Opioids

Question 1

• Physical therapy
• Cognitive behavioral therapy
• Yoga
• Ice, heat, stretching
• pet and music therapy
• acupuncture

Answer 1

Non-Pharmacologic Pain Strategies

Question 2

Pain management strategy that combines 2 or more analgesic agents/techniques that act by different mechanisms to provide analgesia

• Designed by American Society of Anesthesiologists (ASA)
• Guideline: all pts should receive around-the-clock regimen of a non-opioid agent

Answer 2

Multimodal analgesia

Question 3

• NSAIDs (Non-steroidal anti-inflammatory drugs)
  or COXIBs (Cyclooxyrgenase- 2 specific drugs)
• Acetaminophen

Answer 3

Non-opioid agents

Question 4

• ↓ opioids requirement to manage pain
• ↓ side effects of opioid-related AVE
• better pain relief
• better pt satisfaction
• improves pt functional outcomes
• ↓ length of stay
• avoids safety concerns and contribution to opioid epidemic :
  addiction, dependence, and dependence diversion

Answer 4

Benefits of Multimodal Analgesia

Question 5

pt who has taken opioids and their body can handle/tolerate opioids

Answer 5

Opioid tolerate pts

Question 6

• watch vital signs: make sure respiratory rate is not too low and BP
• pain assessment: chart b/f and after, reassess 30 min to 1 hr after adm.
  • know when med is expected to take effect
• secure meds
• give IV opioids slowly over min
• opioids are sedating - don’t give w/ other sedating drug (ex. Benzodiazepine)

Answer 6

Safe opioid administration

Question 7

• abruptly stop taking these drugs

- fetus develops during preg

Answer 7

Dependence (Abstinence Syndrome)

Question 8

Overdose Tx (Antidote) for opioids

Answer 8

Naloxone (Narcan)

Question 9

• MOA:
  • binds to Mu -> WEAK opioid activity
  • inhibit norep. and serotonin - reuptake in SPINAL neurons
• S/S:
  • pain - neuropathic pain
  • restless leg
• Interactions:
  • MAOIs and SSRIS and carbamazepine -> can induce serotonin syndrome
  • ALCOHOL -> sudden DEATH

Answer 9

Tramadol

Question 10

• estimates risk of opioid-related aberrant (odd) behaviors
• pain meds should NOT be withheld for painful conditions b/c a pt is deemed “high risk”
  • these pts should be considered for other modalities of pain control, if appropriate
• high risk pts may be appropriate candidates for referral to pain management
• adm on initial visit

Answer 10

Opioid Risk Tool

Question 11

• 0-3: low
• 4-7: moderate
• > or = to 8: high

Answer 11

Opioid Risk Tool scoring

Question 12

- family & personal history of substance abuse
   • alcohol
   • illegal drugs
   • Rx drugs
- age
- history of preadolescent sexual abuse
- psychological disease
   • ADD, OCD, bipolar, schizophrenia
   • depression

Answer 12

Opioid Risk Tool contributing factors