoking, 8hrs after ingestion
Vaporizer preferred
SE: drowsy, memory impairment
Sign drug agreement

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6
Q

Dosing for cannabis

A

100-400mg of 9% THC daily

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7
Q

What to consider when providing analgesia for acute pain

A

Dose appropriately based on narcotic naivete and renal function
consider addiction risk
consider metabolic responses (codeine in pregnant/ breastfeeding pts)
Inform pt not to use OTC drugs from same class
Use non-pharmacological treatments to control pain and manage function
Recognise transition to chronic pain

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8
Q

Management of trigeminal neuralgia

A

Carbamazepine
Gabapentin
Pregabalin
Phenytoin
Lamotrigine
Valproic Acid
Tricyclic Antidepressants
Baclofen

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9
Q

Difference between Trigeminal Neuralgia and Herpes Zoster

A

Trigeminal Neuralgia and Herpes Zoster are both unilateral presentations; however Trigeminal Neuralgia will usually have a normal physical and sensory examination while Herpes Zoster is usually accompanied by either allodynia, numbness and has an associated rash and/or occular involvement if involving the face.

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10
Q

Indications for marijuana

A

palliative pain, neuropathic pain, N/V post chemo, spasticity w/ MS

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11
Q

Opioid guidelines for chronic non cancer pain

A

max new start 50mg MED, taper to 90mg MED if currently higher

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12
Q

When to use opioids?

A

When TCAs, nabilone, NSAIDs, CBT, exercise, PT, self management

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13
Q

Guidelines for opioids + elderly

A

Rx should only be for 3d, max 1w. Slow taper

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14
Q

Managing sx of withdrawal: pain

A

rx w/ neuropathic or NSAIDs

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15
Q

Managing sx of withdrawal syndrome

A

clonidine if BP >90/50 + pulse >50

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16
Q

Managing sx of withdrawal: diarrhea

A

loperamide

17
Q

Managing sx of withdrawal: cramping (muscle + abdo)

A

muscle = quinine, abdo = hyoscine

18
Q

Managing sx of withdrawal: sweating

A

oxybutinin

19
Q

Guidelines for cannabis in elderly

A

avoid if hx of MH/ SU, brain or balance impairment, CVD. Assess falls + driving risk, use CUDIT