L 77-79 Rogers- Non-malignant pain Flashcards
what is the PQRSTU acronym for? list it after you answer that.
subjective questions to ask pt to assess pain.
- Palliative or Precipitating Factors
- Quality of pain
- Region of pain
- Severity of pain
- Time-related nature of pain
- U- impact on yoU
5 physio changes for assessment of pain slide
dilated pupils (mydriasis)
paleness
sweating
tachycardia
tachypnea
4 pain intensity scales, which one is special
verbal
numeric
visual
wong-baker (for kids*)
step 1 of WHO treatment approach *
non-opioid with or without adjuvant analgesic
step 2 of WHO treatment approach *
Opioid for mild-moderate pain, + non-opioid, with or without adjuvant analgesic
Step 3 of WHO treatment approach *
Opioid for moderate-severe, +non-opioid, with out without adjuvant analgesic
what meds/med classes are considered adjuvant therapies to opioids
(6)
gaba
snris
tca
skeletal muscle relaxants
antiepileptics
topical agents
Recommended dosing tylenol:
Adult: (regimen) (max dose)
Kids: (regimen) (max dose)
Adult: 325-1000mg po q4-6h, max dose 3-4 g/day
Kids: 10-15 mg/kg po q4h, max 75 mg/kg/day or 3-4 g/day
if a pt has liver disease, what is the max dose of tylenol?
2 or less g/day
1 side effect listed on tylenol slide
hepatotoxicity (most likely doses above 10g)
2 clinical pearls listed with tylenol *
injection is super expensive
gold standard for osteoarthritis
4 side effects listed with NSAIDs
GI bleed
nephrotoxicity
fluid retention
increase CV events
4 clinical pearls listed with NSAIDs
take with food
caution in old farts
avoid in pts with cardiac history
avoid in liver and kidney disease
aspirin adult dosing with max dose
325-1000mg po q4-6h prn
max - 4g/day
aspirin pediatric dosing with max dose
sike, dont give it to kids dumbass (bc of reye’s)
2 clinical pearls on aspirin slide
avoid in pts taking blood thinners
some formulations available OTC (no shit)
Ibuprofen adult dosing with max
200-800mg po q6-8h prn
max- 3200 mg/day
Ibuprofen pediatric dosing with max (under 6 months)
5-10 mg/kg po q4-6h prn
max - 40mg/kg/day or 2400 mg
2 interesting/different formulations of diclofenac that might catch you off guard
ophthalmic solution
patch
adult dosing of diclofenac
50 mg po q8h or 2-4 g applied topically 4 times/day
2 clinical pearls for diclofenac
minimal systemic side effects with gel (duh)
some available OTC (duh)
Naproxen adult dosing with max
220-500 mg po q6-12hr
max - 1,000mg/day
two weird formulations of ketorolac
nasal spray
ophthalmic
ketorolac adult dosing
15-30 mg IV q6h or 10 mg po q6h
ketorolac pediatric dosing
0.5mg/kg dose IM/IV q6h
2 clinical pearls for ketorolac (first one is underlined)
- maximum duration is 5 days ** bc increased risk of GI bleed
- oral dosing is continuation of IM or IV
Celecoxib adult dosing
200 mg po bid
clinical pearl celecoxib
Cox 2 selective -> less GI toxicity
3 uses of gabapentinoids
fibromyalgia
neuropathies
post-op pain
gabapentin recommended dosing and max
100-300 mg po tid
max - 3600 mg/day
pregabalin recommended dosing and max
75 mg po bid
max - 600mg/day
3 side effects listed with gabapentinoids
sedation
dizziness
peripheral edema
4 clinical pearls for gabapentinoids
- renally dose adjusted
- titrate up to limit sedation
- use in combo to lower requirements of other analgesics
- pregab is schedule V, gaba is not scheduled
2 SNRIs used in pain
venlafaxine and duloxetine
2 uses for SNRIs in pain
fibromyalgia
neuropathy
venlafaxine rec dosing and max
37.5-75 mg po qd
max - 225 mg/day
duloxetine rec dosing and max
30 mg po qd x 1 week, then up to 60 mg po qd daily
max- 60 mg/day
5 side effects with SNRIs
nausea
headache
htn
sedation
weakness
2 clinical pearls with SNRIs
- start low dose and titrate up
- renally dose adjust venlafaxine and avoid duloxetine w/ CrCl <30 * (might come up on exam tbh)
2 TCAs used in pain
amitriptyline and nortriptyline
3 uses of TCAs in pain (all off label btw)
fibromyalgia
neuropathy
migraine prophylaxis *
amitriptyline/nortriptyline rec dose and max
10 mg po qhs
max- 150 mg/day