L24: Pain Meds II

Question 1

Visceral nociceptive pain presentation

Answer 1

Localized, sharp, aching, squeezing, stabbing, throbbing

Question 2

Somatic nociceptive pain presentation

Answer 2

Poorly localized, dull, crampy, achy

Question 3

Neuropathic pain presentation

Answer 3

Burning, shooting, electric, or tingling in

nature

Question 4

Refer pain which has

Answer 4

▪ Interventions are not alleviating patients pain
▪ Chronic pain
▪ Patient-controlled analgesia (PCA)
▪ Life-limiting conditions

Question 5

At what age does a child have enough cognitive ability to self report pain?

Answer 5

3 years and older

Question 6

A child <3 years needs to be assessed for pain using behavioral observations, which are scored based on:

Answer 6

Facial expressions
• Ability to be consoled
• Level of interaction
• Limb and trunk motor responses
• Verbal responses

Question 7

Wong-Baker FACES pain rating scale: 0

Answer 7

No hurt

Question 8

Wong-Baker FACES pain rating scale: 1

Answer 8

Hurts a little bit

Question 9

Wong-Baker FACES pain rating scale: 2

Answer 9

Hurts little more

Question 10

Wong-Baker FACES pain rating scale: 3

Answer 10

Hurts even more

Question 11

Wong-Baker FACES pain rating scale: 4

Answer 11

Hurts whole lot

Question 12

Wong-Baker FACES pain rating scale: 5

Answer 12

Hurts worse

Question 13

The behavioral score for pain is called the _______

Answer 13

FLACC Score

Question 14

FLACC stands for

Answer 14

Face
Legs
Activity
Cry
Consolability

(each gets 0-2 pts)

Question 15

The Monthly Pain scale assesses 4 areas on a scale of 1-10:

Answer 15

Pain right now
At its worst in the past month
At its least in the past month
Average for the past month

Question 16

Opioids commonly used in children

Answer 16

morphine
hydromorphone
oxycodone
hydrocodone
fentanyl
methadone

Question 17

Does an ear infection need opioid pain management?

Answer 17

NOPE
She gets: 
Tylenol (10-15mg/kg Q 4-6 hrs prn)
OR
Ibuprofen (4-10mg/kg Q 6-8 hrs prn)

Question 18

Testicular torsion pain meds

Answer 18

IV analgesics + IV antiemetics

Question 19

Do appendicitis patients get opioids?

Answer 19

** YES, morphine **

Question 20

Morphine dosing

Answer 20

** .05/.1 mg/kg q2-4 hours **

Question 21

2 antiemetics discussed this lecture

Answer 21

Promethazine

Metoclopramide

Question 22

How old dose someone have to be to take promethazine? What’s the max dose?

Answer 22

Must be > 2 years, Max dose 25 mg

Question 23

What’s the max dose of metoclopramide?

Answer 23

Max dose 10 mg

Question 24

Promethazine dosing

Answer 24

.25-1 mg/kg PO/IV/IV/PR Q6 hours PRN for N/V

Question 25

Metoclopramide dosing

Answer 25

.1 mg/kg PO/IV q6 hour

Question 26

Do burns get opioids?

Answer 26

Yes, IV morphine for now More meds before wound care The case was a 2nd degree burn

Question 27

Please review the rule of 9s

Answer 27

Idk it's in the lecture

Question 28

ABA Referral criteria

Answer 28

• Partial-thickness burns of > 10% of TBSA • Third-degree burns in any age group • Burns that involve the face, hands, feet, genitalia, perineum, or major joints • Electrical burns, including lightning injury • Chemical burns • Inhalation injury • Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality • Any patients with burns and concomitant trauma • Children in hospitals without qualified personnel or equipment to care for their burn injuries • Burn injury in patients who will require special social, emotional, or rehabilitative intervention

Question 29

Codeine and tramadol should be avoided if

Answer 29

The patient is less than 12 years old

Question 30

Adverse side effects of opioids you should anticipate

Answer 30

``` N/V/C sedation cognitive dysfunction resp depression pruritus myoclonus hyperalgesia ```

Question 31

2 herbal supplement + Rx drug interactions

Answer 31

* Ginkgo biloba extract + warfarin→ increased risk of bleeding * St. John’s wort + SSRI→ increased risk of serotonin syndrome

Question 32

Polypharmacy is very common in the elderly and

Answer 32

• Increased risk for adverse drug events (ADEs) due to metabolic changes and decreased drug clearance • Increased potential for drug-drug interactions and for prescribing inappropriate medications • Potential independent risk factor for hip fractures associated with falls • Increased risk for “prescribing cascades” • Adherence issues related to taking multiple medications especially if patient suffers from visual or cognitive impairment

Question 33

SSRI + ____ = increased risk of serotonin syndrome

Answer 33

St John's wort

Question 34

SSRI + ____ = increased risk of serotonin syndrome

Answer 34

St John's wort

Question 35

Age related changes

Answer 35

* Increased body fat relative to muscle with aging * Natural decline in renal function * Declining hepatic function

Question 36

Any new symptoms should be _______

Answer 36

considered drug-related until proven otherwise

Question 37

Beers criteria: avoid these meds + opioids

Answer 37

Don't mix benzos or gabapentinoids with opioids | Risk of Overdose, respiratory depression and death

Question 38

Beers criteria: avoid use of ______ in a patient with a history of falls or fractures

Answer 38

SNRIs

Question 39

Screening Tool of Older Person’s Prescriptions (STOPP) criteria

Answer 39

Considers drug-drug interactions, Duplications of drugs within a class

Question 40

A _______ is important for avoiding Adverse Drug Effects (ADEs)

Answer 40

Stepwise approach

Question 41

The stepwise approach for avoiding ADEs includes

Answer 41

* Review current medications * Discontinue unnecessary medications * Consider adverse drug events for any new symptoms * Consider nonpharmacologic options * Care in the use of commonly prescribed drugs * Reduce dosing when able * Simplify the dosing schedule * Prescribe beneficial therapy

Question 42

Geriatric pain management pearls

Answer 42

Start low and go slow! Consider pts hx – are they opioid naive? Consider their living situation Always, always, always review your pt’s medication list Consider any new symptom a possible adverse reaction from medication When possible have pts bring in their medications Encourage them to carry an updated list of their medications When possible, include pt caregivers in discussions and education about medications

Question 43

Pharmacologic options for the knee pain OA case

Answer 43

Tylenol, NSAIDS, oral steroids, short acting opioids

Question 44

Nonpharmacologic options for the knee pain OA case

Answer 44

Ice/heat, massage, PT, Joint aspiration and steroid injection

Question 45

Risk of opioids tx in the knee pain OA case

Answer 45

Respiratory depression, Fall risk, Cognitive impairment, Constipation

Question 46

Does low back pain with a compression fracture get opioids?

Answer 46

Yes, but <5 days of short-acting