Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pain > Pain management > Flashcards

Pain management Flashcards

1
Q

How should you treat acute/temporary pain?

A

remove the cause, treat early, use least potent analgesic, properly titrate dose, and admin for adequate amt of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What forms is acetaminophen available in?

A

oral, rectal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the MOA of acetaminophen?

A

weak COX-1/2 inhibitor, decreases pain but has no anti-inflammatory effects. is a anti-pyretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the dosages of acetaminophen?

A

325-1000mg every 4-6 hours. max dose 4gm/day. onset 15-30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are SE of acetaminophen?

A

large doses cause liver toxicity, lethality, dizziness, disorientation. Normal doses can cause renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the MOA of aspirin (salicylic acid)?

A

irreversibly inhibits COX and inhibits platelet aggregration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the effects of aspirin on the body?

A

reduces mild/moderate pain thru its effects on inflammation. inhibits pain stimuli at subcortical site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What else besides pain is aspirin used for?

A

anti-pyretic, decrease thrombosis after CABG, long-term use reduces risk of colon cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What patient popn should not receive aspirin and why?

A

children under 12 yrs old to avoid the development of Reye’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the SE of aspirin?

A

GI upset/ulcers, hepatotoxicity, renal toxicity, asthma, rashes, salicylism, overdoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe salicyclism

A

vomiting, tinnitus, decreased hearing and vertigo due to too high of aspirin dose. is reversible with reduced dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens as a result of toxic levels of aspirin?

A

metabolic acidosis, respiratory depression, cardiotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are indications of NSAIDS?

A

mild to moderate pain of somatic origin due to soft tissue injury, HA, arthritis. anti-pyretic (ibuprofen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the MOA of NSAIDS?

A

inhibits cyclooxygenase, impairing the transformation of arachnidonic acid to prostaglandins, prostacyclins, and thromboxanes. nonselective inhibitors of COX-1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are physiologic effects of prostaglandins?

A

activation of the inflammatory response, elicitation of pain/fever, contraction/relaxation of smooth muscle, inhibition of acid synthesis and increased secretion of stomach mucus, increased blood flow to kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the GI SE of NSAIDS?

A

N/V, heartburn, ulcers/bleeding, diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the renal SE of NSAIDS?

A

Na and H2O retention, HTN, damaging if taken with other nephrotoxic drugs (ACE, diuretics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the dosages for ibuprofen (advil/motrin)?

A

200/400 mg every 4 hrs. No more than 600mg every 6 hrs or 3200mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the dosages for naproxen (aleve)?

A

250-500mg every 12 hrs. max daily dose 1000mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different chemical classes of prescription NSAIDS?

A

propionic acid derivatives, acetic acid derivatives, enolic acid derivatives, fenamic acid derivatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some propionic acid derivatives?

A

ketoprofen (Orudis), naproxen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some acetic acid derivatives?

A

indomethacin, ketorolac (Toradol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some enolic acid derivatives?

A

peroxicam (Feldine), meloxicam (Mobic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a fenamic acid derivative?

A

mefanamic acid (Ponstel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the benefits of NSAIDS that are selective COX-2 inhibitors?

A

as effective as other NSAIDS, less GI toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the one COX-2 inhibitor and what is it used for?

A

Celecoxib (Celebrex), good for arthritis. onset is 3 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Who is at risk for gastroduodenal toxicity with NSAID use?

A

age >65, use of anticoagulants, previous GI bleed, acute PUD, use of glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are other considerations for NSAID use besides the risk of gastroduodenal activity?

A

take with food, give daily or BID instead of TID, know renal status and other meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are three indications for opioid use?

A

acute postop pain, severe pain, chronic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the MOA of opioids?

A

exert effects on Mu1/2, delta, kappa receptors that are widely distributed thruout the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where are the most profound analgesic effects of opioids mediated?

A

through the Mu receptors within the CNS, a large number are in the periaquaductal gray matter and dorsal horn of spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the three chronic nonmalignant types of pain?

A

nociceptive, neuropathic, mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the three most critical SE of opioids?

A

delayed gastric emptying (constipation), euphoria, addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the other SE of opioids besides constipation, addiction, and euphoria?

A

N/V, hypotension, bradycardia, sedation, respiratory depression, physical dependence, tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define physical dependence

A

body is dependent on receiving a medication and will go into physical withdrawal if it does not get it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are some withdrawal symptoms of opioid abuse?

A

anxiety, volatility, HTN, tachycardia, diaphoresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Define tolerance

A

an increasing amt of drug is required to produce an equivalent level of efficacy that was previously achieved with a lower dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Define addiction

A

psychological dependence, results in extreme behavior patterns associated w/procuring and consuming the drug

39
Q

What are the different ways morphine can be administered?

A

IM, IV, orally, rectally, intrathecally

40
Q

When should morphine be used?

A

for severe pain

41
Q

What is the onset and dosages of morphine

A

onset 5-30 min depending on route. IV: 2-5mg slowly. IM: 10-15mg, orally: 10-30mg BID

42
Q

When is demerol used?

A

severe pain

43
Q

What are the routes of admin for demerol?

A

IV, IM

44
Q

What are the dosages for demerol?

A

25-50mg slow IV push

45
Q

What is methadone used to treat?

A

opioid dependence and heroin withdrawal

46
Q

Why is methadone used to wean pts off opioids?

A

It has extended duration of action with slow onset that reduces the euphoric effects

47
Q

What is oxycodone used to treat?

A

severe pain, chronic pain

48
Q

What are the different combinations of oxycodone with another agent?

A

oxycodone/acetaminophen (percocet, roxicet), oxycodone/aspirin (percodan)

49
Q

What are some other combinations of opioids meds besides the oxycodone combos?

A

hydrocodone/acetaminophen (vicoden), hydrocodone/ASA (lortab), codeine/acetaminophen (tylenol #3)

50
Q

What does WHO recommend for use of opioid analgesics?

A

Give on a fixed schedule around the clock and not on a PRN basis for the best pain control

51
Q

Name an opioid reversal medication and what it can be used for?

A

Naloxone (Narcan). injection is indicated for respiratory depression induced by opioids. Also used for opioid/heroin overdoses

52
Q

What is the dosage for Narcan?

A

repeated every 2-3 minutes as needed to reach appropriate respiratory level (12-14) NOT to reach full alertness

53
Q

Describe Fentanyl

A

very strong mu opioid agonist, 100x more potent then morphine

54
Q

What are the different forms fentanyl is available in?

A

IV, transdermal patch, suckers

55
Q

What is fentanyl used for?

A

surgery for quick onset pain relief, post-op pain control, chronic pain

56
Q

What is the hypothesized MOA for tramadol?

A

binds w/low affinity to mu opioid receptors, inhibits reuptake of NE an serotonin. Does not inhibit production of prostaglandins

57
Q

What is tramadol used for?

A

mild to moderate pain and neuropathic pain

58
Q

What are SE of tramadol?

A

HA, dizziness, nausea, constipation, somnolence

59
Q

When is a pain contract used?

A

when a pt is being treated w/opioids for chronic pain a contract is made btw provider and pt

60
Q

What purpose does the pain contract serve?

A

to provide informed consent, foster adherence to treatment, limit abuse, improve efficacy of treatment program

61
Q

What components are included in a pain contract?

A

informed consent, rx come from only one provider and pharmacy, meds taken as prescribed, no early refills, lack of adherence may result in discontinuation of opioid therapy

62
Q

What kind of pain are TCAs used for?

A

chronic pain, especially neuropathic

63
Q

What is the MOA of TCAs?

A

analgesic properties are associated w/their action as serotonin and NE reuptake inhibitors. may potentiate the endogenous opioid system

64
Q

How do you prescribe TCAs?

A

give at lower doses than what’s used for depression and titrate up. takes 4-6 weeks to see a response

65
Q

What are anticholinergic SE of TCAs?

A

dry mouth, constipation, urinary retention, blurred vision paralytic ileus

66
Q

When are TCAs contraindicated?

A

patients w/severe cardiac disease, patients with conduction disturbances, and patients with severe GI dysfxn

67
Q

What are the TCA drugs?

A

amitriptyline (elavil), doxepin (sinequan), imipramine (Tofranil), Nortriptyline (Pamelor), Desipramine (norpramin)

68
Q

Discuss amitriptyline

A

most widely used TCA, strong anticholinergic effect

69
Q

Discuss doxepin

A

CI with acute angle glaucoma. SE increased appetite, weight gain, impotence in men

70
Q

Discuss nortriptyline

A

minimal anticholienergic SE

71
Q

Discuss desipramine

A

high risk of cardiac dysrhythmias

72
Q

How are anticonvulsants used for the treatment of pain?

A

used for neuropathic and other mild/moderate chronic pain states

73
Q

What are anticonvulsant meds?

A

Gabapentin (neurontin), pregabalin (lyrica), lamotrigne (lamictal), topiramate (topamax), carbamaepine (tegretol)

74
Q

Describe gabapentin and its use

A

doesn’t act on GABA receptors, structurally related to GABA. usually first line med. can’t be used with trigeminal neuralgia

75
Q

What is the dosage for gabapentin?

A

1800-3600mg/day

76
Q

What are SE of gabapentin?

A

Somnolence, ataxia, nausea, diarrhea, dizziness, fatigue, mood swings

77
Q

What is pregabalin (lyrica) used for?

A

peripheral neuropathy, fibromyalgia, trigeminal neuraglia

78
Q

What are the SE of pregabalin (lyrica)?

A

somnolence, weight gain, dizziness, blurred vision, dry mouth, peripheral edema

79
Q

What is the theorized MOA for lamotrigine (lamictal)?

A

stabilize neuronal membranes thru inhibition of Na channels

80
Q

What are SE of lamotrigine (lamictal)?

A

steven’s johnson, rash, dizziness, ataxia, n/V

81
Q

What is steven’s johnson syndrome?

A

mild rash to severe skin peeling. can be lethal

82
Q

What is the MOA of Topiramate (Topamax)?

A

blocks voltage dependent Na channels which potentiates the action of inhibitory GABA transmission

83
Q

What are SE of topiramate (topamax)?

A

loss of appetite, weight loss, diarrhea, somnolence

84
Q

What is carbamazepine (tegretol) used for?

A

drug of choice for trigeminal neuralgia

85
Q

What are potential drug interactions of carbazepine (tegretol)?

A

many because it effects the CP450 system

86
Q

What test should be done prior to prescribing and with long term use of carbamazepine (tegretol)?

A

CBC, LFT

87
Q

What are SE of carbamazepine (tegretol)?

A

dizziness, ataxia, n/v, liver toxicity, rash, steven’s johnson syndrome

88
Q

What is duloxatine (cymbalta) used for?

A

SNRI antidepressant, indicated for treating diabetic peripheral neuropathy, fibromyalgia, chronic LBP

89
Q

What dosage should you use for duloxatine (cymbalta)?

A

30-60mg/day

90
Q

What are SE of duloxatine (cymbalta)?

A

dry mouth, fatigue, nausea, constipation, insomnia or somnolence

91
Q

What are CI to duloxatine (cymbalta)?

A

patient’s with hepatic or severe renal disease

92
Q

Describe intrathecal injection for pain management

A

an injection into the space around the spinal cord. used for LBP. usually there is a reservoir of an opioid analgesic that’s pumped in

93
Q

Describe epidural injection for pain management

A

one time injection by anesthesiologist. injects marcaine and steroid. may be repeated if patient obtains relief

pain (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions