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Neuro > FINAL-Acute Pain > Flashcards

FINAL-Acute Pain Flashcards

1
Q

Treatment for Acute Pain

A

Treat the underlying cause

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2
Q

Mild Acute Pain Info

A

Pain score 1-3

APAP and/or NSAIDs
Titrate to max dose

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3
Q

Moderate Acute Pain Info

A

Pain score 4-6

Opioid/APAP or NSAIDs

May use schedules NSAID + PRN Opioid

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4
Q

Severe acute pain Info

A

Pain Score 7-10

Opioids

Pt specific factors for Route of admin

Avoid excessive sedation

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5
Q

Goal of Therapy

A

Take meds for shortest amount of time
Lowest effective dose
that gives effective pain relief and minimal SE

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6
Q

Non pharm Treatment

A 
RICE
Rest
Ice
Compression
Elevation
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7
Q

IV Acetaminophen

A

OFIRMEV 2yr+

  • Mild/mod
  • Mod/sever + Opioid
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8
Q

Ofirmev Dosing and IV infusion time

A

Adult: 650mg q4 or 1000mg q6

Peds: 12.5mg/kg q4 or 15mg/kg q 6

INFUSED OVER 15 MINS

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9
Q

BBW of Acetaminophen

A

Med errors and Hepatotoxicity

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10
Q

Pain Level 4-6…

A

Lots of options

Plain NSAID, muscle relaxant, maybe topical, hydrocodone + tylenol

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11
Q

IV Ibuprofen

A

CALDOLOR +6M

  • Mild/Mod
  • Mod/Severe w/Opioid
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12
Q

IV CALDOLOR Dosing Adults

A

Ibuprofen

PAIN: 400-800mg IV over 30 min q 6h PRN

FEVER: 400mg IV 30 min, 400mg q 4-6 hours or 100-200mg q4h PRN

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13
Q

IV CALDOLOR Peds Dosing

A

12-17: 400mg over 10 mins q4-6hr PRN

6months-12: 10mg/kg IV over 10 min up to max dose of 400mg q4-6 hrs

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14
Q

Morphine

A

IR Formulas
MS Contin, Kadian, AVINza

Histamine release may cause pruritus and exacerbate bronchospasm

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15
Q

Morphines metabolites

A

M6G: Analgesic
M3G: SE

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16
Q

Morphine dose reduction?

A

Dose reduction if there is renal insufficiency because its renally excreted

17
Q

Abuse deterrent ER formulas of Morphine

A

Embeda (morphine/naloxone)
Arymo ER
MorphaBond ER

18
Q

Hydrocodone

A

Mod/Severe tx
PO Combo w/acetaminophen: Norco, Anexsia, Vicodin, Lortab, Lorcet

ER (alone): Hysingla ER
Zohydro ER

ER used in chronic pain

19
Q

Hydrocodone eliminated how

A

Hepatically, risk of hep tox

20
Q

Oxycodone

A

mod/severe

IR PO: Oxy IR, Roxicodone

21
Q

Oxycodone with Acetaminophen

A

Percocet, Endocet, Roxicet

Roxicet comes in a solution too

22
Q

Oxycodone Abuse Deterrent formula

A

CR PO-Oxycontin
CR PO-XTAMPZA
IR PO-OXAYDO

23
Q

Drug metabolized in the liver by CYP2D6 to morphine…

A

Codeine

24
Q

Hydromorphone

A

Dilaudid, Exalgo ER (1x day dosing)

7-11x more potent than morphine

NO DDI

25
Q

Oxymorphone

A

Opana, Opana ER

3x more potent than PO morphine

NO DDI
Renally excreted-watch

IR dosing has long half life so dose q6h

26
Q

Fentanyl

A

Sublimaze
IV-short onset and half life

100x more potent than morphine

Transdermal patch for chronic pain-used for pts who are opioid-tolerant

27
Q

Fentanyl facts

A
  • High lipid solubility resulting i n rapid transfer across BBB
  • conc peak of IV is 4-6 mins
  • Good for rapid pain control but may accumulate in adipose tissue with multiple doses SO–>NOT GOOD FOR OBESE PATIENTS
28
Q

Meperidine

A

Demerol IM or IV
NO PO

Less potent than morphine Shorter duration

  • CNS TOXICITY*
  • Avoid renal dysfunction a nd elderly
29
Q

Petnazocine

A

W/APAP-TALACEN
W/Naloxone-TALWIN NX
IV TALWIN

May precipitate withdrawal in opioid dependent patients

30
Q

Nalbuphine

A

Nubain

May precipitate withdrawal in opioid dependent patients

31
Q

Butorphanol

A

Mu Antagonist
Kappa Partial Agonist

Mainly used for migraines

must attach pump atomizer and fully prime

32
Q

What do you need for a PCA?

A
  • Initial Bolus Dose
  • Dose/Demand dose for when button is pushed
  • Lockout Interval minimum between doses
  • Continuous basal rate (mg/hr) reserved for mechanically ventilated or opioiod tolerant patients
  • Max tolerated dose in 1 hr

-Pt must have Naloxone PRN

33
Q

Two most common modes of PCA administration

A

Demand dosing-fixed size dose is self administered intermittently

Continuous infusion plus demand dose (constatn rate with supplement by patient demand)–>NEVER USED FOR OPIOID NAIVE PATIENTS

34
Q

PCA Things to note…

A

Caution in respiratory depression pts-Obese, Elderly 75, snoring. sleep apnea, COPD, renal insufficiency, hepatic dx

Monitor: BP, RR, O2 sat, RASS, pain

7 days post op

Neuro (12 decks)

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