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Unit 3 Pharm III > L24: Pain Meds II > Flashcards

L24: Pain Meds II Flashcards

1
Q

Visceral nociceptive pain presentation

A

Localized, sharp, aching, squeezing, stabbing, throbbing

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2
Q

Somatic nociceptive pain presentation

A

Poorly localized, dull, crampy, achy

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3
Q

Neuropathic pain presentation

A

Burning, shooting, electric, or tingling in

nature

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4
Q

Refer pain which has

A

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

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5
Q

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

A

3 years and older

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6
Q

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

A 
Facial expressions
• Ability to be consoled
• Level of interaction
• Limb and trunk motor responses
• Verbal responses
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7
Q

Wong-Baker FACES pain rating scale: 0

A

No hurt

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8
Q

Wong-Baker FACES pain rating scale: 1

A

Hurts a little bit

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9
Q

Wong-Baker FACES pain rating scale: 2

A

Hurts little more

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10
Q

Wong-Baker FACES pain rating scale: 3

A

Hurts even more

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11
Q

Wong-Baker FACES pain rating scale: 4

A

Hurts whole lot

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12
Q

Wong-Baker FACES pain rating scale: 5

A

Hurts worse

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13
Q

The behavioral score for pain is called the _______

A

FLACC Score

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14
Q

FLACC stands for

A 
Face
Legs
Activity
Cry
Consolability

(each gets 0-2 pts)

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15
Q

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

A

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

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16
Q

Opioids commonly used in children

A 
morphine
hydromorphone
oxycodone
hydrocodone
fentanyl
methadone
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17
Q

Does an ear infection need opioid pain management?

A 
NOPE
She gets: 
Tylenol (10-15mg/kg Q 4-6 hrs prn)
OR
Ibuprofen (4-10mg/kg Q 6-8 hrs prn)
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18
Q

Testicular torsion pain meds

A

IV analgesics + IV antiemetics

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19
Q

Do appendicitis patients get opioids?

A

** YES, morphine **

20
Q

Morphine dosing

A

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

21
Q

2 antiemetics discussed this lecture

A

Promethazine

Metoclopramide

22
Q

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

A

Must be > 2 years, Max dose 25 mg

23
Q

What’s the max dose of metoclopramide?

A

Max dose 10 mg

24
Q

Promethazine dosing

A

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

25
Q

Metoclopramide dosing

A

.1 mg/kg PO/IV q6 hour

26
Q

Do burns get opioids?

A

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

27
Q

Please review the rule of 9s

A

Idk it’s in the lecture

28
Q

ABA Referral criteria

A

• 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

29
Q

Codeine and tramadol should be avoided if

A

The patient is less than 12 years old

30
Q

Adverse side effects of opioids you should anticipate

A 
N/V/C
sedation
cognitive dysfunction
resp depression
pruritus
myoclonus
hyperalgesia
31
Q

2 herbal supplement + Rx drug interactions

A
  • Ginkgo biloba extract + warfarin→ increased risk of bleeding
  • St. John’s wort + SSRI→ increased risk of serotonin syndrome
32
Q

Polypharmacy is very common in the elderly and

A

• 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

33
Q

SSRI + ____ = increased risk of serotonin syndrome

A

St John’s wort

34
Q

SSRI + ____ = increased risk of serotonin syndrome

A

St John’s wort

35
Q

Age related changes

A
  • Increased body fat relative to muscle with aging
  • Natural decline in renal function
  • Declining hepatic function
36
Q

Any new symptoms should be _______

A

considered drug-related until proven otherwise

37
Q

Beers criteria: avoid these meds + opioids

A

Don’t mix benzos or gabapentinoids with opioids

Risk of Overdose, respiratory depression and death

38
Q

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

A

SNRIs

39
Q

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

A

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

40
Q

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

A

Stepwise approach

41
Q

The stepwise approach for avoiding ADEs includes

A
  • 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
42
Q

Geriatric pain management pearls

A

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

43
Q

Pharmacologic options for the knee pain OA case

A

Tylenol, NSAIDS, oral steroids, short acting opioids

44
Q

Nonpharmacologic options for the knee pain OA case

A

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

45
Q

Risk of opioids tx in the knee pain OA case

A

Respiratory depression, Fall risk, Cognitive impairment, Constipation

46
Q

Does low back pain with a compression fracture get opioids?

A

Yes, but <5 days of short-acting

Unit 3 Pharm III (10 decks)

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