Pain Flashcards
what is a large barrier to older people receiving proper analgesia
inadequate assessment
what are the preferred opioids in older people?
hydromorphone and oxycodone
better SE profiles
START LOW GO SLOW
prescribing CDS beings with what?
clear assesment, informed consent and treatment goals, risk of misuse and complications, monitoring and treatment, and tapering or de-prescribing
what are some classes of non-opioid pharm treatment for chronic pain
non-opioid analgesics (acetaminophen, NSAIDS)
antidepressants (TCA, SNRI)
anticonvulsants (gabapentin, pregabalin, carbamazepine, lamotrigine, topiramate)
transdermal compound (topical NSAID, topical rubefacients)
cannabinoids (nabilone, nabixmois, dried cannabis)
what should be done prior to initiating CDS treatment
optimize non-opioid and non pharm strategies
stabalize psychiatric disorders
what is the max dose of opioid medication recommended (MME)
Max 90MME
caution >50 –> start under 50 for sure
if exceeds 90MME should be tapered
what is recommended for when pain is persistent and or there are AEs to opioid treatment
rotating opioids
what are teh 6 A’s important when documenting pain management?
analgesia, activities, adverse effects, aberrant drug behaviour, accurate med record (use tracking tool), and affect
what are the three anticonvulsants used for (neuropathic) pain
carbamazepine, gabapentin, pregabalin
what is carbamazapine first line for?
trigeminal neuralgia
what is gabapentin first line for
neuropathic pain
how long of a taper does carbamazepine need?
3 months
how long of a taper does gabapentin need
1 week
what is pregabalin used for?
fibromyalgia (or 2nd line for neuropathic pain if amitriptyline or gaba ineffective)
