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Advanced Principles 2 > Pain lecture part 2 > Flashcards

Pain lecture part 2 Flashcards

1
Q

The primary action of oxymorphone is

A

Mu (respiratory depression)

some delta activity (psychomimetic)

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2
Q

Hydrocodone has activity on

A

Mu, some Kappa (dysphoria)

combined with acetaminophen

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3
Q

Hydromorphone as activity on

A

Mu & Kappa (dysphoria)

-may be used intrathecally

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4
Q

Methadone is a

A

NMDA antagonist
Mu agonist
cardiotoxic

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5
Q

Tramadol is a

A

weak opioid analogue of codeine
considered to be non-addictive but can be
not safer than opioids

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6
Q

Opioid therapy for chronic pain is

A

NOT a good long term solution

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7
Q

Tolerance to opioids over time includes

A

opioid induced hyperalgesia

rotation of opioids improve analgesia and reduce side effects

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8
Q

Corticoid steroids commonly used in pain management include

A

methylprednisolone
triamcinolone
betamethasone

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9
Q

All steroids have some

A

mineralcorticoid effects such as sodium retention & insulin resistance

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10
Q

Long acting particulate steroids can cause ______ if vascular injection

A

spinal infarct

-short acting dexamethasone is okay

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11
Q

Frequent side effects of steroids include

A

fluid retention

hyperglycemia with increased insulin requirements

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12
Q

Infrequent side effects of steroids include

A 
hypertension
amenorrhea
hypokalemia 
exacerbation of CHF
anaphylactoid/hypersensitivity reactions
adrenal suppression
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13
Q

Long term use of steroids causes

A

hyperpigmentation
osteoporosis
myopathy

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14
Q

Topical steroids can be used for

A

multiple chronic pain syndromes because they have continued peripheral nerve stimulation,
high benefit/low risk

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15
Q

Sleep aids can

A

decrease pain because lack of sleep contributes to pain and vice versa
-sleep aids combined with pain medications pose a significant risk

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16
Q

Treatment for sleep should begin with

A

non-pharmaceuticals & include
mechanical aids (pillows, positioning)
natural aids, exercise (stretching), biofeedback

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17
Q

Antidepressant considerations

A

complimentary to pain medications
not appropriate for acute pain (take days to weeks to be effective)
increased compliance and mood reported

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18
Q

Pain due to changes in sensory process may be effectively treated with

A

anticonvulsants

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19
Q

Anticonvulsants may treat

A

fibromyalgia (functional pain)
trigeminal neuralgia- most effective
little evidence exists for support of other treatments

20
Q

NMDA receptors may play a role in

A

Alzheimers disease and schizophrenia

21
Q

NMDA receptors are critical in

A

synaptic plasticity, a cellular mechanism for learning and memory

22
Q

NMDA antagonists include

A

Ketamine
PCP
robitussin
methadone

23
Q

Low dose ketamine has been studied for the treatment of

A

complex regional pain syndrome

24
Q

Preemptive treatment with NMDA antagonist may be effective to prevent

A

post-operative pain hypersensitivity (0.25 mg/kg)

25
Q

Muscle relaxants should not be used

A

as a first line agent & should be limited for use for a short amount of time
used for myofascial pain

26
Q

Pain has ______ consequences

A

psychological

27
Q

______ & _____ often develop simultaneously

A

chronic pain & depression

28
Q

The two dimensions of perceptive pain include

A 
sensory discriminators in dorsal
sensory cortex (causes perception of pain)
29
Q

The most common cause of pain and disability is

A

lumbar radicular syndrome

30
Q

Causes of lumbar radicular syndrome include

A

various
discogeic, osteogenic, neurogenic
associated nerve root inflammation

31
Q

The purpose of treatment for lumbar radicular syndrome is to

A

reduce nerve root pressure caused by inflammation

32
Q

Symptoms of lumbar radicular syndrome include

A

pain, parestehsia, and/or numbness following a particular dermatomal distribution, diminished reflexes, increased pain with straight-leg raises

33
Q

Treatment options for lumbar radicular syndrome include

A

interlaminar ESI
transforaminal ESI
caudal ESI

34
Q

Interlaminar ESI includes

A

catheter or without
lowest risk
lowest results

35
Q

Transforaminal ESI includes

A

highest risk

best results

36
Q

Caudal ESI includes

A

most versatile
good results
catheter recommended for lumbar

37
Q

Red flags for lumbar radicular syndrome (i.e. explore other possibilities)

A 
<20 years old, congenital issue
>50 years, rule out malignancy, AAA
short term <3 m. more serious etiology 
recent trauma
ay signs of infection 
unrelated pain 
incontinence, bilateral neurological symptoms (excluding pain)
38
Q

Describe the symptoms of facet arthropathy.

A

focal pain over joint, no significant radiculopathy, no neurological deficit, pain exaggerated on twisting movement

39
Q

Qualifications for insurance pre-authorization includes:

A

must have radicular symptoms following a specific dermatome
must have failed conservative treatment for three weeks (NSAIDs, PT, etc.)
must have an average pain score greater than 6 out of 10
must cause reduction in ability to work and perform ADL
must not be at more than two levels

40
Q

Qualifications for repeat injection include

A

must have had greater than 50% improvement from first injection
must have shown improved mobility
must not have more than 3 injections in a six month period of time

41
Q

The purpose of the SI joint is

A

shock absorption for the spine, along with the job of torque conversion

42
Q

Symptoms of sacroiliac joint syndrome include

A

pain in the superior medial buttock, lateral buttock, radiation to the hip and groin

43
Q

Symptoms of occipital neuritis include

A

headaches that originate in the neck and radiate along the occipital skull to the top of the head and later to ear

44
Q

Patient barriers to treat pain include

A 
lack of access to care
ignorance and fear of treatment
misinformation 
cultural issues
provider barriers
inadquate continuing education 
lack of pain treatment as a prioirty 
absence of adequate pain monitoring 
regulatory hostility toward aggressive pain treatment 
lack of empathy
45
Q

Consequences of failure to treat pain include

A 
debilitation 
lower quality of life
depression 
divorce 
suicide

Advanced Principles 2 (42 decks)

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