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CDM 2 Exam 2 > Lecture 4.4 - Pain Management (Opioids) > Flashcards

Lecture 4.4 - Pain Management (Opioids) Flashcards

1
Q

CDC Guidelines for Opioid Prescribing

A

suggest only 3-7 day supply in many cases

careful to not exceed >50mg/day MME for chronic pain

Give naloxone w/ opioids

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2
Q

General Dosing guide opioids

A

Start minimal dose and alter based on pain response/ SE

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3
Q

Avoid or careful dosing opioids in….

A 
Renal, hepatic dysfunction
Elderly > 65
Pregnant
Meds w/ additive CNS adverse effects
Other disease ie Severe COPD, sleep apnea
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4
Q

Oral Onset + Duration

A

Onset ~ 30-45min

Duration: IR = 4-6hrs, SR = 8-12hrs

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5
Q

IR Oral Onset, Peak, Duration

A

30min
1-2hrs
4-5hrs

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6
Q

SR oral Onset, Peak, Duration

A

30-45min
3.5hrs
8-12hrs

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7
Q

Rectal Onset, Peak, Duration

A

30min
1-2hrs
4-5hrs

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8
Q

SC Onset, Peak, Duration

A

10-30min
50-90min
4-5hrs

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9
Q

IM Onset, Peak, Duration

A

10-30min
30-60min
4-5hrs

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10
Q

IV bolus Onset, Peak, Duration

A

5min
20min
2-4hrs

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11
Q

When are IR tabs used?

A

Used as needed

usually for short duration (post-surgical, post-trauma)

Used prn to control breakout pain

Dispense amount should be limited to duration expected to have pain severe enough to require opioids

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12
Q

When not to use IR tabs?

A

do not use on scheduled basis for chronic pain

increased risk for abuse & pill burden

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13
Q

ER preparations used for…

A

Severe chronic pain
Usually start on IR, then convert to ER
** Dosing is q12hrs **

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14
Q

Usual Fentanyl Patch dosing?

A

Q 3 days

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15
Q

Switching from IR to ER dosing

A

Use same med if possible

  1. calc total daily dose in 24hrs for IR
  2. divide total dose into appropriate intervals of ER (q12hrs)
  3. monitor and reassess for effectiveness and tolerability
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16
Q

Morphine IV to oral equivalent

A

10mg = 30mg

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17
Q

Dilaudid IV to oral equivalent

A

1.5mg = 7.5mg

18
Q

Codeine IV to oral equivalent

A

130mg = 200mg

19
Q

Oxycodone IV to oral equivalent

A

NA = 20mg (so 20mg is equivalent to other opioids)

20
Q

Hydrocone IV to oral equivalent

A

NA = 30mg ( so 30mg is equivalent to other opioids)

21
Q

Switching 1 opioid to another

A
  1. calculate 24hrs total
  2. use analogies conversion table
  3. reduce by 50% to help offset incomplete cross tolerance
  4. divide daily dose based on duration of actions of drug/dosage form
22
Q

Opioid Patient counseling

A
  1. follow instructions, don’t increase w/o calling Dr.
  2. explain what “AS NEEDED” means
  3. don’t drive
  4. don’t use alc or take sedatives unless approved
  5. Discuss switching from 1 to another
  6. Potential SE
  7. Dispose left overs
23
Q

Most common opioid SE

A

Constipation
Nausea/vomiting
Pruritis (itchy)
Sedation

Other:
Respiratory depression
Drug interactions
Accumulation
urinary retention
24
Q

Tolerance

A

larger doses needed for same effect

25
Q

Dependence

A

Withdrawal sx will happen if DC abruptly

26
Q

Addiction

A

behavioral pattern characterized as loss of control over drug use, compulsive drug use, and continued use of a drug despite harm

27
Q

Opioid OD treatment

28
Q

Morphine info

A

gold standard, effective and 1st cjce for severe acute and chronic pain management

29
Q

Oxycodone info

A

similar to morphine, not more effective than others tho

high potential for abuse

30
Q

Hydromorphone info

A

more potent than morphine

similar to morphine, no advantage over morphine

31
Q

Codeine info

A

less potent than morphine
used in moderate pain
many pts have GI upset

32
Q

Codeine contraindications

A

due to pro drug, metabolized to morphine by CYP2D6

Kids < 12yrs old
Kids < 18 after tonsillectomy or adenoidectomy
Dont use in kids 12-18 who are obese or sleep apnea
Avoid in breastfeeding women

33
Q

Methadone info

A

used for opioid dependence

used as analgesic (chronic pain and 4th line Neuropathic pain)

Long Hal-life = why used in OUD

34
Q

Methadone risks

A

can increase QT interval

Has bunch of drug interactions

35
Q

Meperidine info

A

Short acting

usually used in anesthesia cocktails

36
Q

Fentanyl info

A

comes in IM, IV, Patch, and transmucosal

Patch used for ppl on chronic opioids

37
Q

Converting opioids to patch

A

add up opioids pt is taking

use conversion table

table only goes left to right, not reverse

most likely keep breakthrough dose just incase

38
Q

Tramadol info

A

effective for mild to moderate nociceptive pain
effective for treatment of neuropathic pain

SE: tend to be less than opioids
Efficacy similar to Tylenol #3

also CYP2D6 prodrug, same CI as codeine

39
Q

Tramadol risks

A

Serotonin syndrome risk

Lower seizure threshold, avoid in at risk patients (history of seizures, or on drugs that also lower threshold)

40
Q

Tramadol CI

A

Kids < 12yrs old
Kids < 18 after tonsillectomy or adenoidectomay
Kids 12-18 who have sleep apnea
Dont use in breastfeeding women

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