E3: Pain Meds CC (Adults) Flashcards
Out of the short acting pain medications, which drug is a Class IV (DEA)?
Tramadol
*ALL other short acting meds are Class II
Of the short acting pain meds, which 4 drugs can be administered in other ways besides orally? List the different routes of administration.
- Oxymorphone immediate release (PO, IV)
- Morphine (PO, IV)
- Hydromorphone (Dilaudid) (PO, IV)
- Fentanyl (for tx of CA pain) (IV, sublingual, transmucosal nasal spray)
Of the long acting pain meds, which drug can be given as a topical patch?
Fentanyl
List the 8 short acting pain meds.
Sorry this card is dumb
- Tramadol
- Tapendatol
- Hydrocodone/apap (Norco)
- Oxycodone or oxycodone/apap (Percocet)
- Oxymorphone immediate release
- Morphine
- Hydromorphone (Dilaudid)
- Fentanyl (every form besides patch)
List the 8 long acting pain meds.
This card is also stupid.
- Tramadol ER
- Tapendatol ER
- Oxycodone ER (Oxycontin)
- Oxymorphone ER
- Morphine Sulfate ER
- Hydromorphone ER
- Fentanyl PATCH
- Methadone* (different than short acting drugs)
List 8 possible SE of opioids.
- Constipation!!!
- N/V
- Pruritus
- Dry mouth
- AMS
- Respiratory depression
- Tolerance
- Dependence
Define pseudo-addiction.
Undertreated pain resulting in red flag behaviors
Define physical dependence.
Withdrawal sxs with abrupt discontinuation/decrease in opioid (usually chronic pain)
Define tolerance.
Need increased dose for pain relief/or reduced effect of constant dose over time
What are 2 characteristics of addiction?
- Impaired control over drug use/craving
- Compulsive and continued use despite harm
What are the 3 types of pain?
- Nociceptive
- Neuropathic
- Psychogenic
ETIOLOGY OF PAIN DICTATES TX
Describe Nociceptive pain. List a few examples.
- Caused by injury to tissues
- Activation of peripheral pain receptors (somatic or visceral)
Examples:
Laceration, skin injury, fractures, surgery, CA/tumors, internal organ injury
What are the 2 preferred pharmacological txs for nociceptive pain? What other txs can be considered?
Short term NSAIDs or Tylenol
Can also consider:
- Corticosteroids
- Oral/topical opioids (last resort)
- PCA pump
- Physical therapy
- TENS unit
- +/- muscle relaxants vs trigger point injections
Describe Neuropathic pain. List a few examples.
Results from damage to or dysfunction of nerves, spinal cord, or brain
Examples:
Post-herpetic neuralgia, C/T/L radiculopathy, trigeminal neuralgia, diabetic neuropathy, phantom limb pain, central pain syndrome (CVA)
List the 8 medications that can be considered for the tx of neuropathic pain.
- Neurontin (Gabapentin)*
- Lyrica*
- Amitriptyline
- Cymbalta
- Tramadol
- Nucynta
- Lidoderm patch/creams
- Epidural steroid inj/nerve blocks
A ________ nerve block could improve a patient with pain in their UE, chest, head/neck, breast, or thorax.
Stellate ganglion
A ________ nerve block could improve a patient with pain in their pancreas, gastric, hepatic, biliary tree.
Celiac plexus
A ________ nerve block could improve a patient with pain in their lower abdomen and LE.
Lumbar sympathetic/splanchnic
A ________ nerve block could improve a patient with pain in their entire pelvis (with the exception of the ovaries).
Superior hypogastric
A ________ nerve block could improve a patient with pain in their perineal region, rectum, or coccydynia.
Ganglion of Impar
Describe psychogenic pain.
- Pt with persistent pain typically with evidence of psychologic disturbance
- No evidence of disorder that could account for the pain or its severity
What is the tx for psychogenic pain and what is the primary goal of tx?
- Biofeedback/distraction techniques
- Encourage exercise
- Psychologic/psychiatric eval and therapy
GOAL: Improve comfort/psychologic function
What are some reasonable considerations for switching a patient with a chronic disease (like RA) from short acting to long acting pain medications?
- Pt tolerates opioids well
- Pt experiencing insomnia
- Difficulty with ADLs
- Pt is compliant
- Pt has chronic and debilitating dz
*Tolerance increases faster on high dose, short acting opioids vs long acting pain meds!
What are 3 important considerations to remember when switching a pt b/w different pain meds (such as from a short to a long acting)?
- Reduce daily dose of current med by 50-75% when converting to new med
- Consider low dose opioid for breakthrough pain during conversion
- Breakthrough medication no more than 20-25% of daily long acting dose
