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Therapeutics > Pain > Flashcards

Pain Flashcards

1
Q

2 Subtypes of Nociceptive Pain ?

A

Somatic and visceral

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2
Q

Somatic pain involves what? (4)
-Pain is usually ___
-Described as __,__ or __
-Pain is usually ___
-Increases with ___
Patient can point to ___

A

Skin, bone, joint, soft tissue
-well localized
-sharp, aching, throbbing
constant
movement
site of pain

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3
Q

Visceral Pain
-Arises ___ damage of the __ or ___
-Described as ___ (3)
-Poorly ___ , hard to ___, “deep or __”, “____ or coming in waves”

A

afferent nerves, soft tissue, viscera (heart, lung, GI or GU tract)
-stretching, cramping, distention
localized, describe, aching, colicky

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4
Q

Neuropathic pain can be both __ or __
-Described as ? (5)

A

peripheral, central

burning, shooting, pricking, paresthesias or dyesthesias

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5
Q

Acute Pain
-Time period?
-Sx’s?
-Temporary ___?
-May require __ then ___ or just ___ for a short time

A

<1-3 months

pain, bruising, swelling

loss of function

scheduled therapy, prn therapy, prn therapy

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6
Q

Chronic Pain
-Time period
-Sx/s?
-___ impairement
-___ pain
-___ of sx’s
-Requires __ and ___

A

> 1-3 months to life long
just pain
functional
neuropathic
progression
scheduled ,prn therapy

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7
Q

Opioids : Tx of ___ to ___ pain that doesnt respond to ___

Role in Therapy?
(4)

A

moderate, severe, non opioids alone.

acute (trauma or postop), cancer , chronic non cancer, Visceral and somatic pain > neuro pain

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8
Q

Phenanthrenes ? (5)
Phenylpiperidines? (1)
Diphenylhepatnes? (1)
Atypical opioids? (1)

A

Morphine, hydromorphone, hydrocodone, oxycodone, buprenorphine

fentanyl
methadone
tramadol

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9
Q

Common AE of Opioids : Constipation

Gets better over time?
Tx?
Schedule meds ___ not __
Can u use osmotic agents?
Docusate?
Fiber?

A

No
Stim laxatives like Senna
around the clock, prn

yes can be added on

not helpful

can make it worse

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10
Q

Common AE of Opioids : Nausea

MOA?
__ over time
TX? (5)

A
  1. Dopamine agonist
  2. Subsides
  3. Prochlorperazine
    -Metoclopramide (D2 antag and prokinetic which helps with constip)
    -Promethazine (D2 antag and antichol)
    -Haloperidol ??
    -Olanzapine ??
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11
Q

What secret side effects does zofran have?

A
  1. HA and constipation
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12
Q

Sedation : COMMON AE
-__ over time
TX?

Pruritis UNCOMMON
-Gets better over time?
-TX?

A

Subsides
-Education to pt and caregiver to watch out for extreme sleepiness

NO
CHange to diff opioid also called opioid rotation
-non sedating antihistamine

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13
Q

Uncommon AE : Respir Depression

Defined as ?

TX?

A

Respiratory rate of < 8 breaths per min
-oxygen saturation of <90%
-decrease of more than 5% from baseline in pt’s with baseline oxygen saturation of <90%

-NALOXONE

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14
Q

For acute pain , use __ pain meds usually given as __
What drug?

A

short acting, prn
oxycodone 5mg PO q4 hrs prn pain

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15
Q

Chronic Pain , use ___ and ___
What drugs?

A

LA scheduled meds , Short acting prn meds

Oxycodone 20 mg CR PO q12hrs
Oxy 5 mg IR PO q 4 hrs prn

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16
Q

If patient has true morphine allergy what do u use?

A

methadone, fentanyl, tramadol

17
Q

Renal Impaired/Hemodialysis
CI? (2)
Caution with?
Better choices? (3)
Start with low doses, immed release formulations, and prn dosing
Best choice for LA meds ? (2)

A

Codeine and Meperidine

morphine

oxycodone, hydromorph, fentanyl IV only

Methadone + fent patch for chronic pain

18
Q

Hepatic Dysfunction
CI? (2)
Caution ? (2)
Better choices? (3)
-Start with low dose, IR forms, and prn dosing
Best choice for LA?

A

Codeine + Meperidine

Morphine + methadone

Oxy, hydromorph, fentanyl IV

Fent PATCH

19
Q

Chronic Pain Dosing Regimen :
2 options
-Short acting med should be ___ of total daily dose of LA med

A

LA Med + IR

20
Q

Titrate up to the next dose after?

For breathrough or intermittent acute pain, dose IR opioid once____

A

Med reaches steady state concentrations

every time to Cmax as needed

21
Q

Steps to Opioid Conversion For LA and SA opioids
1. Calculate ?
2. For LA, how do u dose based on pt pain scale?

  1. Whats dosing frequency?
  2. What about short acting?
A
  1. total amount of opioid in 24 hrs
  2. Severe pain (7-10) Include 90-100% of calculated dose in LA

Mod pain (4-6) include 75% of calc dose in LA

Mild pain score of 1-3 : Include 50% of the calculated dose in LA

  1. Scheduled around the clock!
    -Divide LA dose/day by 2 and dose q12
  2. 10% of Long acting dose/day (Dosed as PRN q2-4 hrs)
22
Q

FDA definition of Opioid Tolerant?

A

On at least 60 mg/day of morphine or equiv opioid for at least 7 days

23
Q

Tramadol pros and cons ?

A

Pro : nociceptive and neuro pain.

Cons : Schedule 4, risk of seizures and serotonin syndrome . Hypoglycemia, need to adjust dose for renal and hepatic impairment

24
Q

Tapentadol pros and cons?

A

Pros : Nocicpetive and neuro pain . NO risk of seizures and serotonin syndrome.

Cons : Only used in opioid toelrant pt’s
Schedule 2
Need to adj for renal ad hepatic impairment

25
Q

Name 4 1st line agents for neuropathic pain

A
  1. TCAs
    2.Gabapentin or pregabalin
  2. SNRI’s
  3. Lidocaine patch (Lidoderm)
26
Q

Tertiary Amines Name 4
Secondary Amines name 2
Effective to treat neuro pain at __ doses and ___ at higher doses

A

Amitriptyline, imipramine, doxepin, clomipramine

Nortriptyline, desipramine

lower, depression

27
Q

TCA’s and their AE’s

A

Sedation , dry mouth, blurred vision, weight gain , urinary retention
DDI’s with MAOis, SSRI’s , anticholinergic agents , agents that prolong QTc

28
Q

START TCA dose low for pain . Whats the dose?

A

10-25 mg QHS .

29
Q

Gabapentin and Pregabalin AE’s ?

-Requires?

A

well tolerated!
Dose dependent dizziness, ataxia, sedation and diplopia
Weight gain and periph edema
-renal dose adjustment !

30
Q

Gabapentin : Titrate dose to pain relief!
-Start with?
-if partial relief achieved at 1800 mg/day, titrate up to?

A

100-300 mg QHS
Titrate dose every 2-3 days

3600 mg/day

31
Q

Pregabalin begin dosing at?
Increase to ? within a week
-requires?

A

150 mg per day
-300 mg/day
renal dosing

Therapeutics (15 decks)

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