Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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
What are the benefits of NSAIDS that are selective COX-2 inhibitors?
as effective as other NSAIDS, less GI toxicity
26
What is the one COX-2 inhibitor and what is it used for?
Celecoxib (Celebrex), good for arthritis. onset is 3 hrs
27
Who is at risk for gastroduodenal toxicity with NSAID use?
age >65, use of anticoagulants, previous GI bleed, acute PUD, use of glucocorticoids
28
What are other considerations for NSAID use besides the risk of gastroduodenal activity?
take with food, give daily or BID instead of TID, know renal status and other meds
29
What are three indications for opioid use?
acute postop pain, severe pain, chronic pain
30
What is the MOA of opioids?
exert effects on Mu1/2, delta, kappa receptors that are widely distributed thruout the body
31
Where are the most profound analgesic effects of opioids mediated?
through the Mu receptors within the CNS, a large number are in the periaquaductal gray matter and dorsal horn of spinal cord
32
What are the three chronic nonmalignant types of pain?
nociceptive, neuropathic, mixed
33
What are the three most critical SE of opioids?
delayed gastric emptying (constipation), euphoria, addiction
34
What are the other SE of opioids besides constipation, addiction, and euphoria?
N/V, hypotension, bradycardia, sedation, respiratory depression, physical dependence, tolerance
35
Define physical dependence
body is dependent on receiving a medication and will go into physical withdrawal if it does not get it
36
What are some withdrawal symptoms of opioid abuse?
anxiety, volatility, HTN, tachycardia, diaphoresis
37
Define tolerance
an increasing amt of drug is required to produce an equivalent level of efficacy that was previously achieved with a lower dose
38
Define addiction
psychological dependence, results in extreme behavior patterns associated w/procuring and consuming the drug
39
What are the different ways morphine can be administered?
IM, IV, orally, rectally, intrathecally
40
When should morphine be used?
for severe pain
41
What is the onset and dosages of morphine
onset 5-30 min depending on route. IV: 2-5mg slowly. IM: 10-15mg, orally: 10-30mg BID
42
When is demerol used?
severe pain
43
What are the routes of admin for demerol?
IV, IM
44
What are the dosages for demerol?
25-50mg slow IV push
45
What is methadone used to treat?
opioid dependence and heroin withdrawal
46
Why is methadone used to wean pts off opioids?
It has extended duration of action with slow onset that reduces the euphoric effects
47
What is oxycodone used to treat?
severe pain, chronic pain
48
What are the different combinations of oxycodone with another agent?
oxycodone/acetaminophen (percocet, roxicet), oxycodone/aspirin (percodan)
49
What are some other combinations of opioids meds besides the oxycodone combos?
hydrocodone/acetaminophen (vicoden), hydrocodone/ASA (lortab), codeine/acetaminophen (tylenol #3)
50
What does WHO recommend for use of opioid analgesics?
Give on a fixed schedule around the clock and not on a PRN basis for the best pain control
51
Name an opioid reversal medication and what it can be used for?
Naloxone (Narcan). injection is indicated for respiratory depression induced by opioids. Also used for opioid/heroin overdoses
52
What is the dosage for Narcan?
repeated every 2-3 minutes as needed to reach appropriate respiratory level (12-14) NOT to reach full alertness
53
Describe Fentanyl
very strong mu opioid agonist, 100x more potent then morphine
54
What are the different forms fentanyl is available in?
IV, transdermal patch, suckers
55
What is fentanyl used for?
surgery for quick onset pain relief, post-op pain control, chronic pain
56
What is the hypothesized MOA for tramadol?
binds w/low affinity to mu opioid receptors, inhibits reuptake of NE an serotonin. Does not inhibit production of prostaglandins
57
What is tramadol used for?
mild to moderate pain and neuropathic pain
58
What are SE of tramadol?
HA, dizziness, nausea, constipation, somnolence
59
When is a pain contract used?
when a pt is being treated w/opioids for chronic pain a contract is made btw provider and pt
60
What purpose does the pain contract serve?
to provide informed consent, foster adherence to treatment, limit abuse, improve efficacy of treatment program
61
What components are included in a pain contract?
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
What kind of pain are TCAs used for?
chronic pain, especially neuropathic
63
What is the MOA of TCAs?
analgesic properties are associated w/their action as serotonin and NE reuptake inhibitors. may potentiate the endogenous opioid system
64
How do you prescribe TCAs?
give at lower doses than what's used for depression and titrate up. takes 4-6 weeks to see a response
65
What are anticholinergic SE of TCAs?
dry mouth, constipation, urinary retention, blurred vision paralytic ileus
66
When are TCAs contraindicated?
patients w/severe cardiac disease, patients with conduction disturbances, and patients with severe GI dysfxn
67
What are the TCA drugs?
amitriptyline (elavil), doxepin (sinequan), imipramine (Tofranil), Nortriptyline (Pamelor), Desipramine (norpramin)
68
Discuss amitriptyline
most widely used TCA, strong anticholinergic effect
69
Discuss doxepin
CI with acute angle glaucoma. SE increased appetite, weight gain, impotence in men
70
Discuss nortriptyline
minimal anticholienergic SE
71
Discuss desipramine
high risk of cardiac dysrhythmias
72
How are anticonvulsants used for the treatment of pain?
used for neuropathic and other mild/moderate chronic pain states
73
What are anticonvulsant meds?
Gabapentin (neurontin), pregabalin (lyrica), lamotrigne (lamictal), topiramate (topamax), carbamaepine (tegretol)
74
Describe gabapentin and its use
doesn't act on GABA receptors, structurally related to GABA. usually first line med. can't be used with trigeminal neuralgia
75
What is the dosage for gabapentin?
1800-3600mg/day
76
What are SE of gabapentin?
Somnolence, ataxia, nausea, diarrhea, dizziness, fatigue, mood swings
77
What is pregabalin (lyrica) used for?
peripheral neuropathy, fibromyalgia, trigeminal neuraglia
78
What are the SE of pregabalin (lyrica)?
somnolence, weight gain, dizziness, blurred vision, dry mouth, peripheral edema
79
What is the theorized MOA for lamotrigine (lamictal)?
stabilize neuronal membranes thru inhibition of Na channels
80
What are SE of lamotrigine (lamictal)?
steven's johnson, rash, dizziness, ataxia, n/V
81
What is steven's johnson syndrome?
mild rash to severe skin peeling. can be lethal
82
What is the MOA of Topiramate (Topamax)?
blocks voltage dependent Na channels which potentiates the action of inhibitory GABA transmission
83
What are SE of topiramate (topamax)?
loss of appetite, weight loss, diarrhea, somnolence
84
What is carbamazepine (tegretol) used for?
drug of choice for trigeminal neuralgia
85
What are potential drug interactions of carbazepine (tegretol)?
many because it effects the CP450 system
86
What test should be done prior to prescribing and with long term use of carbamazepine (tegretol)?
CBC, LFT
87
What are SE of carbamazepine (tegretol)?
dizziness, ataxia, n/v, liver toxicity, rash, steven's johnson syndrome
88
What is duloxatine (cymbalta) used for?
SNRI antidepressant, indicated for treating diabetic peripheral neuropathy, fibromyalgia, chronic LBP
89
What dosage should you use for duloxatine (cymbalta)?
30-60mg/day
90
What are SE of duloxatine (cymbalta)?
dry mouth, fatigue, nausea, constipation, insomnia or somnolence
91
What are CI to duloxatine (cymbalta)?
patient's with hepatic or severe renal disease
92
Describe intrathecal injection for pain management
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
Describe epidural injection for pain management
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