Interactive module - Pain Flashcards
Why are larger oral opioids required compared to parenteral injections
first pass effect where it is absorbed in the stomach and then processed by the liver
where are sublingual/transmucosal/buccal morphine absorbed
- not in the sublingual tissue
- dissolved in saliva and swallowed -> similar to oral
Fentora usage
fentanyl buccal tablet - disintegrates
Abstral usage
fentanyl sublingual
Onsolis usage
fentanyl buccal soluble film
Butorphanol (Stadol) usage
intranasal opioid for acute headache/recurrent intense pain
Lazanda usage
fentanyl nasal spray
which pain meds can be given rectally
hydromorphone
oxymorphone
morphine
acetaminophen
fentanyl (Duragesic) usage
transdermal fentanyl patch
when are transdermal fentanyl patches used
pain is stable
dose to control is unknown
easy to overdose so use caution
how long before fentanyl patches work
12-17 hrs
what is 5% lidocaine (Lidoderm patch) used for
post-therapeutic neuralgia (inflammation of nerves from varicella zoster)
what is 10% trolamine salicylate (Aspercreme, Myoflex) cream used for
joint/muscle pain
why is IM route not recommended for giving pain meds
pain and poor absorption
chronic use -> abcesses, fibrosis (thickening of skin)
when is subQ route used for giving pain meds
end-of-life care
poor venous access or abnormal GI function
where are intraspinal/neuraxial catheters inserted
subarachnoid space (intrathecal) or epidural space
catheter into nerve supplying pain dermatome
why use intrathecal/neuraxial/epidural pain meds
requires less analgesics
complications of neuraxial/intrathecal analgesics
displacement
infusion of neurotoxic agents with preservatives
epidural hematomas
infection
what to always do with neuraxial/intrathecal analgesics
labeling it and only use preservative free analgesics
what is equinanalgesic dosing
convert one dose to equivalent of another
pseudoaddiction
undermanagement of pain and continuous requests for pain meds usually subside once managed
acute vs. chronic pain
less than 6 months is acute
more is chronic
if pt doesn’t report pain despite having dementia do you still treat the pain
no, they don’t feel the pain
or nonopioids okay
what is pain
pain is a perception
addiction vs. dependence
addiction: will seek without pain
dependence: can function with drug and builds natural tolerance
both can occur at the same time
3 examples of neuropathic pain
diabetic neuropathy
sciatic nerve pain
phantom limb pain
how to diagnose and treat neuropathic pain
MRI to see nerve damage unless covered by bone
then use gabapentin to block signals
diagnose peripheral pain
EMG: needle in muscle to detect
types of nociceptive pain and define
somatic pain - MSK and tissue
visceral - inner organs
