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Neuro Pharm > Pain > Flashcards

Pain Flashcards

1
Q

What are the four key points to remember about treating pain?

A
  1. Function is the goal and the measure of success
  2. Non-pharm modality first or concomitantly
  3. Treatment agreements, esp with narcotics
    “Pseudoaddiction” is not “addiction”, and “dependence” is not “addiction”
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2
Q

What is the WHO’s recommendation for mild pain (1-3/10)?

A

Regularly scheduled non-opioids

Ex: APAP 1000mg q6h or Ibuprofen 600mg q6h

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3
Q

What is the WHO’s recommendation for moderate pain (4-6/10)?

A

Regularly scheduled analgesic with an added opioid

Ex: APAP 325/Codeine 60mg q4h or APAP 325/Oxycodone 5mg q4h

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4
Q

What is the WHO’s recommendation for severe pain (7-10/10)?

A

Regularly scheduled highly potent opioid

Ex: Morphine 10mg q4h or Hydromorphone 4mg q4h

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5
Q

What are the 11 things to document regarding persistent pain syndrome management?

A
  1. Pt’s functional level
  2. Aberrant behaviors
  3. Adverse drug reactions
  4. Focus s/s for pain monitoring
  5. Adequacy of analgesia
  6. Pt affect
  7. Pt adherence to pain management plan
  8. Date/result of most recent drug screen testing
  9. Date of most recent narcotic agreement
  10. Pt misuse or diversion potential
  11. Consultations
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6
Q

ASA: MOA

A

Inhibits COX-1 and 2

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7
Q

ASA: max daily dose

A

4g/24h

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8
Q

Acetaminophen: MOA

A

Blocks peripheral transmission

Inhibits CNS COX-1 and 2

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9
Q

Acetaminophen: max daily dose for healthy adult

A

4g/24h

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10
Q

What are the two classes of opioids?

A
  1. Pure agonists

2. Partial agonists/antagonists

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11
Q

Pure agonists are further divided into 3 classes

A
  1. Phenanthrenes (morphine, oxycodone, hydrocodone)
  2. Phenylpiperdine (meperidine, fentanyl)
  3. Diphenylheptane (methadone)
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12
Q

Excess stimulation of peripheral and CNS serotonin receptors can lead to….

A

Serotonin syndrome

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13
Q

What are some ways serotonin syndrome can occur?

A 
Increased 5HT production
Inhibited 5HT reuptake
Inhibited 5HT metabolism
Increased 5HT release
Stimulation of 5HT receptors
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14
Q

Name some opioid side effects

A 
Sedation
Constipation
Nausea
Pruritis
Nausea
Resp depression
Convulsions
Cough suppression
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15
Q

What enzyme metabolizes opioids?

A

CYP2D6

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16
Q

Does everyone have the ability to metabolize opioids?

A

No. ~10% of Caucasians lack the CYP2D6 enzyme.

Tell them to suck it up and rub some dirt on it already.

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17
Q

By itself, codeine is a ____ drug

A

Class II

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18
Q

As a combo product, codeine is a _____ drug

A

Class III

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19
Q

Codeine is a prodrug that gets metabolized into…

A

Morphine

20
Q

One time, on “Trauma, Life in the ER,” a nurse gave this guy a dose of an IV med.

The guy looks at her and says, “that tastes like heroine.”

The nurse says, “yeah, I just gave you some Morphine.”

The guy says, “I’ve been clean for three years. Why did you do that?”

A

Don’t be like that nurse.

21
Q

Hokay! Hydrocodone…Is Hydrocodone available as an individual drug or a combo?

A

Combo only (Lortab, Vicodin, Lorcet)

22
Q

Hydrocodone + APAP =

A

Vicodin

23
Q

Oxycodone - in what two forms is Oxycodone available?

A

Percocet - combo

Oxycontin - long acting monoproduct

24
Q

In addition to 2D6, what enzyme metabolizes Oxycodone?

A

3A4

25
Q

What is the “standard” high potency opioid analgesic?

A

Morhphine

26
Q

Morphine is available in what two release formulas?

A

MSIR - immediate release

MSER - extended release

27
Q

This set of cards is unlike my well organized pharm cards of the past. This pain med lecture doesn’t follow the usual pattern…

A

And this type A, anal retentive student isn’t having an easy time with it.

28
Q

So, in general, what is the MOA for any given opioid?

A

They bind to mu receptors in the CNS, inhibit ascending pain pathways, and alter pain perception. +/- cough suppression.

29
Q

Dilauded is more potent than Morphine. By how much?

A

PO 4x more

IV 5x more

30
Q

Demerol…what are some of the absorption issues with Demerol?

A

There is very erratic absorption when given IM.
Given PO, it takes 4x the IM dose to work.

Don’t be like Demerol.

31
Q

Fentanyl…There are reservoir issues, leading to what issue?

A

Onset of action can take 12-24 hours to occur.

Drug clearance can take as long after you D/C the drug.

32
Q

What effect does heat have on a Fentanyl patch?

A

It increases absorption.

33
Q

Naloxone: class

A

Competitive opioid antagonist

34
Q

Naloxone: MOA

A

Competes with and displaces narcotics at opiate receptors

35
Q

Naloxone: indication

A

Complete reversal of opioid drug impacts

36
Q

Naloxone: side effects

A

Withdrawal with catacholamine release (AMI, BP changes, agitation, dyspnea, diphoresis, etc)

37
Q

Agitation…that’s a way of saying it

A

Agitation…anger….fighting

Titrate to effect is all I’m saying

38
Q

Naloxone: monitor

A

RR, HR, BP, temp, LOC, SpO2

39
Q

Naloxone: t1/2

A

30-120 minutes…not as long the narcotic. Will likely need more dosing.

40
Q

One time I went to this house for an overdose, and I was placing an IV in this guys hand, and all of a sudden I realized my knee was wet…and that he was all wet….and then I smelled vanilla…

A

He shot up and decided to have some coffee. He went out while he was pouring vanilla creamer into his coffee.

41
Q

I was only kneeling in his coffee.

A

Don’t be like me. Look before you kneel. It might not be coffee the next time.

42
Q

What are the steps in establishing a longer term, high potency opioid dose schedule?

A
  1. Start with q4-6h dosing
  2. Titrate to pain control
  3. Calculate total 24h dose
  4. Convert to 24 hour equianalgesic dose –> long acting preparation
  5. Reduce total 24h dose by ~25%
  6. Divide into 2 dosing intervals (q12h)
  7. Add a lower does (10-20% of 24h total) for breakthrough pain
43
Q

Let’s look at an example of that…

A
  1. MSIR 10mg q6h
  2. Total 24h dose = 40mg MSIR
  3. 24h equianalgesic dose = 40mg (morphine to morphine)
  4. Reduce 40mg by 25% –> 30mg
  5. Divide dose to q12h dosing –> 15mg MSER q12h (note the change from immediate to extended release)
  6. 10-20% of 24h dose for breakthrough pain = 3-6mg….so give 5mg MSIR q4-6 hours PRN for breakthrough pain.
44
Q

That was easy

A

Right? Easy? If I keep telling myself that this is easy, everything with be oooookkkkaaaayyyyyyy.

45
Q

What are some adjunct drugs we can use for pain control?

A 
TCA
Clonidine
Anti seizure meds like Gabapentin, Lyrica, Carbamazepine
Cymbalta
Transdermal lidocaine
46
Q

So after all this fluff, what are the three points to remember about pain control?

A
  1. Function is key and the measure of success
  2. Non-drug modalities are very important and should be used fort or concomitantly
  3. Treatment agreements are important for your Pt’s wellness, and yours

Neuro Pharm (5 decks)

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