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Pharm III > E3: Pain Meds CC (Adults) > Flashcards

E3: Pain Meds CC (Adults) Flashcards

1
Q

Out of the short acting pain medications, which drug is a Class IV (DEA)?

A

Tramadol

*ALL other short acting meds are Class II

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2
Q

Of the short acting pain meds, which 4 drugs can be administered in other ways besides orally? List the different routes of administration.

A
  • Oxymorphone immediate release (PO, IV)
  • Morphine (PO, IV)
  • Hydromorphone (Dilaudid) (PO, IV)
  • Fentanyl (for tx of CA pain) (IV, sublingual, transmucosal nasal spray)
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3
Q

Of the long acting pain meds, which drug can be given as a topical patch?

A

Fentanyl

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4
Q

List the 8 short acting pain meds.

Sorry this card is dumb

A
  • Tramadol
  • Tapendatol
  • Hydrocodone/apap (Norco)
  • Oxycodone or oxycodone/apap (Percocet)
  • Oxymorphone immediate release
  • Morphine
  • Hydromorphone (Dilaudid)
  • Fentanyl (every form besides patch)
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5
Q

List the 8 long acting pain meds.

This card is also stupid.

A
  • Tramadol ER
  • Tapendatol ER
  • Oxycodone ER (Oxycontin)
  • Oxymorphone ER
  • Morphine Sulfate ER
  • Hydromorphone ER
  • Fentanyl PATCH
  • Methadone* (different than short acting drugs)
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6
Q

List 8 possible SE of opioids.

A
  • Constipation!!!
  • N/V
  • Pruritus
  • Dry mouth
  • AMS
  • Respiratory depression
  • Tolerance
  • Dependence
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7
Q

Define pseudo-addiction.

A

Undertreated pain resulting in red flag behaviors

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8
Q

Define physical dependence.

A

Withdrawal sxs with abrupt discontinuation/decrease in opioid (usually chronic pain)

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9
Q

Define tolerance.

A

Need increased dose for pain relief/or reduced effect of constant dose over time

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10
Q

What are 2 characteristics of addiction?

A
  • Impaired control over drug use/craving

- Compulsive and continued use despite harm

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11
Q

What are the 3 types of pain?

A
  • Nociceptive
  • Neuropathic
  • Psychogenic

ETIOLOGY OF PAIN DICTATES TX

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12
Q

Describe Nociceptive pain. List a few examples.

A
  • Caused by injury to tissues
  • Activation of peripheral pain receptors (somatic or visceral)

Examples:
Laceration, skin injury, fractures, surgery, CA/tumors, internal organ injury

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13
Q

What are the 2 preferred pharmacological txs for nociceptive pain? What other txs can be considered?

A

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
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14
Q

Describe Neuropathic pain. List a few examples.

A

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)

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15
Q

List the 8 medications that can be considered for the tx of neuropathic pain.

A
  • Neurontin (Gabapentin)*
  • Lyrica*
  • Amitriptyline
  • Cymbalta
  • Tramadol
  • Nucynta
  • Lidoderm patch/creams
  • Epidural steroid inj/nerve blocks
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16
Q

A ________ nerve block could improve a patient with pain in their UE, chest, head/neck, breast, or thorax.

A

Stellate ganglion

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17
Q

A ________ nerve block could improve a patient with pain in their pancreas, gastric, hepatic, biliary tree.

A

Celiac plexus

18
Q

A ________ nerve block could improve a patient with pain in their lower abdomen and LE.

A

Lumbar sympathetic/splanchnic

19
Q

A ________ nerve block could improve a patient with pain in their entire pelvis (with the exception of the ovaries).

A

Superior hypogastric

20
Q

A ________ nerve block could improve a patient with pain in their perineal region, rectum, or coccydynia.

A

Ganglion of Impar

21
Q

Describe psychogenic pain.

A
  • Pt with persistent pain typically with evidence of psychologic disturbance
  • No evidence of disorder that could account for the pain or its severity
22
Q

What is the tx for psychogenic pain and what is the primary goal of tx?

A
  • Biofeedback/distraction techniques
  • Encourage exercise
  • Psychologic/psychiatric eval and therapy

GOAL: Improve comfort/psychologic function

23
Q

What are some reasonable considerations for switching a patient with a chronic disease (like RA) from short acting to long acting pain medications?

A
  • 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!

24
Q

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)?

A
  • 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
25
Q

What 4 medications can be used to tx diabetic neuropathy?

A
  • Gabapentin
  • Pregabalin (Lyrica)
  • Cymbalta
  • Topical compounded cream (lido or gabapentin)

*can also use TENS unit

26
Q

What is the primary recommendation for the tx of fibromyalgia?

A

Physical activity!!!!

  • Aqua therapy
  • Encourage them to work their way up to land exercise
27
Q

What 3 medications can be considered for the tx of fibromyalgia? What medications should be avoided?

A

Tx with: Lyrica, Gabapentin, or Cymbalta (mood)

AVOID OPIOIDS!!!

28
Q

In what 2 primary conditions would a PCA be considered?

A
  • Intractable CA pain

- Severe post op pain

29
Q

Describe how a PCA works.

A
  • Pt has IV attached to delivery system to administer a specific dose of pain meds
  • Demand dose (“every time”) vs Continuous dose (“over time”)
30
Q

What are the pros and cons of a PCA pump?

A

Pros: Pt feels in control of their pain, less opioid use overall (not using while sleeping), and can help lessen debilitating pain fairly quickly

Cons: Family members push button for the patient, risk of overdose (discuss w/ nurse, order Narcan PRN, titrate if needed, check in q 12-24 hours, wean as soon as pain is tolerable)

31
Q

What is the typical conversion of IV morphine to PO morphine?

A

Typically 3:1 but can be patient dependent

32
Q

What are 4 strategies for CA pain management?

A
  • Optimization of opioid therapy + analgesic adjuncts!!!
  • Consult palliative care, pain mgmt, and hospice
  • Manage other sxs unrelated to pain (like anxiety)
  • Consider interventional pain mgmt
33
Q

How long does it take for a fentanyl patch to reach therapeutic levels? How does this apply to CA patients?

A
  • Takes up to 12hrs to reach therapeutic levels
  • Not great for acute pain
  • Less effective in cachectic patients!!!
34
Q

What should patients be warned about when using a fentanyl patch?

A

EXPOSURE TO HEAT

  • Can increase absorption of heat
  • Can be fatal!
35
Q

What are 2 pros to Methadone use? 3 cons?

A

Pros:

  • Decrease NEUROPATHIC pain
  • Inexpensive

Cons:

  • QT prolongation/risk of Tdp (Baseline EKG, check renal/hepatic function, EKG yearly thereafter)
  • Loooong half life, very slow titration q 3-5 days
  • Lots of drugs interactions
36
Q

When would the use of Tramadol be considered? Tramadol should be avoided when taking what other meds?

A
  • Can be used for NEUROPATHIC pain (and fibromyalgia if absolutely necessary)
  • Caution in pts on anti-depressants due to risk of Serotonin Syndrome
37
Q

What are the drugs of choice for txing pain in a patient with ESRD?

A
  • Fentanyl (patch or parenteral)

- Methadone

38
Q

What 4 meds should be avoided with ESRD? What 2 meds should you use extreme caution?

A

Avoid: morphine, demerol, hydrocodone, codeine

Extreme caution: hydromorphone, oxycodone

39
Q

What class of meds should be avoided when txing pain in a patient with hepatic disease?

A

Opioids

40
Q

What class of meds should be avoided when txing pain in a patient with increased intracranial pressure?

A

NO OPIOIDS!

41
Q

You should only consider prescribing opioids if you can answer “yes” to the following 5 questions:

A
  1. Does the pt have a definitive dx?
  2. Has there been a documented work up with abnormal findings?
  3. Is the patient experiencing impairment in function?
  4. Have you evaluated for CI to opioid management?
  5. Has the pt failed adjunct txs?

Pharm III (7 decks)

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