Interactive module - Pain

Question 1

Why are larger oral opioids required compared to parenteral injections

Answer 1

first pass effect where it is absorbed in the stomach and then processed by the liver

Question 2

where are sublingual/transmucosal/buccal morphine absorbed

Answer 2

• not in the sublingual tissue
• dissolved in saliva and swallowed -> similar to oral

Question 3

Fentora usage

Answer 3

fentanyl buccal tablet - disintegrates

Question 4

Abstral usage

Answer 4

fentanyl sublingual

Question 5

Onsolis usage

Answer 5

fentanyl buccal soluble film

Question 6

Butorphanol (Stadol) usage

Answer 6

intranasal opioid for acute headache/recurrent intense pain

Question 7

Lazanda usage

Answer 7

fentanyl nasal spray

Question 8

which pain meds can be given rectally

Answer 8

hydromorphone
oxymorphone
morphine
acetaminophen

Question 9

fentanyl (Duragesic) usage

Answer 9

transdermal fentanyl patch

Question 10

when are transdermal fentanyl patches used

Answer 10

pain is stable
dose to control is unknown
easy to overdose so use caution

Question 11

how long before fentanyl patches work

Answer 11

12-17 hrs

Question 12

what is 5% lidocaine (Lidoderm patch) used for

Answer 12

post-therapeutic neuralgia (inflammation of nerves from varicella zoster)

Question 13

what is 10% trolamine salicylate (Aspercreme, Myoflex) cream used for

Answer 13

joint/muscle pain

Question 14

why is IM route not recommended for giving pain meds

Answer 14

pain and poor absorption
chronic use -> abcesses, fibrosis (thickening of skin)

Question 15

when is subQ route used for giving pain meds

Answer 15

end-of-life care
poor venous access or abnormal GI function

Question 16

where are intraspinal/neuraxial catheters inserted

Answer 16

subarachnoid space (intrathecal) or epidural space
catheter into nerve supplying pain dermatome

Question 17

why use intrathecal/neuraxial/epidural pain meds

Answer 17

requires less analgesics

Question 18

complications of neuraxial/intrathecal analgesics

Answer 18

displacement
infusion of neurotoxic agents with preservatives
epidural hematomas
infection

Question 19

what to always do with neuraxial/intrathecal analgesics

Answer 19

labeling it and only use preservative free analgesics

Question 20

what is equinanalgesic dosing

Answer 20

convert one dose to equivalent of another

Question 21

pseudoaddiction

Answer 21

undermanagement of pain and continuous requests for pain meds usually subside once managed

Question 22

acute vs. chronic pain

Answer 22

less than 6 months is acute
more is chronic

Question 23

if pt doesn’t report pain despite having dementia do you still treat the pain

Answer 23

no, they don’t feel the pain
or nonopioids okay

Question 24

what is pain

Answer 24

pain is a perception

Question 25

addiction vs. dependence

Answer 25

addiction: will seek without pain
dependence: can function with drug and builds natural tolerance

both can occur at the same time

Question 26

3 examples of neuropathic pain

Answer 26

diabetic neuropathy
sciatic nerve pain
phantom limb pain

Question 27

how to diagnose and treat neuropathic pain

Answer 27

MRI to see nerve damage unless covered by bone
then use gabapentin to block signals

Question 28

diagnose peripheral pain

Answer 28

EMG: needle in muscle to detect

Question 29

types of nociceptive pain and define

Answer 29

somatic pain - MSK and tissue
visceral - inner organs