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Q4 Clin Lab II thyroid, rheum, coag, LFT, body fluids > Exam 2 Pain Mgmt > Flashcards

Exam 2 Pain Mgmt Flashcards

1
Q

Nociception is?

A

Potentially tissue-damaging activity in nervous system

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2
Q

Pain is?

A

Perception of nociception

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3
Q

Suffering is?

A

Distress from factors that decrease quality of life

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4
Q

Nociceptive pain is result of?

Stim transmitted along?

Presentation?

A

Direct stim of intact nociceptors from injury or illness

Normal nn

Sharp, aching, throbbing

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5
Q

Nociceptive pain: Types? (2)

A 
Somatic = mm, joints, bones
Visceral = organs
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6
Q

Neuropathic pain caused by?

Result of? (5)

A

Peripheral or central nn damage/inflammation maintained by sympathetic (autonomic) DYSFUNCTION

Compression
Transection
Infiltration
Ischemia
Metabolic injury
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7
Q

Neuropathic pain: Presentation?

A

Burning, shooting, tingling, stabbing, electric

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8
Q

Chronic, intractable pain is?

A

“benign” (not from malignant condition)

e.g. back pain, post-herp neuralgia

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9
Q

Chronic, progressive pain is?

A

“malignant”

e.g. cancer pain

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10
Q

Pain is composed of what 4 things?

A

1) Physical problem needing dx and tx
2) Anxiety, anger, depression
3) Interpersonal problems affecting sxs
4) Non-acceptance-caused suffering

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11
Q

Approach to pain: ABCDE?

A 
Ask about pain and Assess
Believe the pt
Choose appropriate pain control
Deliver timely, logical, coordinated interventions
Empower pt and family
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12
Q

Comprehensive Pain Eval should include? (4)

A

1) Pain description (OLDCARTS)
2) Exam of organ system involved w/ neuro/orth/mm
3) Psychosocial (beliefs abt pain/meds, social support)
4) 6 mo med hx

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13
Q

Tx of pain should start?

A

Immediately
Do not delay for investigation of or tx of disease ->
Unmanaged pain = permanent neuro damage

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14
Q

WHO 3-Steps for pain: Mild? (3)

A

ASA
Acetamin
NSAIDS
+/- adjuvants

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15
Q

WHO 3-Steps for pain: Mod? (3)

A

Codeine + acetam
-codones + acetam
Tramadol
+/- adjuvants

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16
Q

WHO 3-Steps for pain: Severe? (3)

A 
Morphines
Methadone
Levorphanol
Fentanyl
\+/- adjuvants
17
Q

Acetaminophen toxic dose?

A

> 4g/24hrs

18
Q

NSAIDS affective for what type of pain?

A

bone, inflammatory

19
Q

NSAIDS drawbacks?

A

Highest adverse effects (Gastropathy)

Inhibit platelets -> assess coagulopathy

20
Q

Opioids kinetics?

A

Conjugated in liver
Excreted in kidney
1st order

21
Q

Opioids Time to Max Blood Level (Cmax):

PO?

SC/IM?

IV?

A

PO = 1 hr

SC/IM = 30 min

IV = 6 min

22
Q

Opioids t 1/2?

A

3-4 hrs for all routes

23
Q

Opioids: Immediate Release duration?

A

PO/PR = 3-5 hr (except methadone)

Parenteral bolus = shorter

24
Q

Opioids: Routine Oral Dosing for Immediate Release Codeine, -codones, Morphines?

Daily dose adjustment by what percent?

A

Q4h

Mild/Mod pain = ↑ 25 -50 %
Severe = ↑ 50 - 100%

25
Q

Opioids: Routine Oral Dosing for Extended Release?

Adjust dose how?

Why do you not crush or chew ext release?

A

Q8, 12 or 24h

Q2-4d (when steady state reached)

Flushes time-release granules = get whole dose at once

26
Q

Breakthrough dosing: Use what meds?

Amount?

When?

A

Immediate-release (NEVER extended-release)

12 - 15% of 24h dose
25 - 30% of 12h dose

After Cmax reached

27
Q

If dehydration or renal/hepatic failure, next step?

If oliguria or anuria, next step?

A

↓ dosing interval and amount

STOP routine morphine -> change to PRN ONLY!

28
Q

Why do we not use Meperidine (Demerol) for pain management?

A

Poor oral absorb

Makes toxic metabolite = psychosis, myoclonus, seizures

29
Q

Equianalgesic Doses of Opioids?

A

See slide 50

30
Q

Cross-tolerance change in dosing?

A

Start w/ 50 - 75% of equi dose

31
Q

Opioid S/E: Common? (5)

A 
Constipation
Dry mouth
N/V
Sedation
Sweats
32
Q

Opioid S/E: Uncommon? (6)

A 
Hallucinations
Delirium
Seizures
Pruritus
Resp depress
Urinary retention
33
Q

Adjuvant meds? (6)

A 
Anxiolytics
Antidepression
Anticonvulsant
Antiemetics
Laxatives
Steroids
34
Q

Pain Flare is?

Tx how?

A

Increased pain in setting of chronic pain ->

Keep base dose the same,
Add add’l analgesic for short time

35
Q

Periodic flairs should NOT be treated w/?

Why not?

A

breakthrough dosing (for malignant pain)

can lead to escalating opioid use

36
Q

Pseudo-tolerance is?

A

Representation of pain flair by pt as tolerance

Q4 Clin Lab II thyroid, rheum, coag, LFT, body fluids (14 decks)

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