pain

Question 1

NSAIDs

Answer 1

-inhibit COX
-do not mess with CNS
-irritate GI
-reduce bloodflow to kidneys

Question 2

opioids

Answer 2

-act on higher centers of brain

long acting = oral morphine/oxy/hydromorphone and fentynyl patches
short acting= most –> 4 hrs

max dose= 2-3 times lower/min dose

EXTENDED RELEASE ARE NOT PRN

Question 3

side effects and extended use

Answer 3

short term = 3-5 days

common side effects = nausea, vomitting, constipation, memory/thought changes

RESP DEPRESSION –> naloxone –> may need to apply multiple times because it lasts shorter than opioids

Question 4

morphine

Answer 4

inactivated by hepatic metabolism when taken orally –> oral doses have to be bigger than parenteral doses –> that’ s true for a lot of drugs

Question 5

IM and Subq drug administration

Answer 5

painful
absorbtion is unreliable
not ideal route

Question 6

old ppl and opioids

Answer 6

start low and go slow
dizziness, confusion, and vision changes can happen

Question 7

adjuvants

Answer 7

treat other stuff but help with pain

good for neuropathic pain
-tricyclic antidepressants (notriptyline)
-anticonvulsants (gabapentin)
-infusional lidocaine

corticosteroids, bisphosphonates, and calcitonin help with inflammation and bone pain

Question 8

what aren’t analgesics?

Answer 8

-sedatives
-anti anxiety stuff
-muscle relaxants

Question 9

PCA

Answer 9

usually IV or SubQ, but sometimes oral

-not recommended for opioid naive patients post op

-sometimes continuous dose for tolerant ppl - cancer

-PCA byproxy is bad, but sometimes a patient who can’t push button has AACA (authorized agent-control analgesia)

-usually 2 nurses should check the setting

Question 10

topical products

Answer 10

NSAID = ketoprofen patch

capsaicin

local anesthetics: lidocaine, prilocaine, diclofenac

FEW SIDE EFFECTS

Question 11

transdermal

Answer 11

systemic

work even if not right by site of pain

lidocaine = 12 hr on; 12 hr off

don’t put on wounds, damaged skin, or face

skin irritation is common

application to vascular mucous membrane will speed absorption

use gloves and wash hands when applying or removing

Question 12

local vs regional anesthesia

Answer 12

local = topical or injected to induce loss of sensation to a body part

regional = local anesthesia used to block a group of sensory nerve fibers to a larger area

if enough local anesthesia is used, motor and autonomic function is inhibited too

Question 13

perineural infusion

Answer 13

catheter is placed by group of nerves and anesthesia is administered like an IV

used post surgically

usually 48 hrs

Question 14

epidural

Answer 14

-example of regional anesthesia

-acute post op pain, delivery pain, cancer pain –> reduces overall opioid requirement

-risk of bleeding and/or hematoma –> don’t use anticoagulants

-monitor every 15 mins at first then move to every hour

-constipation, urinary retention, nausea, vomiting, hypotention, resp depression, and pruritis are side effects

-long term epidural exits through patient’s side

NO PRESERVATIVES OR ADDITIVES –> NEUROTOXIC

Question 15

invasive interventions

Answer 15

FOR CHRONIC PAIN

intrathecal implantable pumps/injections
spinal cord and deep brain stimulation
neuroablative procedures
trigger point injections
cryoablation
intraspinal medications

Question 16

cancer pain

Answer 16

can be chronic or acute
-often experience breakthrough pain

Question 17

transdermal fentynal

Answer 17

100 times more potent than morphine
for opioid tolerant ppl with cancer or chronic pain
long acting –> not prn–> up to 72 hrs
do not use for anyone under 100 lbs (not enough subq)
do not use if hyperthermic (absorption is too fast) –> don’t exercise hard while wearing patch
flush patch down toilet when done

Question 18

long term opioid use

Answer 18

need higher doses
-not the worst thing in the world bc they also become tolerant to resp depression

Sometimes (not usually) leads to hyperalgesia

make extra sure that noncancer patients aren’t getting addicted

Question 19

transmucosal fentanyl unit

Answer 19

for breakthrough pain in opioid tollerant ppl

put bt cheeks and gum and let dissolve for 15 mins without chewing or swallowing

1 at a time – no more than 2 per breakthrough episode

if 4+ breakthrough episodes in a day, contact HCP

Question 20

pseudoaddiction

Answer 20

patients with real pain exhibit druggie behavior (like doctor shopping) to get relief

Question 21

rectal administration of pain meds

Answer 21

for ppl who can’t swallow, have nausea/vomiting, or are near death

not for ppl with diarrhea or cancerous lesions in but area

morphine, hydromorphone, oxymorphone

Question 22

physical dependence vs addiction vs drug tolerance

Answer 22

phys dependence = withdrawal when you don’t have it

drug tolerance = it takes more to have the same effect

addiction = neurobiological disease with genetic, psychosocial, and environmental factors –> includes impaired control over use, compulsive use, continued use despite harm, and craving

Question 23

palliative care vs hospice

Answer 23

palliative care is for life limiting conditions

hospice is for end of life