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Neuro > FINAL-Chronic Pain > Flashcards

FINAL-Chronic Pain Flashcards

1
Q

Chronic Pain definition…

A

Persistent pain recurring for greater than 3 months or 1 month after resolution of an acute tissue injury or non-healing lesion

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2
Q

Acute vs Chronic Pain tx goals…

A

Acute-CESSATION of pain

Chronic-Decrease pain and increase QOL

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3
Q

Cycle of Pain

A

Pain-Avoidance Behavior-Decreased Mobility-Altered functional status-Diminished self-efficacy-Social Limitations-Pain Augmented

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4
Q

Meds to use for Neuropathic Pain

A 
Gabapentin (Neurontin)
G. enacarbil (Horizant)
Pregabalin (Lyrica)
Gralise
Carbamazepine (Tegretol)
Topiramate
Lamotrigine
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5
Q

Use for Horizant

A

Gabapentin Enacarbil

  • PHN
  • RLS
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6
Q

Use for Pregabalin

A

Lyrica

  • Good for SEDATION
  • Peripheral Edema
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7
Q

Use for Gralise

A

PHN

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8
Q

DOC for Carbamazepine

A

Trigeminal Neuralgia

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9
Q

Carbamazepine Brand

A

Tegretol

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10
Q

Membrane Stabilizing Anticonvulsants

A

Topiramate

Lamotrigine

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11
Q

Antidepressants preferred for pain

A 
TCAs
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Desipramine (Norpramin)
Imipramine (Tofranil)
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12
Q

Amitriptyline

A

Elavil

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13
Q

Nortriptiyline

A

Pamelor

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14
Q

Desipramine

A

Norpramine

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15
Q

Imipramine

A

Tofranil

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16
Q

Side Effects of TCAs

A 
Dry mouth
Somnolence
Sedation
Constipation
Cardiac
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17
Q

SNRIs important to chronic pain tx…

A

Duloxetine (Cymbalta)
Venlafaxine(Effexor)
Milnacipran (Savella)

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18
Q

Duloxetine indication for

A

CYMBALTA

FDA INDICATED FOR

  • Fibromyalgia
  • Low Back Pain
  • Diabetic Neuropathy
19
Q

Milnacipran Indication

A

SAVELLA

FDA approved for FIBROMYALGIA

20
Q

SSRIs are not proven effective for pain tx, but are used in pts with

A

Depression

21
Q

Benzos

A

Shown in one study to provide some efficacy for neuralgic pain

22
Q

NMDA Receptor Agonists

A

Dextromethorphan
Memantine
Methadone
Amantidine

23
Q

NMDA receptor agonists should be used….

A

Neuropathic pain

PHN, Diabetic neuropathy, Phantom limb pain, Peripheral nerve injury, CRPS etc

24
Q

NSAIDs should be used for….

A

Patients with back pain

25
Q

Skeletal Muscle Relaxants are recommended for…

A

Short term use for acute low back pain, but you will see them used for muliple chronic pain conditions

26
Q

Skeletal muscle relaxants used for Spasticity (MS, Cerebral palsy, Post stroke syndrome, TBI, Spinal cord injury)

A

Tizanidine

Baclofen

27
Q

Skeletal Muscle Relaxants

A 
Carisoprodol
Cyclobenzaprine
Methocarbamol
Metaxolone
Baclofen
Orphenadrine
Tizanidine(Alpha 2 agonist)
Dantrolene
28
Q

CI for chronic opioid therapy

A

Decompensated psychiatric illness, psychotic dx, or mania

History of drug or alcohol abuse

29
Q

Weak to Mod Opioids

A

Codeine and Tramadol

30
Q

Morphine

A 
MS Contin, Kadian
Gold Standard 
ER not for naive
RENAL ADJUST
CNS depression, Resp depression, Hypotension

Abuse deterrent ER formulas:
Embeda(+naloxone)
Arymo ER
MorphaBond ER

31
Q

Hydrocodone

A 
Pro-drug converted to hydropmorphone
Hepatic caution
Usually in combo with acetaminophen
ER TOO E XPENSIVE
CNS Depression, hepatotoxicity(acet.)
32
Q

ER Hydrocodone

A

Zohydro ER

Hysingla ER

33
Q

Oxycodone

A

NO IV**
renal/hepatic
CNS depression, resp despression, hypotension

34
Q

Oxymorphone

A

Opana

PO ONLY IR & ER

35
Q

Buprenorphine

A

Transdermal-BUTRANS

Indicated for the management of pain sever enough to require daily, around-the clock, long term opioid treatment and for which alternative treatment options are inadequate

Q WEEKLY
Combo with Naloxone for treatment of opioid dependence

36
Q

Transdermal Fentanyl Info and CI

A

NOT FOR NAIVE
Hep/Renal

CI: respiratory disease

DDI with Erythromycin and Clarithromycin

37
Q

Opioid Tolerant Patients

A

Taking daily for a week or longer 60mg of oral morphine, 30mg oxycodone, or at least 8mg of oral hydromorphone or and equianalgesic dose of another opioid

38
Q

Methadone

A

Considered ideal candidate for chronic pain
-highly inexpensive
-High efficay
-Extended duration of action
Lot of BBW
QT PROLONGATION–>ECG at baseline AND 30 DAYS AFTER STARTING**
PK non-linear to morphine

SE & NE

39
Q

Fentanyl Transmucosal

A 
Actiq (lozenge)
Fentora (buccal tab)
Onsolis (buccal film)
Abstral (SL tablet)
Subsys (SL spray)
Lazanda (nasal spray)

FOR CHRONIC INTRACTABLE PAIN

40
Q

Breakthrough dose should be

A

5-15% of toatl daily dose

dose q2-6 hours

41
Q

Ketamine

A

NMDA
usually used for sedation
USed for Maladaptive pain syndromes (CRPS)
adjunct in acute pain, chronic unclear

42
Q

Diabetic Neuropathy FDA approved tx

A

Duloxetine (CYMBALTA)
Pregabalin (LYRICA)

There are others but these are FDA indicated

43
Q

Post Herpetic Neuralgia

A

Lidocaine patch
FDA indicated:
G. Enacarbil (HORIZANT)
Gralise

Oioids, there are a lot of other options

44
Q

Trigeminal Neuralgia Tx

A

CARBAMAZEPINE (tegretol)

Neuro (12 decks)

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