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Fall Therapeutics > Pain > Flashcards

Pain Flashcards

1
Q

Somatic Pain

A
  • Skin, bone, joint, soft tissue
  • Well localized
  • Sharp, aching or throbbing
  • Constant
  • Increases with movement
  • Can point to the site of pain
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2
Q

Visceral Pain

A
  • Afferent nerves damage of the soft tissue or viscera (heart, lung, GI tract, GU tract)
  • Stretching, cramping, distention
  • Poorly localized
  • “hard to describe”
  • “Deep, aching”
  • “colicky” or coming in waves
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3
Q

Neuropathic Pain

A

Burning, shooting, pricking, paresthesias, dysesthesias

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4
Q

Acute Pain

A
  • < 1-3 month
  • Pain, bruising, swelling
  • Temporary loss of function
  • May require scheduled therapy then prn therapy or just prn therapy for a short term
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5
Q

Chronic Pain

A
  • > 1-3 month to life-long
  • Functional impairment
  • Neuropathic pain
  • Progression of sxs
    -Requires scheduled AND prn therapy
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6
Q

PQRSTU

A

-Palliation
-Quality
-Region
-Severity
-Temporal
-How does it affect U

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7
Q

Opioid Adverse Effects: Common

A

-Constipation: use Senna/bisacodyl (miralax if hard stools)

-Nausea: use dop. anta. (prochlor/meto/prometh)

-Sedation

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8
Q

Opioid Adverse Effects: Uncommon

A

-Pruritus: change opioid, non-sed antihistamine

-Resp. Dep.: <8 breaths/min, ox <90
*start at low doses, titrate, monitor
*TX: Naloxone

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9
Q

IF true morphine allergy, rare:

A

Methadone, fentanyl, tramadol

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10
Q

Renal impairment/hemodialysis

A
  • Contraindicated: codeine, meperidine
  • Caution: morphine
  • Better choices are oxycodone, hydromorphone, fentanyl (IVonly)
    -Chronic pain: best are methadone, fentanyl patch
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11
Q

Hepatic dysfunction

A
  • Contraindicated: codeine, meperidine
  • Caution: Morphine, methadone (used by hepatology)
  • Better choices are oxycodone, hydromorphone, fentanyl (IVonly)
    -Chronic pain: best is fentanyl patch
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12
Q

Short-acting pain medication dose should be ___of the total daily dose of the long-acting medication.

A

10%

EX
* Long acting regimen is morphine 60 mg SR PO q12h
* Shorting acting dose should be morphine 15 mg IR q2h prn pain

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13
Q

Css is good to know WHEN to titrate up to the next dose

A
  • Mean half-life of extended-release hydromorphone tablets (Exalgo) is 11 hours
  • Steady state is 5 half-lives (3.3 half-lives)
  • 11x 5= 55 hours ~2.5 days
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14
Q

Opioid tolerant

A

on at least 60 mg/day of morphine (or equivalent opioid) for at least 7 days

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15
Q

Tramadol, ultram VS Tapentadol, nucynta

A

Both for nocicpetive/neuro pain

Tramadol: C4, seizures/serotonin syn, hypoglycemia, renal/hepa dose adj

Tapentadol: only in opioid tolerant pts, C2, renal/hepa dose adj

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16
Q

Fentanyl Transdermal

A

-DOC in renal/hepatic dysf
-good for NPO

-Only for opioid tolerant pts
-long half life

17
Q

Methadone

A

-GOOD for ESRF

-BAD for ESLF, cardiac arr

18
Q

PCA Dosing

A

Opioid naive:
*Start with bolus doses
-Morphine 2, HM 0.2, Fen 20 mcg
-Lockout 10 min

Constant pain:
-If >20 bolus in 24hr OR >2 attempts times doses given = start basal
-Basal dose can be 2/3 of total opioid use in 24 hr (total opioid divided by 24 hr times 0.66)

19
Q

Bolus dose can be one of 3 options based on clinical picture

A
  1. Half the basal dose (pain score of 1-3)
  2. The same as the basal dose (pain score of 4-6)
  3. OR double the basal dose (pain score of >7)
20
Q

Neuro Pain: 1st Line

A
  1. Tricyclic Antidepressants (TCAs)
    *amitriptyline, desipramine
  2. Gabapentin/Pregabalin
  3. Serotonin norepinephrine reuptake inhibitors (SNRIs)
    *duloxetine, venlafaxine
  4. Lidocaine patch (Lidoderm)
21
Q

TCAs
* Amitriptyline,imipramine
* Doxepin,clomipramine
* Nortriptyline,desipramine

A

AE: sedation, dry mouth, blurry vision, weight gain, urinary retention

DI: MAOI, SSRI, AC agents, antiarrhythmics, prolong QTc

Start at 10-25 mg, max is 150

22
Q

Gabapentin, pregabalin

A

AE: dizzy, ataxia, sedation, diplopia, weight gain, edema (WE SADD)

DI: potential sedation if with opioids/alc/benzo

Lower dose in elderly, RENAL DOSE ADJ

-Gaba: start 100-300, max 3600 (not sched, cheaper), give in AM, titrate up 300 every 2-3 days, have to titrate down (seizure/withdrawal)

-Prega: start 150, incr to 300 within 1 wk, max 450-600

23
Q

4% or 5% Lidocaine Patch (Lidoderm)

A

Well localized pain
-12 hour on, 12 hour off
-Up to 3 patches for simultaneous use
-Cut/shaped
-No burned/broken/inflamed skin
-Caution in hepatic disease

24
Q

Fentanyl strengths

A

25, 50, 74, 100 mcg/hr

25
Q

Hydromorphone strengths

A

2, 4, 8 mg ORAL IR

26
Q

Methadone strengths

A

5, 10 mg

27
Q

Morphine strengths

A

Oral: 15, 30, 60
Solution: 10mg/5ml, 20mg/5m
IR: 15, 30

28
Q

Hydrocodone strengths

A

5/325, 7.5/325, 10/325

29
Q

Oxycodone strengths

A

IR: 5, 10, 15
Solution: 20mg/ml, 5mg/5ml
Oral ER: 10, 15, 20, 30

30
Q

Tramadol strengths

A

50 mg

31
Q

STEPS FOR OPIOID CONV FOR LA AND SA

A
  1. Calc total amount of op in 24 hr
  2. LA dose per day:
    -Pain 7-10: 90-100% if calc total
    -Pain 4-6: 75% if calc total
    -Pain 1-3: 50% of calc total
    *LA dose is TWICE a day (divide into 2, q12h)
  3. SA dose per day: 10% of LA dose
    -PRN only, q2-4 hr
    -If rounding up, use 4. Rounding down, use 2.
32
Q

STEPS FOR PCA CONV/DOSING

A
  1. Basal
    -After 24 hr (SS), if > 20 boluses or attempts >2 times doses given: add basal
    -Basal dose is 2/3 (66%) of total opioid use in 24 hr = (total op / 24 hr * 0.66)
  2. Bolus
    -Pain 7-10: double basal
    -Pain 4-6: same as basal
    -Pain 1-3: half basal
33
Q

STEPS FOR FENTANYL CONV

A
  1. Check if pt is opioid tolerant first
    -60 mg morphine (equiv)
  2. Evaluate pain score
    -Same as LA/SA conversions
    -High (100%), Mod (75%), Mild (50%)
  3. Once converted…
    -Morphine to fentanyl ratio is TWO TO ONE
    -Morphine 50 ~ Fentanyl 25
34
Q

SNRI, duloxetine, venlafaxine

A

Sexual dysfunction

BBW for suicidal thoughts

Good for pts who don’t want sedation/sleepy side effect

Take in AM - keeps you up

Fall Therapeutics (34 decks)

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