Pain & ICU

Question 1

SOS mnemonic for pain

Answer 1

Screening

OCA (Opioid Care Agreement)

Surveillance

Question 2

A patient taking more than 100 mg of morphine has what percent chance of overdosing in the following year?

Answer 2

7-9%

Question 3

What is the ORT?

Answer 3

Opioid Risk Tool

50-item yes or no self-report that is designed to predict the probability of a patient’s displaying aberrant behavior when prescribed opioids for chronic pain

0-3 = low risk

4-7 = moderate risk

> 8 = high risk

Question 4

What DIRE score is needed to start a patient on opioids

Answer 4

13 or more

The DIRE is a clinician-rated scale designed to predict the analgesic efficacy of, and patient compliance to, long-term opioid treatment in the primary care setting

Question 5

4 A’s of pain

Answer 5

Analgesia

Activities of daily living

Adverse effects

Aberrant behavior

Question 6

True/False: patients on chronic opioid treatment have 5 times more risk of having constipation

Answer 6

True

Question 7

In addition to constipation, taking opioids can also cause…

Answer 7

hypogonadism

Question 8

Informed consent agreement, patient education, and treatment clinicians/clinics are components of the ______ step of the SOS method.

Answer 8

OCA

Question 9

Diagnosis, Risk Assessments, and Baseline UDT are activities that fall under the ______ step of the SOS method?

Answer 9

Screening

Question 10

What should be your “go to” drugs to provide Analgesia for mechanically ventilated patients in the ICU?

Answer 10

Fentanyl 50-100 mcg prn or

Morphine 2-5 mg prn or

Dilaudid 0.2-1 mg prn

Question 11

When should you choose fentanyl

Answer 11

For acute pain

PROS: Quick on/off

CONS: w/ gtt it can keep redistributing out of fat (prolonged effect)

Question 12

When should you avoid morphine?

Answer 12

Morphine is effective, but…

• it is broken down into active metabolites that are renally excreted (i.e., avoid in patients w/ RF)
• it is extremely sedating (bad for patients that require schedule neuro checks)

Question 13

If your mechanically ventilated patient in the ICU has pain that is not well controlled with < 2-3 doses/hr, what next?

Answer 13

Fentanyl 50-200 mcg/hr gtt

and Fentanyl 25-50 mcg prn

gtt = drip

Question 14

What is the sedation goal for mechanically ventilated patients?

Answer 14

RASS (-1 to 0)

Question 15

What drugs can you give mechanically ventilated patients if they are under-sedated?

Answer 15

1. Propofol 5-30 mcg/kg/min
2. Precedex 0.2-1.5 mcg/kg/hr (if delirous/weaning)
3. Midazolam 1-3 mg prn (only in alcohol withdrawal or propofol intolerance)

Question 16

True/False

Precedex works 50-60% of the time

Answer 16

True

Remember MOA = alpha 2 agonist that decreases HR/BP by blocking central adrenergic outflow

Question 17

What opioid is good for neurosurgical patients?

Answer 17

Remifentanil

Question 18

What is exparel?

Answer 18

Liposomal bupivacaine

used during surgery to provide long-lasting pain relief and decrease post-op opioid use

Question 19

Which pain medication is known to decrease opioid use following surgery when used intraoperatively?

Answer 19

Gabapentin