Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurologic & Psych > EXAM 3 Intro to Pain and Acute Pain Dr. Dahl > Flashcards

EXAM 3 Intro to Pain and Acute Pain Dr. Dahl Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards
1
Q

What is the pathway of Nociceptive Pain?

A

Transduction - Stimulation (of somatic or visceral tissue, could be thermal, chemical, mechanical -> is determination if this stimulus important enough?)

Conduction - Action potential (voltage-gated Ca+ channels)

Transmission - Transfer (passed on to the brain for processing)

Modulation - Fine-tuning (attenuate or inhibit it, could be endogenous (adrenalin) or exogenous (drug))

Perception - Experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are examples of chronic pain?

A

-Neuropathic (peripheral injury)
-Multiple Sclerosis, post-stroke pain (CNS pain)

-Fibromyalgia (chronic pain throughout the body)
-Irritable bowel (centralized where nerve injury or inflammation exists)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Neuroplasticity in chronic pain

A

-rewiring of pain circuits
-increase in dorsal horn neural discharge

->normal stimuli or minor injuries may be perceived as intensely painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain Hyperalgesia and Allodynia

A

Hyperalgesia: exageratted pain

Allodynia: non-noxious stimuli causing pain (feather on the arm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the types of Pain?

A

-Nociceptive
-Neuropathic
-Inflammatory

Duration-wise:
-Acute
-Subacute
-Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which organs are involved in Nociceptive pain?

A

sensory nerves detect tissue damage

-internal organs: (ill-defined, deep, aching, colicky (waves))

-somatic: musculoskeletal -> skin, muscles, bone, joints, ligaments
-> often localized, sharp, throbbing - constant and worse with movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a common cause of neuropathic pain?

A

peripheral or CNS nerve injury

-chronically elevated blood glucose (diabetes)

-drug-induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are drugs that are known to cause Neuropathic pain?

A

-cisplatin
-phenytoin
-amiodarone
-hydralazine
-metronidazole
-fluoroquinolones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characteristics of neuropathic pain

A

Often burning, stabbing, shooting, electrical

-> provoked by a stimulus that usually does not cause pa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is pain considered chronic?

A

-Longer than expected healing

-3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which type of Pain is chronic and acute (breakthrough)?

A

Cancer Pain

-Disease-related (tumor invasion, obstruction)
-Treatment (chemo, surgery, radiation)
-Diagnostic (biopsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the Signs/Symptoms of Pain?

A

Signs:
-HTN
-Tachycardia

Symptoms:
-Diaphoresis (sweating)
-Mydriasis (dilation of the pupil)
-Pallor (pale skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tools to assess pain

A

-Unidimensional scales (quick, single item, focus on intensity)

-Multidimensional: questionnaire (more detailed)
McGill Pain Questionnaire
Wisconsin Brief Pain Inventory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the first-line treatment for pain?

A

Non-pharmalogic w/ or w/o analgesics
-Neurostimulation (acupuncture)
-Anesthesia (nerve block) ???
-Physical Therapy
-Surgical
-Psychological
-Cognitive Behavioral Therapy
-Massage
-Weight loss
-RICE – REST ICE COMPRESSION and ELEVATION
-Diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pharmacologic Approach with Opioids

A
  1. Non-opiod
    +/- Adjuvant
  2. Weak opioid
    +/-Non-opioid
    +/- Adjuvant
  3. Strong opioid
    +/-Non-opioid
    +/- Adjuvant

starting too early with opiiods may lead to chronic opoiod use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What dose of opioids doesn’t require assessment of the appropriateness?

A

3-day supply up to 180 mg morphine equivalent

-don’t need to check the database (CSMD)
-don’t need to link the diagnosis and indiaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do prescriptions need for patients to be exempt from the law to be assessed for appropriateness of opioid use?

A

prescription must include the ICD-10 code
and the word exempt

-> for patients with diseases that require long-term opioid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Characteristics of Acetinominophen

A

-Analgesic
-Antipyretic

NOT anti-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the max doses of Acetaminophen?

A

OTC: <3000 mg/day

Rx: <4000 mg/day

Combo products: 325 mg

-> Box warning: hepatoxicity (< 4g/day)
in case of severe rash -> seek medical help

20
Q

DDI Acetaminophen

A

can increase INR when used chronically
avoid alcohol use

Antidote in case of overdose: N-acetylcysteine

21
Q

What is the primary use for Salcylates?

A

Cardioprotection

81-162 mg (baby dose aspirin)
(analgesic dose: 325-650 mg q4-6h)

22
Q

What to be cautious about when using Aspirin in children?

A

Reyes syndrome (N/V, lethargy, confusion)

other side effects:
dyspepsia, heartburn, bleeding
fatigue, confusion, severe skin reaction

23
Q

Which NSAID is thought to be safer for patients with CV diseases?

A

Naproxen

the evidence is not clear though

24
Q

Which NSAID is commonly used for arthritis?

A

Diclofenac Rx
OTC: topical gel formulation: Voltaren gel

25
Q

Which NSAID has a higher risk for GI toxicity?

A

Indomethacin Rx (also risk for CNS side effects)

Piroxicam (also risk for severe skin reaction)
-> need gut protection (PPI, misoprostol)

26
Q

Which NSAID may be used for acute treatment?

A

Ketorolac (IV

has a 5-day total maximum treatment
-need a dose adjustment if:
>65y or
<50 kg or
high SCr

27
Q

Which NSAID may be used in patients with reduced renal function?

A

Sulindac (not often seen)
-> also for patients on lithium (DDI drug)

lithium should not be apired with NSAIDs or ACEi

28
Q

Which NSAID has the highest COX-2 selectivity?

A

Celecoxib
-often used for osteoarthritis and rheumatic arthritis

-BBW: sulfonamide warning

29
Q

CAUTION with NSAIDs

A

-not appropriate to use 2 NSAIDs
-may use with baby aspirin -> outweigh benefit/risk

-increases bleeding risk (GI)
-avoid with cardiovascular issue
-can cause acute kidney injury (especially when used with ACEi, volume depletion)

30
Q

When is a patient considered opioid tolerant?

A

-more than60 oral ME/day
-more than 25 mg transdermal fentanyl a week
-more than 30 mg oxycodone a week
-more than 8 mg of hydromorphone a week

anything else in opioid-naive

31
Q

What is pseudo-addiction?

A

patients with drug-seeking behavior due to undertreated pain

32
Q

Side effects of opioids

A

-Sedation
-respiratory depression

-constipation -> may need meds to improve bowel movement
-urinary retention
-N/V

-pruritus
-urticaria
-euphoria, dysphoria

33
Q

Which opioids are likely to cross-react in opioid allergies?

A

opioids that have -cod -morph, norph in their name

nausea and itching are not true allergies

34
Q

Which opioid may be avoided in renal-impaired patients?

A

Moprhine

it has metabolites M3G (50%) and M6G (15%)
they can accumulate in renal impairment
-> overdose

M3G: minimal analgesic activity and neuroexcitatory
M6G: analgesic activity and longer half-life than morphine

35
Q

How potent is Hydromorphone in comparison to morphine?

A

Dilaudid

7-10x more potent
-> start low and go slow

start dose: 0.5 mg
-opioid naive
-elderly
-sleep apnea
-concurrent meds

36
Q

What requirements do patients need to use fentanyl transdermal patches?

A

they must be opioid-tolerant

start with the lowest dose and titrate up

37
Q

How should fentanyl be ordered for breakthrough pain?

A

q2h or q3h rather than q6h
bc it has a short duration
(onset is quick)
-> rapid IV administration can cause muscle rigidity

38
Q

Which opioid has a warning for seizure risk and serotonin syndrome?

A

Tramadol (weaker opioid)

lower severity of GI side effects vs other opioids

39
Q

Why has Meperidine fallen out of favor?

A

-it has poor PO absorption
-toxic metabolite: normeperidine
-> can cause seizure, especially in renal impairment (accumulation)

40
Q

When are long-acting opioids not appropriate?

A

-in opioid-naive patients
-in acute pain (quick onset needed)

long-acting opioids:
-Oxycontin
-MS Contin
-Fentanyl transdermal patch
-Xtampza

41
Q

Approach in pain management

A

mild: Acetaminophen, NSAIDs
moderate: consider opioids and adjuvants
severe: opioids (choose the right route) and adjuvants

->use around-the-clock dosing and breakthrough doses
-> monitor patient

42
Q

How would a patient with an opioid disorder or chronic pain be treated?

A

may need a higher dose
-> they have increased pain signal (due to chronic pain)
-> lower threshold to set off pain signals
-> less response to substances that modulate pain

43
Q

Multimodal analgesia opportuniites

A

NSAIDs
Tylenol
Gapapentin/pregabalin perioperatively

44
Q

Which formulation is preferred for opioids?

A

PO before IV

45
Q

Opioid conversion

A
  1. Total daily dose
  2. convert to MME using conversion factor, may need to transfer to another formulation
  3. account for cross-tolerance, renal and liver function, administration route and decrease by 25-50%
  4. divide by the interval (q8h, q12h)
  5. determine dose for breakthrough pain PRN
    -> 5-15% of the 24h dose (usually the IR of the same opioid)

Neurologic & Psych (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions