PA Pain Management (Exam #3) Flashcards
What is the most common AE associated with opioid use?
Constipation
What is undertreated pain resulting in red flag behaviors?
Pseudo-Addiction
What is withdrawal sxs with abrupt discontinuation/decrease in opioid use (esp. chronic)?
Physical Dependence
What are two major characteristics associated with ADDICTION?
- Impaired control over drug use/cravings
- Compulsive/continued use despite harm
What are the three types of pain? Describe each
- Nociceptive: injury to tissue
- Neuropathic: damage to/dysfunction of nerves, spinal cord or brain
- Psychogenic: persistent pain with evidence of psych disturbance
What are two examples of tx options for Nociceptive pain? What other two options may be considered as last resort?
- NSAIDs (short-term)
- Tylenol
Steroids and oral/topical Opioids are last resort
What are two examples of tx options for Neuropathic pain? What other three options may be considered, and under what co-consideration?
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)
Also…
- Amitriptyline if at night
- Duloxetine (Cymbalta) if depression too
- Tramadol only if NOT DM neuropathy
What are three examples of tx options for Psychogenic pain?
NOT MEDS
- Biofeedback/distraction techniques
- Encourage exercise
- Psych eval/therapy
What two pain tx options are specifically recommended for Fibromyalgia? Which meds should be avoided?
- EXERCISE
- Gabapentin (Neurontin)
NOT OPIOIDS
When is use of Patient-Controlled Analgesia (PCA) considered (2)?
- Severe post-op pain
- Intractable CA pain
What are the three options of Patient-Controlled Analgesia (PCA) administration?
- Demand dose (every “time”)
- Continuous dose (over “time”)
- Combination of both
What is the major AE associated with Patient-Controlled Analgesia (PCA)?
Overdose risk (if not properly monitored/titrated)
What is the main goal with CA pain treatment (2)?
Optimize opioid tx + analgesic adjuncts
When is Fentanyl used, and in what population is it less effective?
What is the primary AE?
NOT for acute pain
- Less effective if cachectic
AE: heat exposure (causes increased absorption)
What type of pain is Methadone used to tx?
What are the two primary AEs?
Neuropathic pain
AE: QT prolongation (TdP); many drug interactions
What type of pain is Tramadol used to tx?
What is the primary caution, and what can this cause?
Neuropathic pain
Caution if on antidepressants → possible Serotonin Syndrome
With which two medications should you caution ESRD?
What two meds can be used instead?
- Hydromorphone
- Oxycodone
Use Fentanyl or Methadone
With what two conditions should opioid use be avoided?
- Liver dysfunction
- Increased ICP
Generally, what pain are opioids used to treat? What two opioid characteristics are preferred?
ACUTE PAIN
- Low-dose and long-acting opioids are preferred
When evaluating pain, which three pain-related HPI questions should be asked?
- Type of pain
- Source/location of pain
- Severity of pain
For peds, what does pain assessment depend on?
Child’s cognitive ability (age)
Which two pain medications should be avoided if <12 years?
- Codeine
- Tramadol
What consideration/implementation should always be made for peds pain?
Appropriate adjuvant therapy options
What three aspects of normal aging should be considered in the tx of geriatrics?
- Increased body fat = meds stored
- Decline in renal function
- Decline in hepatic function
