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Unit 3 Pharm III > L23: Pain Meds I > Flashcards

L23: Pain Meds I Flashcards

1
Q

Side effects of opioids

A 
Nausea/vomiting
Constipation
Pruritus
Dry mouth
Altered mental status
Respiratory depression
Tolerance
Dependence
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2
Q

What’s a risk of long term opioid use?

A

Masks pain, as in the case of the old lady with hip pain who actually had a massive abscess

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3
Q

Undertreated pain resulting in red flag behaviors

A

Pseudo-addiction

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4
Q

3 types of pain etiologies

A

Nociceptive
Neuropathic
Psychogenic

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5
Q

Withdrawal symptoms with abrupt discontinuation/decrease in opioid (usually chronic pain)

A

Physical dependence

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6
Q

Need increased dose for pain relief/or reduced effect of constant dose over time

A

Tolerance

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7
Q

Impaired control over drug use/craving, Compulsive and continued use despite harm

A

Addiction characteristics

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8
Q

Nociceptive pain

A

Caused by injury to tissues:

Activation of peripheral pain receptors, somatic or visceral: 
Laceration or injury involving the skin
Fractures, strains, sprains
Surgery (post/op)
Tumors/cancer
Internal organ injury
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9
Q

Neuropathic pain

A

Results from damage to or dysfunction of nerves, the spinal cord or brain:

Post-herpetic neuralgia
Cervical/thoracic/lumbar radiculopathy
Trigeminal neuralgia
Diabetic neuropathy
Phantom limb pain (post-amputation)
Central pain syndrome (CVA, traumatic spinal cord injury)
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10
Q

Psychogenic pain

A

Patient with persistent pain typically w/evidence of psychological disturbance

No evidence of disorder that could account for the pain or its severity

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11
Q

Neuropathic pain is treated with

A

Neurontin, lyrica
TCAs
Tramadol, Nucynta

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12
Q

Opioids with some SNRI properties

A

Tramadol, Nucynta

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13
Q

Interventional pain management for neuropathic pain may include

A 
Epidural Steroid injection
Joint injections
Intrathecal Pump Implant
Spinal Cord Stimulator Implant
Peripheral Nerve Blocks
Sympathetic Nerve Blocks and Neurolysis
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14
Q

Goals of psychogenic pain tx

A

improving comfort/ psychological function

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15
Q

Psychogenic pain tx

A

Biofeedback/distraction techniques
Encourage exercise
Psychological/Psychiatric evaluation and therapy

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16
Q

Probably don’t give opioids if…..

A

History of addictive behavior
Caring for small children at home
Teenagers in home

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17
Q

Muscle relaxant + lower back pain + firefighter

A

Not ideal bc they sedate and probably don’t help that much

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18
Q

Always _____ acute pain to prevent ____-

A

Treat it! Follow up! Can evolve into chronic pain

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19
Q

Ongoing myofascial pain can be treated with _____

A

Transcutaneous electrical nerve stimulator (TENS) unit

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20
Q

Muscle spasms may be treated with

A

Muscles relaxants vs trigger point injections

lecture seemed to favor trigger point injections

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21
Q

Should imaging be done right away for the firefighter with low back pain?

A

Nah, maybe do it at follow up if he hasn’t improved

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22
Q

Example RA medication regiment

A

Celebrex 200 mg daily
Prednisone 5mg daily
Long acting opioid

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23
Q

Tolerance to opioids is faster with ______-

A

high dose short acting opioids

switch patients to long acting

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24
Q

While a patient is converting from short acting to long acting opioids: do these things

A

Reduce daily dose by 50-75% when converting to a new pain medication
+/- lower dose opioid for breakthrough pain while converting→ no more than 20-25% of daily long acting dose

25
Q

RA adjunct therapies

A

topical compound cream for joint pain→ Lidocaine, ibuprofen or diclofenac
TENs unit for myofascial pain
Aqua therapy

26
Q

gradual onset of burning pain in feet bilaterally.

Worse at night/walking long distances

A

Diabetic neuropathy

27
Q

Fibromyalgia tx

A

ncourage physical activity (#1 in treatment of fibromyalgia!)
Aqua therapy (often covered by insurance)
Encourage them that they can work their way up to land exercise
Support→ referral for counseling if depression is a concern
Pregabalin (Lyrica) or gabapentin (Neurontin)
Cymbalta for pain control and to help with mood

28
Q

Are opioids recommended for fibromyalgia?

A

NOT recommended, but many patients with fibromyalgia are on them

29
Q

Are opioids recommended for fibromyalgia?

A

NOT recommended, but many patients with fibromyalgia are on them

30
Q

Cancer pain management

A

May need to consult with palliative care, pain management, hospice

Can include management of symptoms other then pain (anxiety)

Often involves optimization of opioid therapy + analgesic adjuncts

Consider interventional pain management strategies

31
Q

Cancer patients should def get

A

PCA to control their pain

32
Q

Adjuncts to PCA for cancer patients could include

A 
NSAIDs – Toradol (ketorolac) IV/IM/PO
Acetaminophen IV/PO
Lidoderm patch
Antidepressant - Cymbalta (duloxetine)
Neurontin (gabapentin)/Lyrica (pregabalin)
Heat packs/ice packs
33
Q

Describe the PCA system

A

Short term→ Chronic, high dose opioids pt who is NPO
IV + delivery system→
Managed by anesthesiologist or surgeons

34
Q

Indications for PCA

A

Severe post-op pain or intractable cancer pain

35
Q

PCA dosing

A

Demand dose q__ minutes
Continuous dose
Continuous + Demad dose

36
Q

Benefits of PCA

A

control, do not use while sleeping leads to less use overall, gets pain under control quickly

37
Q

Risks of PCA

A

Family members pushing demand dose when pt is a sleep, overdose if not monitored and titrated

38
Q

Considerations for PCA

A 
Continuous pulse oximetry
Orders for naloxone(narcan) prn
Discuss with RN, make note that she/he is to monitor for mental status changes, respiratory distress
New PCA→ follow up again within 12hrs
Titrate PCA if needed
Once dosage stable, patient should be monitored at least every 12-24hrs by
Anesthesia/Surgery
Wean as soon as tolerable
39
Q

IV to PO morphine conversion is typically ____

A

3:1

aka the oral dose is three times the IV dose

40
Q

Converting from PCA to IV

A

Calculate amount of medication patient was receiving in 24hrs
Convert to oral opioids while reducing PCA/IV pain medication dose
PCA is for short term use only
Consider for “pain emergencies”

41
Q

Converting from IV to PO (concepts)

A

Convert to long acting pain medication plus something for
breakthrough pain
Convert while still inpatient to evaluate for tolerance prior to home

42
Q

Contraindications to opioids

A

Hepatic disease

Increased intracranial pressure

43
Q

DOCs (2) for ESRD opioid

A

Fentanyl (patch or parenteral)

Methadone

44
Q

Caution with these 2 opioids and ESRD

A

hydromorphone

oxycodone

45
Q

Avoid these opioids in ESRD

A

morphine
demerol
hydrocodone
codeine

46
Q

In whom is a fentanyl patch less effective, and why?

A

Cacehctic patients bc fentanyl is lipophilic

47
Q

Buprenorphine patch

A

Can cause QT prolongation

Is NOT for use with opioids

48
Q

Tramadol/Nucynta indications

A

Consider for neuropathic pain

Can consider in patients with fibromyalgia if absolutely necessary (but don’t)

49
Q

Tramadol/Nucynta contraindications

A

Relative: fibromyalgia, antidepressants due to serotonin syndrome

50
Q

Is a fentanyl patch good for acute pain?

A

No, it takes 12 hours to reach therapeutic levels

51
Q

When converting IV opioids to fentanyl patch….

A

Two step taper (whatever that means)

52
Q

What increases fentanyl absorption and could even cause fatal OD?

A

Heat exposure! even sunbathing

53
Q

Before using methadone, ______

A

Baseline EKG/check renal/hepatic function

EKG yearly thereafter

Many drug interactions, get a good medication history

54
Q

Which drug has a 1⁄2 life up to 55 hours, so initiating requires a very SLOW titration, every 3-5 days

A

Methadone

55
Q

Benefits of methadone

A

Decrease neuropathic pain

Inexpensive

56
Q

Rx for controlled substances must include

A

Date of issue
Patient’s name and address
Practitioner’s name, address, telephone and DEA registration number
Drug name, strength, form and quantity
Directions for use
Manual signature of prescriber (NOT in EMR)

Don’t use shorthand, write out # of pills per day, quantity and refills in long hand.

57
Q

Always ask about

A

constipation

58
Q

Avoid ______ with other controlled substances

A

polypharmacy

idk which other substances are controlled for testing purposes though?

59
Q

ONLY diagnose an opioid if the following questions are all answered with a YES:

A

Does the patient have a definitive diagnosis?

Has there been a documented work up with abnormal findings?

Is the patient experiencing impairment in function?

Have you evaluated for contraindications to opioid management?

Has the patient tried adjunct treatments and failed?

Unit 3 Pharm III (10 decks)

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