Chronic Pain Management Flashcards
what is serotonin syndrome?
Increased sympathetic activity, headache, shivering, goosebumps
resulting from taking a new drug or increasing its dosage
- can lead to high fever, seizures, irregular heartbeat, and unconsciousness
HCAHPS stands for what?
hospital consumer assessment of healthcare providers and systems
*1-2% funds held by reembursement pending these scores
what is called “the fifth vital sign”?
pain
what is opioid tolerance
adaptive state where you need more drugs to get the same effects
what is opioid induced hyperalgesia (OIH)
prolonged administration of opioids results in a paradoxic increase in atypical pain
how do you treat OIH?
wean the patient off narcotics
what schedule drug is Tramadol?
schedule IV
methadone (dolaphine) does what?
Mu agonist with a long half life (8-60 hrs) avg 25 hrs
huge risk of narcotic overdose and cardiac conduction effects: prolonged QT, torsades de pointes
Name some opioid side effects…
respiratory depression sedation confusion pruritus N/V constipation urinary retention myosis muscle twitching addiction/tolerance/dependence
ketamine acts on
mu receptor agonist non competitive antagonist at NMDA receptor
gin and tonic for opioid dependent PTs means what?
G- gabapentin/neurontin I- ice pack or cryotherapy N - NSAIDS (ketorolac/toradol, celebrex, ibuprofen) T - tylenol L - Lidocain patches
what is methamphetamine?
a strong CNS stimulant
- sympathomimetic amine
what is desoxyn?
methamphetamine
- treats ADHD, obesity, narcolepsy
acts as appetite suppresant
what is adderall?
dextroamphetamine salts
- related to methamphetamine
why do we cancel the case when someone comes in on methamphetamine?
they are extremely hemodynamically unstable under anesthesia
- including severe hyperthermia, can induce MH
what are the benefits of the epidural?
- effective analgesia 1/10 IV dose
- reduced respiratory complications, post-op MI, stress response, blood transfusions
- GI motility improved
- no survival benefit proven for high risk PT
indications for epidural?
thoracic, upper or lower abdominal, pelvic, or lower extremity surgery
contraindications for epidural?
- high PLT (100,000, indicating coagulopathy)
- elevated WBC (indicating infection)
- hypovolemia
- anotomical abnormalities
- multiple sclerosis or syringomyelia
how long do we want patients off coumadin prior to our PT test?
3-4 days
complications related to an epidural?
1 - infection 2 - bleeding 3 - headache 4 - nerve damage 5 - epidural hematoma 6 - epidural abcess 7 - seizures 8 - cardiac arrest
Spinal (intrathecal) narcotics are used for what? What drugs do we use?
- rapid recovery protocol
- primarily morphine, hydromorphone
how will you know that a PT has intrathecal narcotics? (so limit intraop narcotics
they will have
- wrist band, orange hat
- chart sticker
- door sign
if the PT is taking PO narcotics, how should you give the PT narcotics?
PO
