Pain Flashcards
What is nociceptive pain
Noxious stimuli
Just your regular old pain
What is inflammatory pain
Tissue damage present
Still normal
What is neuropathic pain
Damage to nervous system
Pathological
What is functional pain
Abnormal response to normal stimuli
What is chronic malignant pain
Associated with progressive diseases
What is chronic non-malignant pain
Not life threatening disease but >6mos past healing period
What kind of pain is acute pain
Nociceptive or Neuropathic
Tx of mild pain
Non-opiod + adjuvant
Tx moderate pain
Medium opioid + Non-opiod + adjuvant
Tx severe pain
Strong opioid + Non-opiod + adjuvant
What are the Non-opiods
Acetaminophen
NSAIDs
What is the first line for low back pain and OA
Acetaminophen
What is a major AE of Acetaminophen
Hepatotoxicity
When are NSAIDs given
Inflammation pain
RA, Gout
Do Non-opioids have a ceiling
Yes
Moderate pain opioids (4-6)
Codeine Hydrocodone Oxycodone Meperidine Propoxyphene (cept no) Tramadol
Severe pain opioids (7-10)
Morphine Hydromorphone Oxymorphone Levorphanol Fentanyl/Sufentanil Methadone
Which Opioids have ceiling
Mixed
What happens when you go over ceiling
Increased chance of AE
What are the Mixed
Pentazocine
Butorphanol
Nalbuphine
Buprenorphine
How is Pruritis/Urticaria managed
Hydroxyzine
Diphenhydramine
How is constipation managed
Senna + Docusate
Laxative + Softener
Why are bulk formers not good for pts with advanced disease
Needs lots of fluid intake
How is N/V managed
May become tolerant
Hydroxyzine
Metoclopramide
Prochlorperazine
How is Sedation managed
Tolerance
Methylphenidate
How is Resp Depression managed
Naloxone
Which opioid is not given via routine dosing
Meperidine
Mixed (due to withdrawal and psych)
How does routine dosing work
Give till comfortable and give again before the effect wears off
What is the rescue dose
10-20% of daily total requirement - For breakthrough pain (Fentanyl lollipop)
When are TCAs given as adjuvants
Neuropathic pain
Diabetic neuropathy
Post-herpetic neuralgia
Fibromyalgia
What are the TCA AE
Constipation Xerostomia Blurred vision Decreased cognition Tachy Orthostatic hypotention --> falls Weight gain and sedation
Which TCAs are secondary amines
Desipramine
Nortriptyline
Which TCAs are tertiary amines
Imipramine
Amitriptyline
Which TCAs have less AEs
Secondary
How do TCAs work
NE/5-HT reup inhibitor
Descending inhibition of pain
What are the SNRIs
Venlafaxine
Duloxetine
DOC trigeminal neuralgia pain
Carbamazepine
Anticonvulsant for postherpetic neuralgia and diabetic neuropathy
Gabapentin
Anticonvulsant for postherpetic neuralgia and diabetic neuropathy and fibromyalgia
Pregablin
Anticonvulsant for migraine prophylaxis
Valproate
Topiramate
DOC glucocorticoid
Dexamethasone
Misc Adjuvants
Hydroxyzine Clonidine Lidocaine Capsaicin Caffeine
