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704 Geriatrics > Chronic Pain > Flashcards

Chronic Pain Flashcards

1
Q

What are common descriptors of neuropathic pain?

A
  • Burning
  • Tingling
  • Hypersensitivity to touch or cold
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2
Q

What are common descriptors of nociceptive pain?

A
  • Aching
  • Sharp
  • Throbbing
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3
Q

What are some causes of pain treatment failure?

A
  • Failure to use multimodal approach
  • Failure to target correct mechanism of pain
  • Failure to treat neuropathic pain with adjuvant drugs
  • Heavy use of short-acting opioids instead of using long-acting
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4
Q

What are misconceptions with pain?

A
  • It’s a sign of weakness
  • Normal part of aging
  • Punishment (misspent youth)
  • Death is near
  • Indicates serious illness
  • Means intrusive pain tests and loss of independence
  • Elderly = higher tolerance
  • Cognitively impaired can’t be accessed
  • LTC - pain to get attention
  • Likely to become addicted
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5
Q

T/F: Most patients in mild-moderate pain can be assessed using at least one pain scale

A

TRUE

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6
Q

How should we deal with discomfort in dementia?

A
  • Assess history of cause of pain
  • Non-pharmacologic
  • Use non-opioid as needed, if effective then routine
  • No effect? Give opioid analgesic or psychotropic, if response then use routinely
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7
Q

T/F: Pain relief should be done PRN

A

FALSE: persistent pain needs persistent analgesia!!!

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8
Q

What is a great starting point for mild to moderate pain pharmacotherapy?

A

Acetaminophen

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9
Q

When should acetaminophen be avoided?

A
  • Hepatic failure
  • Drug interactions (warfarin)
  • Over 4 grams per day
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10
Q

When should NSAIDs be used for pain management?

A
  • Other safer therapies failed
  • Highly selected individuals with extreme caution
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11
Q

What are downsides of NSAIDs?

A
  • Ceiling effect
  • CI with PUD, CKD, HF
  • Avoid with H. pylori, HTN, PUD history
  • GI and renal risks
  • CHF and MI risk
  • Coagulation issues
  • Avoid with ASA
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12
Q

T/F: You can use topical diclofenac instead of oral to eliminate GI events

A

FALSE: Lower risk but still a problem (35%)

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13
Q

If you need to use ASA with NSAIDs, what should be done?

A

Use COX-2 selective and add on PPI or misoprostol

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14
Q

What is first line for neuropathic pain?

A

a-2 ligands
- Gabapentin
- Pregabalin
SNRIs
- Duloxetine

TCAs… DONT

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15
Q

What is second line for neuropathic pain?

A

Topical agents
- Lidocaine
- Capsaicin

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16
Q

What drugs should be avoided for neuropathic pain?

A

Tertiary TCAs

17
Q

T/F: Pain treatment is not immediate and may take time and multiple doses before being considered an adequate trial

A

TRUE

18
Q

When can steroids be considered for pain?

A
  • Inflammatory disorders
  • Metastatic bone pain
19
Q

T/F: Opioids have no ceiling dose

A

TRUE

20
Q

What are side effects of opioids?

A
  • Respiratory depression
  • Lethargy/sedation
  • Miosis
  • Constipation
21
Q

What are signs of opioid toxicity?

A
  • Severe respiratory depression
  • Decreased level of consciousness, unarousable
  • Pinpoint pupils
22
Q

What are the preferred opioids for elders?

A
  • Morphine
  • Oxycodone
  • Hydrocodone
  • Hydromorphone
  • Fentanyl
23
Q

T/F: Methadone is simple to dose but not very effective for elderly patients

A

FALSE: effective but not preferred since it is difficult to dose

24
Q

What are considerations that need to be taken with topical opioids?

A
  • Active ingredient may still be in used patches, careful!
  • Improper disposal may lead to dangers for children/pets
  • Heat can affect rate of absorption
  • Products with metal foil backing should be avoided if MRI needed
25
Q

What drugs can be used to help with N/V with opioids?

A
  • Metoclopramide
  • Haloperidol
  • Antihistamines
  • Ondansetron
  • Lorazepam
26
Q

What can we use to treat constipation with opioids?

A
  • Stimulants
  • Osmotics
  • Saline
  • Opioid antagonists
  • Lubricant
27
Q

T/F: Softening agents are first line for opioid-induced constipation

A

FALSE: should not be used alone

28
Q

T/F: CDC guidelines can be referenced for palliative care, active cancer, or end-of-life care

A

FALSE: not covered and do not apply

29
Q

T/F: Opioids should be started as IR and then switched to ER as tolerated

A

TRUE

704 Geriatrics (8 decks)

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