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Clinical Pharmacy 4 > Pain > Flashcards

Pain Flashcards

1
Q

Chronic pain is considered to be pain lasting over __________

A

12 weeks

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2
Q

Most people with LBP will have improvement in ________

A

4-6 weeks

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3
Q

Most people with LBP will have recurrence in _______

A

12 months

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4
Q

What is the aetiology of sciatica pain?

A
  • most people have some sort of disc herniation -> nerve root irritation
  • ruptured disc, or herniated disk is usually what causes this
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5
Q

What are the typical s/s of sciatic pain?

A
  • intermittent shooting pain
  • tingling or numbness
  • loss of strength
  • generally unilateral
  • worse than the LBP
  • numbess/tingling/pins and needles
  • positive results on a straight leg raise tests
  • weakness and reflux changes
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6
Q

With chronic pain, likely patients with be better within ______

A

3 months

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7
Q

What is a high pain intensity score often based on?

A
  • suffering, helplessness and hopelessness

- when we use exogenous opioids, we sacrifice normal healthy motivational behaviours, socialization and coping

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8
Q

What are the goals of therapy in chronic pain?

A
  • QOL
  • exercise
  • sleep
  • decreased pill burden
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9
Q

What are the short term opioid AE?

A
  • nausea, sedation, dizziness and cognitive impairment
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10
Q

What are the long term AE of opioids?

A
  • constipation, dependence, tolerance, dental problems, hypogonadism, unintentional overdose, opioid therapy may paradoxically induce abnormal pain sensitivity, including hyperalgesia and allodynia
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11
Q

What is the opioid efficacy in neuropathic pain?

A
  • not really a lot of efficacy in this space

- in chronic neuropathic pain, we should not be using opioids

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12
Q

Response to opioids is less likely if what?

A
  • if there was minimal improvement after 2-3 dose increases
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13
Q

What are the non-pharm options for pain?

A
  • heat
  • massage
  • yoga/tai chi
  • exercise
  • physio
  • acupuncture
  • behavioural therapy
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14
Q

What is the benefit of exercise with pain?

A
  • exercise will not make sciatica go away, but it will make people lose wight and will help with mood
  • exercise will help prevent recurrences in injury - help to increase strength and mobility- core strengthening and balance training
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15
Q

When is the only time muscle relaxants are warranted?

A
  • if spasms are involved
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16
Q

Talk about dosing with cyclobenzaprine?

A
  • high doses do not work better than low doses
  • sedative may still be an issue in the morning
  • effect within the first 4 days
    • this drug likely only really helps people sleep**
  • do not use beyond 2 weeks
17
Q

What agents will help improve global effect?

A
  • acupuncture
  • chiropractic
  • epidural injections
  • non-opioid
  • manipulation
18
Q

What are the SE associated with corticosteroid injections?

A
  • headache, nauseas, abscesses in the epidural space, paralysis
19
Q

Does pregabalin work at all with sciatica?

A
  • NO - no better than placebo
20
Q

Is duloxetine much better than placebo?

A
  • NO

- when placebo drops by 2 points, then duloxetine drops by 2.5 points

21
Q

What are the main SE associated with TCAs?

A
  • weight gain
  • dry mouth
  • sedation
  • orthostatic hypotension
22
Q

What are the main SE associated with gabapentin?

A
  • drowsiness, dizziness, edema (caution in elderly, existing edema, fall risk)
23
Q

What are the main SE associate with duloxetine?

A
  • nausea
  • increased BP
  • dizziness (caution in HTN and bipolar disorder)
24
Q

Does sedation as a SE last a long time?

A

no- sedation fades away over time

25
Q

Naproxen is cardiovascular _____

A

neutral

26
Q

Celebrex is cardio _______

A

neutral at 200 mg or less and as long as the person does not have heart failure

27
Q

What are the efficacy monitoring points?

A
  • an increase in general activity
  • mood
  • walking/activity
  • normal work
  • relations with other people
  • sleep
28
Q

What is a reasonable f/u time in pain?

A

2-4 weeks is reasonable

29
Q

What is a reasonable f/u time with sciatica?

A
  • back pain should be followed up in a 5-6 month time- should monitor then

Clinical Pharmacy 4 (7 decks)

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