Opioid Epidemic Lecture Powerpoint

Question 1

The action potential generated from painful stimuli is the same from person to person, however what differs is how they…

Answer 1

….interpret it

Question 2

Pathway of pain sensation

Answer 2

• “injury” of some kind (change in homeostasis
• Reflex arc initiated as well as
• spinal cord sends message upward
• thalamus relays message to different systems including limbic (interpretation of sensation), somatosensory cortex (what and where is stimulus) and frontal cortex (applies meaning)

Question 3

HPA axis chronic activation as a child predisposes to ___ as an adult

Answer 3

chronic pain or health issues

Question 4

Modifiable factors associated with chronic pain (4)

Answer 4

• mental health
• drugs and alcohol
• sleep
• physical activity level

Question 5

Nonmodifiable factors associated with chronic pain (5)

Answer 5

• age
• sex
• culture
• socioeconomic status
• genetics

Question 6

First steps for working with patients with chronic pain

Answer 6

Assess for underlying disease thru labs and workups for possible alternatives

Question 7

CDC guidelines approach to pain management (12)

Answer 7

• Nonpharmacologic and nonopioid treatment first
• treatment goals set with patient that they won’t be pain free
• review risks and benefits
• begin immediate release opioid
• stay <50 MME a day, if >90 MME need extreme justification
• acute pain treatment requires 7 days or less of opioids and no more to prevent abuse
• Chronic pain treatment requires risk benefit eval and tapering
• frequent evaluation of risk for opioid related harm
• PDMP review
• urine drug testing
• avoid opiates + benzos (synergistic effect exponential)
• offer or refer for buprenorphine (suboxone) or methadone for those with opiate use disorder (OUD)

Question 8

NSAIDS + acetaminophen have been proven to be ___ effective as opioids regarding pain reduction

Answer 8

just as effective

Question 9

Pediatric patients should never get ___ products because of ____, preferred agents are ___ and ____

Answer 9

codeine, variability of metabolism into morphine in patients causing potentially fatal outcomes, hydrocodone and morphine

Question 10

Opioid risk assessments

Answer 10

Screens used on everyone for risk factors, if positive have to keep patient much more in line

Question 11

Opioid contracts

Answer 11

-Require patients go to a single pharmacy for all meds, can get no prescriptions from other providers, can go to ER treatment of acute pain but can’t be discharged with pain meds, requires random drug screens and pill counts

Question 12

Complications of chronic opioid use (4)

Answer 12

• constipation (prescribe a laxative with it)
• allodynia (pain in response to nonpainful stimulation)
• hyperalgesia (excessive response to pain not related to their original pain)
• opioid induced androgen deficiency (infertility, decreased sexual function)

Question 13

Washout period

Answer 13

Opiate free period thought to reset receptors and reduces tolerance so pain meds are more effective

Question 14

If pain is no better after 3 months on opioids, then pain without them will be…

Answer 14

….no different - start reducing doses by 10% each week

Question 15

Neonatal abstinence syndrome (NAS)

Answer 15

Refers to recommendation against withdrawing from drugs such as opioids in pregnancy to ensure better prenatal care in 1st trimester when already at elevated risk, 2nd semester is better to withdrawal but best is to wait until after delivery, child may be delivered in withdrawal depending on mother’s last dose, infant treated with morphine and methadone

Question 16

Any provider with a DEA license (but no DEA-X license) can prescribe buprenorphine and methadone for pain, but prescribing it for opioid addiction withdrawal if not in a pain management clinic is grounds for…

Answer 16

…losing license

Question 17

Addiction definition

Answer 17

Treatable chronic medical disease involved in complex interactions among brain circuits (dopamine bursts), genetics, the environment (vietnam vets example), and an individuals life experiences, people with addiction use substances or engage in behaviors that become compulsive and continue despite harmful consequences, argued to be a disease due to a lack of human connection

Question 18

Everyone on chronic opioid pain medicine will become…

Answer 18

….addicted

Question 19

Substance abuse disorder diagnostic criteria (only 2 criteria need to be met for mild)

Answer 19

• substance taken in larger amounts than intended
• persistent desire or can’t cut down
• time is spent obtaining, using, recovering
• craving
• failure to fufill obligations
• withdrawal

Question 20

Risk factors of addiction development (3)

Answer 20

• family history
• age of first use
• history of trauma (adverse childhood experiences)

Question 21

Alternatives to opioids for pain management (3)

Answer 21

• nerve blocks and trigger point injections
• acupuncture
• alternative drugs to opioids

Question 22

Converting to morphine miligran equivalents (MME)

Answer 22

Take daily dose of med in mg/day, convert using conversion factor to MME, then lower dose by 25% to prevent overshooting mark

Question 23

Narcan (naloxone) reverses ___ overdose and only that

Answer 23

opioid

Question 24

Pain intervention below a ___ level is preferred as it limits side effects

Answer 24

systemic

Question 25

Hydrocodone (vicodin)

Answer 25

A narcotic that is included in acetaminophen or ibuprofen for treatment of moderate to severe pain

Question 26

Oxycodone

Answer 26

Most euphoric opioid used for treatment of moderate to severe pain

Question 27

Morphine (immediate release)

Answer 27

Less euphoric opioid used for treatment of moderate to severe pain but highly stigmatized making it hard to prescribe

Question 28

Drugs most responsible for overdose death involving opioids

Answer 28

• synthetic (fentanyl, tramadol)
• Heroin
• oxycodone
• hydrocodone
• RARELY methocodone (not euphoric)