Pain Management Flashcards
Definition: tissue injury thar activates specific pain receptors
nociceptive pain
What are the two types of nociceptice pain?
somatic & visceral
List the characteristics of visceral pain. (2)
associated with internal organs; hard to pinpoint exact location
What is the main characteristic of somatic pain?
easy to pinpoint the exact location of the pain
How will patients usually describe nociceptive pain?
dull, throbbing, stabbing, aching
Definition: pain due to damage of the nerves
neuropathic pain
How will patients usually describe neuropathic pain?
burning, numbness, tingling
List the questions involved in pain assessment.
Onset; provokes; quality; radiate; severe; time; understanding
What question should you always ask patients before prescribing opioids?
Are you having regular bowel movements?
What would you give a patient who rates their pain as a 7-10?
opioids
What would you give a patient who rates their pain as a 4-6?
combination products/mild opioids
What would you give a patient who rates their pain as a 1-3?
non-opioids (acetaminophen, NSAIDs)
What is the max dose of morphine?
Trick question: there isn’t one
How are morphine metabolites excreted?
renally (do not use in patients with renal insufficiency)
Does oxycodone have an IV formulation?
no
What metabolizes oxycodone?
CYP2D6
What is the most potent opioid?
fentanyl
Can patients with renal and/or hepatic dysfunction use fentanyl?
yes
In what patient populations would you use methadone? (3)
pain refractory to opioids; neuropathic pain; low cost is important
What is important to think about with methadone? (hint: half-life)
half-life is very unpredictable; risk of QT prolongation
When switching between opioids, how much should you dose-reduce?
25%
What should all opioid patients be on?
bowel regimen consisting of a stimulant laxative and stool softener
Which opioid most commonly cause pruritus?
morphine
Do patients develop tolerance to constipation due to opioid use?
No
What is the dose-limiting toxicity of opioids?
respiratory depression
What do you administer to treat respiratory depression?
naloxone given slowly through IV
When are patients at the highest risk for respiratory depression and over-sedation?
in the first 24 hours after surgery
In what patient population would you use a celiac plexus block?
patients with pancreatic cancer
Definition: group of nerves that supply organs in the abdomen
celiac plexus
When would you use an intrathecal pain pump?
in patients who are not obtaining relief with elevated doses of opioids
Would you use a larger or smaller dose of opioids when using an intrathecal pain pump?
smaller (300:1)
What does an On-Q pump do?
delivers local anesthetic on or near the surgical site
List the types of bone-modifying agents. (2)
bisphosphonates (zolendronic acid, alendronate); RANK-L inhibitor (denosumab)
When would you use radiation therapy for pain management? (3)
painful bony metastases; brain metastases; spinal cord compression
