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Principles 2 > Exam 2 (Acute Pain & OFA) > Flashcards

Exam 2 (Acute Pain & OFA) Flashcards

1
Q
  • Which pain feels sharp & stabbing?
A

Visceral/Parietal pain

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2
Q
  • What are the renal consequences of pain?
A

Oliguria & retention

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3
Q
  • What are the coagulation consequences of pain?
A

Increased risk of thromboemboli

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4
Q

Who said pain is directly related to the amount of tissue injury & what theory is it?

A

Rene Descartes Specificity Theory

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5
Q
  • Who came up with the Intensity Theory & what is it?
A
  • Plato
  • Pain is an emotional experience rather than sensory
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6
Q
  • Who came up with the Gate Control Theory?
A

Ronald Melzack & Patrick Wall

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7
Q
  • What are the inflammatory mediators in trauma?
A
  • Bradykinin,
  • prostaglandins &
  • serotonin
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8
Q
  • 2nd order neurons start & end where?
A
  • Start at dorsal horn &
  • end at thalamus
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9
Q
  • Which fiber is larger, C-fibers or A-delta?
A

A-delta

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10
Q
  • What is modulation?
A

Pain transmission alters afferent neural transmission.

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11
Q
  • What is primary hyperalgesia?
A

Augmented sensitivity to painful response

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12
Q
  • What is secondary hyperalgesia?
A

Increased excitability of neurons in the CNS due to glutamate activation of NMDA receptors

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13
Q
  • Which anesthesia med can cause hyperalgesia?
A

Remifentanil

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14
Q
  • What happens to the GI system with age?
A
  • Decreased gastric acid secretion.
  • Elevated gastric pH.
  • Reduced motility & GI blood flow
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15
Q

What type of drugs can be erratic with elderly patients?

A
  • Water soluble drugs &
  • protein binding drugs
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16
Q
  • What are the notable adverse effects of non-opioid analgesics?
A
  • Gastric irritation
  • Bleeding
  • Renal toxicity
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17
Q
  • Which class of drugs have a ceiling effect?
A

Non-opioid analgesics

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18
Q
  • What are the Mu receptor responses to opioids?
A
  • Analgesia,
  • respiratory depression
  • Euphoria
  • Reduce GI motility
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19
Q
  • What are the Kappa receptor responses to opioids?
A
  • Analgesia
  • Respiratory depression
  • dysphoria,
  • delusion/delirium
  • Miosis
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20
Q
  • What are the Delta receptor responses to opioids?
A

Analgesia

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21
Q
  • Which opioid receptor causes dysphoria?
A

Kappa

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22
Q
  • Which drug has better absorption, codeine or morphine?
A

Codeine

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23
Q
  • Which patient should not receive codeine & why?
A

Children <12yrs lack an enzyme causing side effects w/o analgesia

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24
Q
  • What is the adult dose for codeine?
A

15-60mg q4hr

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25
Q
  • Which receptors does tramadol activate?
A
  • Primarily Mu,
  • Kappa &
  • Delta
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26
Q
  • What does Tramadol’s (-) enantiomer do?
A
  • It inhibits NE reuptake &
  • stimulates alpha-2 receptors
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27
Q
  • How effective is Tramadol’s metabolite?
A

2-4 times as strong

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28
Q
  • What is the T½ of tramadol?
A

6hrs + 7hrs for metabolite

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29
Q
  • What is the onset for Tramadol?
A

1-2hrs PO

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30
Q
  • Which Pts should not receive tramadol?
A

Seizure patients

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31
Q
  • What is a big side effect with tramadol?
A

Nausea & vomiting

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32
Q
  • Which receptors are primarily affected by morphine?
A

Mu-1 & Mu-2

33
Q
  • Which morphine metabolite causes issues, & what kind?
A
  • Morphine-3-glucuronide
  • causes neurotoxicity & hyperalgesia
34
Q
  • How does morphine affect the CNS?
A

Poorly d/t poor lipid solubility & high protein binding

35
Q
  • Who possibly needs reduced doses of morphine?
A

Women

36
Q
  • Oxycodone is a derivative of?
A

Thebaine

37
Q
  • What receptors does oxycodone work on?
A

Mu & Kappa

38
Q
  • How long can methadone’s effects last?
A

Up to 36hrs

39
Q
  • What receptors does methadone affect?
A
  • Methadone is a:
  • Mu receptor agonists
  • & an antagonist/inhibitor for:
  • NMDA antagonist,
  • serotonin reuptake inhibitor,
  • MAOI inhibitor,
40
Q
  • What can increase the effects of methadone?
A
  • Grapefruit juice,
  • carbamazepine,
  • antiretroviral agents
41
Q
  • How is methadone affect by the hepatic & renal systems?
A

Not very much

42
Q
  • What is a downside for patients starting methadone?
A
  • It takes ~ 10 days to get to steady state &
  • half-life varies greatly
43
Q
  • What are the PO doses for methadone?
A

2.5 – 10mg

44
Q
  • What is IV dose for methadone?
A

One time 10mg

45
Q
  • What meds cause increased methadone effects?
A
  • Ciprofloxacin,
  • diazepam,
  • ethanol
46
Q
  • What meds are avoided with methadone?
A

MAOI’s

47
Q
  • What are some possible cardiac effects of methadone?
A
  • Prolonged QT
  • Bradycardia
  • Torsades
48
Q
  • What meds can decrease methadone effects?
A

-Phenobarbital,
- phenytoin,
- rifampin,
- amprenavir

49
Q
  • What surgery equipment could interfere with medication patches?
A

Surgeries including cautery

50
Q
  • How do antidepressants help with reducing pain?
A

They increase transmission in the spinal cord to reduce pain signals

51
Q
  • What is the half-life for transmucosal fentanyl?
A

2 – 12hrs

52
Q
  • What is the average half-life for most PO opioids & which is the outlier?
A
  • 2 – 4hrs
  • Propoxyphene lasts 12 – 16hrs
53
Q
  • What is the parenteral dose of Codeine?
A

130mg

54
Q
  • What is the fentanyl metabolite & how long does it stay in the system?
A
  • Norfentanyl &
  • in urine for up to 72hrs
55
Q
  • Why is fentanyl elimination prolonged?
A
  • The lungs serve as an inactive reservoir &
  • They absorb ~ 75% during first-pass effect
56
Q
  • What can be used when a Pt is refractory to fentanyl?
A

Hydromorphone

57
Q
  • What are possible side effects of dilaudid’s metabolite?
A
  • Allodynia,
  • myoclonus &
  • seizures
58
Q
  • What is the post-op pain dose for dilaudid?
A

0.2mg q 3-5mins

59
Q
  • How much stronger is hydrocodone compared to codeine?
A

6 – 8 times

60
Q
  • What are the interactions of hydrocodone?
A
  • CYP inhibitors/inducers
  • Hypotension w/ barbs
  • IV magnesium or CCB may increase opioid effect
61
Q
  • At what receptors does buprenorphine work?
A
  • Partial Mu receptor agonist.
  • Kappa antagonist.
  • Weak Delta agonist
62
Q
  • Where is buprenorphine eliminated?
A

In the liver

63
Q
  • What is the danger with buprenorphine’s metabolite?
A

Respiratory depression is 10 fold

64
Q
  • What is the dose & half-life of buprenorphine?
A
  • 0.3mg IM &
  • 20 – 73hrs
65
Q
  • What is the best route of administration for buprenorphine & why?
A
  • Subliqual or transdermal
  • d/t high first-pass metabolism
66
Q
  • Which drug has higher withdrawal S/S, morphine or buprenorphine?
A

Morphine

67
Q
  • What is the problem with treating a buprenorphine OD?
A

Delayed naloxone onset d/t it being an agonist & antagonist

68
Q
  • What S/S has been observed with buprenorphine?
A

Pulmonary edema

69
Q

Which opioid receptors can cause pruritus & physical dependence?

A

Mu & Delta

70
Q

What is an absolute contraindication to OFA?

A

Allergy to any adjuvant drugs

71
Q

What is the OFA dose for ketamine?

A

< 0.5mg/kg

72
Q

How does Esmolol help in OFA?

A

It decreases the HR, which decreased cardiac output leading to decreased hepatic blood flow, slowing metabolism of other drugs.

73
Q

How does magnesium help in OFA?

A

Acts as non-competitive antagonist of NMDA glutamate receptors → decreased calcium & sodium entry into the cells & prevents potassium efflux.

74
Q

What dexamethasone dose is appropriate as an anti-inflammatory?

A

10mg

75
Q

What NMBd is most appropriate as a maintenance drug in elderly?

A

Cisatracurium (Nimbex)

76
Q

What is an appropriate OFA ketamine dose?

A

0.3 mg/kg

77
Q

How many opioid doses can cause tolerance?

A

1 dose

78
Q
A

Principles 2 (10 decks)

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