Exam 2 - Pain Flashcards
Acute Pain lasts how long? What are common causes?
Lasts hours to weeks. Surgery, trauma, medical procedures
General tx for Acute Pain?
Treat underlying causes, analgesics
Chronic Pain lasts how long? What are common causes?
Lasts months to years. Cancer or non-cancer causes.
Chronic Pain general treatment criteria?
Multimodal treatment (non-pharm, non-opioid-pharmacologic, opioids)
Mild to Moderate pain best treated by which pharm agents?
Non-opoid analgesics: APAP, ASA, NSAIDs
MOA: PG inhibition
Moderate to Severe pain treated with which pharm options?
Opioids +- non-opioids +- adjuvant analgesics
MOA of NSAIDSs?
Inhibit prostaglandin synthesis via COX enzymes in peripheral tissue. Reversibly inhibit platelet function.
Somatic Pain location and quality?
Localized. Acute/pressure/sharp.
Somatic Pain fibers and examples?
C-fibers.
Superficial lacerations, burns.
Somatic Pain tx?
APAP, NSAIDs, Opioids. Superficial heat/cold.
Visceral Pain location and quality?
Generalized. Sharp/stabbing.
Visceral Pain fibers and example?
A-Fibers. Appendicitis.
Visceral Pain tx?
Steroids, NSAIDs, opioids, instraspinal LA.
Neuropathic Pain location and quality?
Radiating or specific.
Burning, shock-like, electric-like
Neuropathic Pain mechanism and examples?
Dermatomal or Central mechanism.
Diabetic neuropathy, post-herpetic neuralgia.
Neuropathic Pain tx?
Anticonvulsants, antidepressants, neuroblockade
MOA of Opioid Analgesics?
Activate descending inhibitory pathway which modulates transmission in spinal cord; alters limbic system activity
PO vs Parenteral ratio (in general)
3 : 1
PO vs Rectal ratio (in general)
1 : 1
Max APAP dose/day?
4g
Ketorlac is which class of pain drug and what route?
IV NSAID
Can you give Ketorlac for more than 5 days? Why?
NO, dt bleeding and renal impairment
Celebrex should not be given to a patient with which allergy?
Sulfa allergy
If giving NSAID at high dose for chronic pain what should also give?
PPI
Guideline for starting and titrating Opioids?
Start with lowest possible dose. Titrate up or down as percent of total daily dose.
Goal for Opioids?
Minimal analgesia with minimal ADRs
What is bowel regimine for opioid induced constipation?
Softener + Stimulant
Tx for Opioid-induced pruritis not due to allergy?
Mixed agonist/antagonist
Tx for Opioid-induced delerium/hallucinations?
Lower dose, change opioids, Haldol
Tx for Opioid-induced myoclonic jerking?
Lower dose, change opioid, muscle relaxant
Tx for Opioid-induced respiratory depression?
Hold opioids, supportive care, Narcan
Indications for Corticosteroids? (Hint: 3, not all pain-related)
- Acute spinal cord/nerve compression
- Alleviate N/V
- Bone pain
Corticosteroid ADRs?
GI upset, hyperglycemia, weight gain, increased appetite, immunosppression, behavior changes
Local Anesthetics indication?
Neural blockade to reduce surgery-indiced immune response
What is Multimodal Analgesia?
2 or more analgesics with different MOAs
3 examples of Multimodal Analgesia?
- Opioid + APAP
- Opioid + NSAID
- Opioid + alpha-2-agonist
Antidepressants and pain? Which to give? MOA?
For chronic pain. TCA and SNRIs work (SSRIs don’t).
MOA=increase descending pathway modulation
Anticonvulsants and pain tx?
Decrease neuroanal hyperexcitability
In Chronic Pain what should be tried before opioids?
Non-pharm and non-opioid treatment
Before starting opioids for chronic pain what need to establish?
Realistic goals for pain and function, and how to d/c if benefits not outweight risk
When to continue opioids for chronic pain?
If clinically meaningful improvement in pain and function outweights safety risk
When starting opioids can give long-acting/extended-release?
No! Start with immediate-release!
Urine and chronic pain?
Check before starting and annually
Can give BZD and opioids together?
Try not to if possible
