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Clin Therapeutics 1 > Exam 2 - Pain > Flashcards

Exam 2 - Pain Flashcards

1
Q

Acute Pain lasts how long? What are common causes?

A

Lasts hours to weeks. Surgery, trauma, medical procedures

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2
Q

General tx for Acute Pain?

A

Treat underlying causes, analgesics

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3
Q

Chronic Pain lasts how long? What are common causes?

A

Lasts months to years. Cancer or non-cancer causes.

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4
Q

Chronic Pain general treatment criteria?

A

Multimodal treatment (non-pharm, non-opioid-pharmacologic, opioids)

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5
Q

Mild to Moderate pain best treated by which pharm agents?

A

Non-opoid analgesics: APAP, ASA, NSAIDs

MOA: PG inhibition

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6
Q

Moderate to Severe pain treated with which pharm options?

A

Opioids +- non-opioids +- adjuvant analgesics

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7
Q

MOA of NSAIDSs?

A

Inhibit prostaglandin synthesis via COX enzymes in peripheral tissue. Reversibly inhibit platelet function.

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8
Q

Somatic Pain location and quality?

A

Localized. Acute/pressure/sharp.

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9
Q

Somatic Pain fibers and examples?

A

C-fibers.

Superficial lacerations, burns.

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10
Q

Somatic Pain tx?

A

APAP, NSAIDs, Opioids. Superficial heat/cold.

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11
Q

Visceral Pain location and quality?

A

Generalized. Sharp/stabbing.

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12
Q

Visceral Pain fibers and example?

A

A-Fibers. Appendicitis.

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13
Q

Visceral Pain tx?

A

Steroids, NSAIDs, opioids, instraspinal LA.

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14
Q

Neuropathic Pain location and quality?

A

Radiating or specific.

Burning, shock-like, electric-like

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15
Q

Neuropathic Pain mechanism and examples?

A

Dermatomal or Central mechanism.

Diabetic neuropathy, post-herpetic neuralgia.

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16
Q

Neuropathic Pain tx?

A

Anticonvulsants, antidepressants, neuroblockade

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17
Q

MOA of Opioid Analgesics?

A

Activate descending inhibitory pathway which modulates transmission in spinal cord; alters limbic system activity

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18
Q

PO vs Parenteral ratio (in general)

A

3 : 1

19
Q

PO vs Rectal ratio (in general)

A

1 : 1

20
Q

Max APAP dose/day?

A

4g

21
Q

Ketorlac is which class of pain drug and what route?

A

IV NSAID

22
Q

Can you give Ketorlac for more than 5 days? Why?

A

NO, dt bleeding and renal impairment

23
Q

Celebrex should not be given to a patient with which allergy?

A

Sulfa allergy

24
Q

If giving NSAID at high dose for chronic pain what should also give?

A

PPI

25
Q

Guideline for starting and titrating Opioids?

A

Start with lowest possible dose. Titrate up or down as percent of total daily dose.

26
Q

Goal for Opioids?

A

Minimal analgesia with minimal ADRs

27
Q

What is bowel regimine for opioid induced constipation?

A

Softener + Stimulant

28
Q

Tx for Opioid-induced pruritis not due to allergy?

A

Mixed agonist/antagonist

29
Q

Tx for Opioid-induced delerium/hallucinations?

A

Lower dose, change opioids, Haldol

30
Q

Tx for Opioid-induced myoclonic jerking?

A

Lower dose, change opioid, muscle relaxant

31
Q

Tx for Opioid-induced respiratory depression?

A

Hold opioids, supportive care, Narcan

32
Q

Indications for Corticosteroids? (Hint: 3, not all pain-related)

A
  • Acute spinal cord/nerve compression
  • Alleviate N/V
  • Bone pain
33
Q

Corticosteroid ADRs?

A

GI upset, hyperglycemia, weight gain, increased appetite, immunosppression, behavior changes

34
Q

Local Anesthetics indication?

A

Neural blockade to reduce surgery-indiced immune response

35
Q

What is Multimodal Analgesia?

A

2 or more analgesics with different MOAs

36
Q

3 examples of Multimodal Analgesia?

A
  1. Opioid + APAP
  2. Opioid + NSAID
  3. Opioid + alpha-2-agonist
37
Q

Antidepressants and pain? Which to give? MOA?

A

For chronic pain. TCA and SNRIs work (SSRIs don’t).

MOA=increase descending pathway modulation

38
Q

Anticonvulsants and pain tx?

A

Decrease neuroanal hyperexcitability

39
Q

In Chronic Pain what should be tried before opioids?

A

Non-pharm and non-opioid treatment

40
Q

Before starting opioids for chronic pain what need to establish?

A

Realistic goals for pain and function, and how to d/c if benefits not outweight risk

41
Q

When to continue opioids for chronic pain?

A

If clinically meaningful improvement in pain and function outweights safety risk

42
Q

When starting opioids can give long-acting/extended-release?

A

No! Start with immediate-release!

43
Q

Urine and chronic pain?

A

Check before starting and annually

44
Q

Can give BZD and opioids together?

A

Try not to if possible

Clin Therapeutics 1 (12 decks)

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