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Pharm 3 > E3: Pain Management > Flashcards

E3: Pain Management Flashcards

1
Q

How is tramadol, tapendatol, hydrocodone, and oxycodone administered?

A

Oral

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2
Q

How is oxymorphone immediate release, morphine, and hydromorphone administered?

A

Oral or IV

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3
Q

What are the side effects of opioids?

A

Constipation, N/V, pruritis, dry mouth ,AMS, respiratory depression, tolerance, and dependence

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4
Q

What is pseudo addiction?

A

Undertreated pain resulting in red flag behaviors

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5
Q

What are the 3 different types of pain?

A
  • Nociceptive
  • Neuropathic
  • psychogenic
  • etiology of pain dictates treatment
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6
Q

What is nociceptive pain?

A

-Caused by injury to the tissues and activation of peripheral pain receptors, somatic or visceral

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7
Q

What is the recommended treatment of Nociceptive pain?

A
  • Short term NSAIDs
  • Tylenol
  • Corticosteroids
  • Oral/topical opioid pain medication
  • Parenteral pain medications
  • PT
  • TENS unit
  • muscle relaxants
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8
Q

What is neuropathic pain?

A

Results from damage to or dysfunction of nerves, spinal cord or brain

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9
Q

what is the recommended treatment of neuropathic pain?

A
  • Gabapentin
  • Pregabalin
  • Amitriptyline
  • Cymbalta
  • Tramadol
  • Nucynta
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10
Q

What are the options for interventional pain management?

A
  • Epidural steroid injection
  • Joint injection
  • Intrathecal pump implant
  • spinal cord stimulator implant
  • peripheral nerve blocks
  • sympathetic nerve blocks and neurolysis
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11
Q

What kind of nerve block can treat pain of the UE, chest, head, neck, breast, and thorax?

A

Stellate ganglion

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12
Q

What kind of nerve block can treat pancreatic, gastric, hepatic, or biliary tree pain?

A

Celiac plexus

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13
Q

What kind of nerve block can treat lower abdominal pain and lower extremity pain?

A

Lumbar sympathetic

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14
Q

What kind of nerve block can be used to treat pain of the entire pelvis with exception of the ovaries?

A

Superior hypogastric

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15
Q

What kind of nerve block can be used to treat pain of the perineum and rectum?

A

Ganglion of Impar

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16
Q

What is psychogenic pain?

A

Persistent pain typically with evidence of psychologic disturbance
-No evidence of disorder that could account for the pain or its severity

17
Q

What is the treatment of Psychogenic pain?

A
  • Biofeedback/distraction techniques
  • encourage exercise
  • psychologic/psychiatric evaluation and therapy
18
Q

What are the treatment options for muscle spasm pain?

A
  • NSAIDs
  • Possible muscle relaxant
  • Trigger point injections
  • Medrol dose pack
  • Ice/heat
19
Q

You are treating a patient for muscle spasms and on their 1-2 week follow up, they are not having any improvement. What should you consider?

A
  • PT
  • imaging
  • may repeat trigger point injection if they were effective short term
  • TENS unit
20
Q

You are converted a patient from a short acting opioid to a long acting opioid for pain. What should you consider for breakthrough pain?

A

Low dose opioid- should not be more than 20-25% of daily long acting dose

21
Q

What medications should you consider for diabetic neuropathy?

A
  • Gabapentin
  • Pregabalin
  • Cymbalta
  • topical compounded cream
  • TENS unit
22
Q

How should you dose Gabapentin for diabetic neuropathy?

A

-Titrate slowly up, 100mg-300mg, start qd, then BID, then TID over weeks to months

23
Q

How should you dose Pregabalin for diabetic neuropathy?

A

Titrate slowly up, 25mg-50mg, start QD, then BID, then RID over weeks to months

24
Q

What is the treatment for fibromyalgia?

A
  • Encourage physical activity (#1 treatment)
  • Support and counseling
  • Pregabalin or Gabapentin
  • Cymbalta for pain control
  • AVOID OPIOIDS
25
Q

What is PCA?

A
  • Patient controlled analgesia
  • used most often for severe post operative pain and intractable cancer pain
  • Can be used short term for patients on chronic, high dose opioids outpatient that are suddenly NPO
26
Q

What is the PO to IV conversion of morphine?

A

Typically 3:1, but patient dependent

27
Q

What is the main risky side effect of methadone?

A

-Risk of QT prolongation, get baseline EKG and check EKG annually thereafter

28
Q

What is Tramadol commonly used for?

A
  • Consider for neuropathic pain

- Fibromyalgia if absolutely necessary

29
Q

What pain medications should be avoided in ESRD?

A
  • Avoid morphine, Demerol, hydrocodone, and codeine

- EXTREME caution with hydromorphine and oxycodone

30
Q

What is the DOC in ESRD?

A
  • Fentanyl (patch or parenteral)

- Methadone

Pharm 3 (20 decks)

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