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Palliative Care > Pain management > Flashcards

Pain management Flashcards

1
Q

Indications for rotating opioids

A
  • dose-limiting side effects (sedation, nausea, pruritis, myoclonus)
  • Need for new dosing route
  • Cost/insurance changes
  • Inadequate analgesia despite dose escalation of current opioid
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2
Q

Brief pain inventory

A

assesses pain influence and mood and function

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3
Q

McGill Pain Questionnaire

A

Evaluates pain qualities

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4
Q

Methylnatrexone MOA

A

mu-opioid receptor antagonist
Reversed opioid induced constipation and urinary retention and pruritis.

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5
Q

MOA and use clonidine

A

alpha 2 adrenergic agonist

Used as neuraxial adjuvant – reduces concentration of local anesthetic need
increases duration of sensory block
decreased adrenal stress response

SE: hypotension, sedation, bradycardia

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6
Q

CYP450 inhibitors

A

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

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7
Q

CYP450 inducers

A

Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas

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8
Q

CYP2D6 inhibitors

A

Bupropion
Dacomitinib
Fluoxetine
Paroxetine
Quinidine
Tipranavir

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9
Q

Medications metabolized by CYP2D6

A

Amitriptyline, clozapine, desipramine, flecainide, haloperidol, nortriptyline, risperidone, and valbenazine

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10
Q

Neuraxial conversions

A

Morphine
PO 300
IV 100
epidural 10
intrathecal 1

(fentanyl IV 15:1 intrathecal, 3:1 epidural)

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11
Q

Use of Behavioral pain scale

A

For critically ill pts

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12
Q

which opioids have no phase one metabolism with CYP450

A

Oxy, morphine, hydromorphone

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13
Q

Metabolism of gabapentin

A

Renally excreted
peak concentration 2-3 hr

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14
Q

Pathophys of hyperalgesia caused by chronic opioid use

A

Increased neuronal activity in dorsal horn
Sensitization of afferent neurons
Increased expression of substance P

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15
Q

Nerve block for pancreatic cancer, distal 2/3 esophagus to transverse colon

A

Celiac plexus block (T12-L1)

or splanchnic nerve block (for visceral pain; T5-T12)

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16
Q

Nerve block for descending colon to rectum and urogenital

A

Superior hypogastric plexus block

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17
Q

Nerve block for distal pelvic structures, anus, rectum

A

Ganglion impar block

18
Q

Metabolites of morphine

A

Morphine-3-glucuronide (acts as a convulsant)
Morphine- 6- glucuronide (responisble for the pain relief effect)

19
Q

signs of morphine build up

A

convulsions, agitation, hallucinations, hyperalgesia, coma

20
Q

Opioid side effects that do not resolve with tolerance

A

Constipation
Miosis

21
Q

Rate to taper opioids

A

10% of original dose per week.

22
Q

Signs that opioid is being tapered too quickly

A

hyperactive bowel sounds
temp instability
pain
sense of impending doom

peak sx 2-3 days (resolve in 5-10; cravings insomnia and dysphoria can last wks to mos)

23
Q

Most potent opioid

A

Sufentanil

(Sufentanil>fentanyl>hydromorphone>oxymorphone>morphine>hydrocodone)

24
Q

Mechanism of neuropathic pain

A
  1. ectopy from injured nerves (increased NA channels)
  2. up reg receptors around C-fibers (heat sensing)
  3. phenotype switch to wide dynamic range neurons
  4. Loss of K channels
  5. decreased expression of opioid receptions
  6. new collateral peripheral afferents to sympathetic fibers
25
Q

Chemo meds that cause neuropathic pain

A

Acute: oxaliplatin and paclitaxel

Chronic: carboplatin, cisplatin, bortezomib, lenalidomide, thalidomide

26
Q

Methadone conversion: OME<60

A

2.5mg PO q8h max

27
Q

Methadone conversion: 60-199 OME

A

10:1 ratio (<30mg/d max)

28
Q

Methadone conversion: >200 OME

A

20:1 ratio (<30mg/d max)

29
Q

Starting dose of morphine PO

A

5-10mg

30
Q

Starting dose of hydromorphone PO

A

1-2mg

31
Q

Starting dose of oxycodone

A

2.5-5mg

32
Q

Timing of dose adjustment for long acting medications

A

2-3 days

33
Q

Timing of dose adjustment for transdermals

A

3-6 days

34
Q

Timing of dose adjustment of methadone

A

5-7days

35
Q

For which pain syndrome is acupuncture most effective

A

Migraine headache

36
Q

First line treatment fir patient with mild opioid use disorder

A

Naltrexone
3-6 days after last short acting dose

37
Q

First generation antipsychotics

A

fluphenazine, haloperidol, loxapine, perphenazine, pimozide, thiothixene, and trifluoperazine

Lower potency: chlorpromazine and thioridazine

38
Q

What life expectancy needed to get intrathecal pain pump

A

> 3mo

39
Q

Which drugs are opiates?

A

morphine, codine and thebaine

40
Q

Timing of pain relief from XRT

A

with in first few tx. peak 4weeks

41
Q

timing of pain relief from radionuclide therapy

A

(used for multiple sites of bone mets)
peak effect 3-6weeks

42
Q

Indications for XRT

A

localized bone mets
Epidural mets
spinal cord compression
Brain mets (whole brain) – Gamma Knife for small lesions in brain
obstruction: SVC, esophagus, airway, rectum, biliary tract
Pain: adrenal mets w/ flank pain, tumors causing nerve impingement
Bleeding: Stomach, esophagus, H/N CA, bladder, cervix
Ulceration/fungation

Palliative Care (11 decks)

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