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Clin Specialties Surgery Exam > Lecture 9: Pain Management > Flashcards

Lecture 9: Pain Management Flashcards

1
Q

What are the three parts of anesthesia?

A
  1. Analgesia (pain relief)
  2. Amnesia (loss of memory)
  3. Immobilization
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2
Q

What is the difference b/t analgesia and sedation?

A

analgesia - consciousness not altered, just lack of pain

sedation - consciousness altered (depression of awareness to the environment and decreased responsiveness)

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3
Q

What are the differences b/t sedative and analgesic drugs?

A

Sedatives - anxiolysis, amnesia, analgesia, more serious S/Es
Analgesics - some anxiolysis, NO amnesia, mild sedation, less serious S/Es

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4
Q

What type of drug class make up the commonly used sedatives?

A

BZs (-pam, -lam)

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5
Q

When should diazepam NOT be used?

A

In pts w/ cirrhosis or liver dz

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6
Q

In patients with kidney or liver failure what type of BZ should be used for pain management?

A

Lorazepam

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7
Q

When/what type of procedures should Midazolam (Versed) be used to control pain?

A

Best for amnesia - use for short procedures or in ED

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8
Q

A patient is taking diazepam for pain management, but the nurse accidentally gave the patient way too much, what medication should be used in this situation?

A

Flumazenil

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9
Q

What is the timeframe for acute vs chronic pain?

A

Acute pain: typically last less than 3 months

Chronic pain: last 3-6 months or more and is beyond the expected period of healing

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10
Q

A patient presents w/sudden, sharp onset of pain after falling off of his bike and breaking his arm but he is feeling better after the bone is casted, what type of pain is this?

A

Acute pain

  • started suddenly, sharp, intense
  • has identifiable cause
  • warning present
  • pain disappears when Tx

note: Chronic pain has gradual onset from acute, has unknown cause, no alarm system, will persist despite Tx

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11
Q

What are the objective tools to assess pain?

A
  1. VAS/Numerical Scale/Wong-Baker Faces
  2. Functional Status
  3. PE
  4. Pathology, imaging, diagnostics
  5. Pain medication usage (is it helping?)

note: subjective assessment = CHLORIDE PAC

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12
Q

What is the difference b/t hyperalgesia and allodynia?

A

Hyperalgesia is an amplified/exaggerated response to mildly noxious stimuli (curve shifts L)

Allodynia is a painful response to a normally NON-NOXIOUS stimuli

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13
Q

ASA, Tylenol, NSAIDs, and COX2 inhibitors fall under which drug class?

A

Non-opioid analgesics

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14
Q

What are the first line drugs used for pain?

A

Acetaminophen (Tylenol) and NSAIDs (ibuprofen)

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15
Q

Elavil (amitriptyline), Cymbalta (duloxetine), and Pamelor (noritriptyline), and Paxil all belong to what drug class?

A

Anti depressants

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16
Q

Neurontin (gabapentin) and Lyrica (pregabalin) belong to what drug class? and what is their use?

A

Anticonvulsants/GABA analogs

- used for post herpetic neuralgia, CRPS

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17
Q

What medication can be topically for pain relief (post herpetic neuralgia)?

A

Capsaicin

18
Q

What medications can be applied as patches for pain relief?

A

Fentayl, Lidocaine, Salonpas

19
Q

What type of opioid should be used for severe or chronic pain, provides pain relief at a constant steady state level, and should not be crushed/split/chewed?

A

Long Acting Opioids (Extended Release)

note: short acting are for mild-mod pain, need dosed more freq, are taken PRN, and are easier to titrate

20
Q

When giving morphine sulfate to pts w/renal failure what should you be concerned about?

A

prolonged respiratory depression

- d/t impaired elimination of drug

21
Q

What drug varies in schedule based on its formulation?

A

Codeine

22
Q

What schedules are allowed to be called into a pharmacy?

A

Schedule 3-5

23
Q

A patient is on hydrocodone, can it be called in?

A

No it is a schedule 2 drug

24
Q

What the 5 common S/Es of opioid use and their Tx?

A
  1. Respiratory depression/arrest - Narcan
  2. Delirium/CNS effects - Narcan, opioid rotation, decr dose
  3. GI disturbance - Reglan (Metoclompramide)
  4. Constipation - Movantik
  5. Pruritus - Diphenhydramine
25
Q

What is the Tx for opioid OD?

A

Narcan (Naloxone)

26
Q

What are the CIs for using Movantik? (3)

A

Sensitivity to Naloxgel, GI obstruction, risk of concurrent obstruction

27
Q

When weaning someone off opioids when should you consider an inpatient setting?

A
  1. medically unstable
  2. psych diagnosis
  3. polysubstance abuse
  4. non-adherent/failed outpatient detox
28
Q

What is the general goal for weaning pts off opioids?

A

Decrease daily regimen by 10-25% w/each visit

*ER/LA forms can be decreased more rapidly

29
Q

What is utilized in PCAs to avoid peaks and valleys by delivering a Small, CONSTANT flow of pain medication?

A

Basal rate

30
Q

What are the advantages to PCAs?

A
  1. avoids peaks/valleys
  2. Less OD, S/E and lag time
  3. Can be used in pts > 7 y/o

note: not for use in kids < 4 y/o

31
Q

A cancer patient requires pain medication while in the hospital, what should you set their basal rate to?

A

2/3 of the hourly requirement (also for chronic pain pts)

note: 1/3 used if acute pain, 1/2 used for bolus

32
Q

A patient is placed on oxycodone post-operatively after his hip replacement, what should be started prophylactically and why?

A

bowel regimen - to prevent opioid induced constipation

Ex: stool softener + laxative

33
Q

What are the indications for Docusate and Sennakot (Senna)?

A

Docusate - prevent post-op ileus

Sennakot (Senna) - relieve constipation

34
Q

When transitioning to PO pain medication/changing opioids why should you decrease the dose by 25%?

A

To adjust for incomplete cross tolerance

35
Q

How does regional anesthesia work & what are the methods of administration?

A

Blocks Na channels to prevent AP propagation (nerve impulses) using local anesthetics

Neuraxial –> Epidural and Spinal

36
Q

What are the advantages to neuraxial anesthesia?

A
  • decreases ileus, opioid requirements, stress response

- facilitates early PO intake, mobilization & return of bowel function

37
Q

What are the absolute CI to neuraxial anesthesia?

A

Refusal, Allergy to LA, Uncorrected hypovolemia, Site infection, Elevated ICP, Coagulopathy

38
Q

How does TENS (transcutaneous electrical nerve stimulation) work to decrease pain signals sent to the brain?

A

Gain Control Theory

- utilizes faster pain pathways to get to the brain (via the A beta fibers)

39
Q

When using ER/LA opioids what should you never use as a first choice?

A

Fentanyl and Methadone

40
Q

What drugs should not be combined w/opioids due to risk of sleepiness, respiratory depression, coma and death

A

BZs

Clin Specialties Surgery Exam (13 decks)

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