Chronic Pain Management

Question 1

what is serotonin syndrome?

Answer 1

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

Question 2

HCAHPS stands for what?

Answer 2

hospital consumer assessment of healthcare providers and systems
*1-2% funds held by reembursement pending these scores

Question 3

what is called “the fifth vital sign”?

Answer 3

pain

Question 4

what is opioid tolerance

Answer 4

adaptive state where you need more drugs to get the same effects

Question 5

what is opioid induced hyperalgesia (OIH)

Answer 5

prolonged administration of opioids results in a paradoxic increase in atypical pain

Question 6

how do you treat OIH?

Answer 6

wean the patient off narcotics

Question 7

what schedule drug is Tramadol?

Answer 7

schedule IV

Question 8

methadone (dolaphine) does what?

Answer 8

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

Question 9

Name some opioid side effects…

Answer 9

respiratory depression
sedation
confusion
pruritus
N/V
constipation
urinary retention
myosis
muscle twitching
addiction/tolerance/dependence

Question 10

ketamine acts on

Answer 10

mu receptor agonist non competitive antagonist at NMDA receptor

Question 11

gin and tonic for opioid dependent PTs means what?

Answer 11

G- gabapentin/neurontin
I- ice pack or cryotherapy
N - NSAIDS (ketorolac/toradol, celebrex, ibuprofen)
T - tylenol
L - Lidocain patches

Question 12

what is methamphetamine?

Answer 12

a strong CNS stimulant

- sympathomimetic amine

Question 13

what is desoxyn?

Answer 13

methamphetamine
- treats ADHD, obesity, narcolepsy
acts as appetite suppresant

Question 14

what is adderall?

Answer 14

dextroamphetamine salts

- related to methamphetamine

Question 15

why do we cancel the case when someone comes in on methamphetamine?

Answer 15

they are extremely hemodynamically unstable under anesthesia

- including severe hyperthermia, can induce MH

Question 16

what are the benefits of the epidural?

Answer 16

• 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

Question 17

indications for epidural?

Answer 17

thoracic, upper or lower abdominal, pelvic, or lower extremity surgery

Question 18

contraindications for epidural?

Answer 18

• high PLT (100,000, indicating coagulopathy)
• elevated WBC (indicating infection)
• hypovolemia
• anotomical abnormalities
• multiple sclerosis or syringomyelia

Question 19

how long do we want patients off coumadin prior to our PT test?

Answer 19

3-4 days

Question 20

complications related to an epidural?

Answer 20

1 - infection
2 - bleeding
3 - headache
4 - nerve damage
5 - epidural hematoma
6 - epidural abcess
7 - seizures
8 - cardiac arrest

Question 21

Spinal (intrathecal) narcotics are used for what? What drugs do we use?

Answer 21

• rapid recovery protocol

- primarily morphine, hydromorphone

Question 22

how will you know that a PT has intrathecal narcotics? (so limit intraop narcotics

Answer 22

they will have

• wrist band, orange hat
• chart sticker
• door sign

Question 23

if the PT is taking PO narcotics, how should you give the PT narcotics?

Answer 23

PO