Brainscape's Knowledge GenomeTM

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


See full index

Pharm Spring 2023 > Pain Management > Flashcards

Pain Management Flashcards

1
Q

What are the 3 main areas within accrediting standards when evaluating pain

A
  1. Assessment and management of acute pain
  2. Assessment and management of chronic pain
  3. Recognition, management, and/or referral of patients addicted to opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is break-through-pain

A
  1. Sharp spikes of severe pain despite use of ER opioid
    *must treat with fast acting agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the broad efficacy outcomes

A
  1. Pain relief
  2. Change in pain
  3. Pain intensity
  4. adequate functionality
  5. Duration of action
  6. Route of adminsitration
  7. QOL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the safety outcomes

A
  1. Side effects
  2. Route of adminsitration
  3. QOL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the five A

A
  1. Analgesia
  2. Activities of daily living
  3. Aberrant drug behavior
  4. Adverse effects
  5. Affect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What to consider when selecting a pharmacological agent

A
  1. Select the simplest approach possible
  2. When starting for chronic pain use IR release at lowest effective dose (avoid LA/RA)
  3. Use the lowest effective IR dose for acute pain
    *3 days typically enough
  4. Avoid placebos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does “By the clock, by the mouth, by the ladder” mean

A

When the schedule pain medications
*PO
*ladder = mild pain 1-3, moderate 4-7, severe pain 7-10

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

What are the medication for mild pain (1-3) and moderate pain (4-6)

A

Nonopioid adjuvant
1. Codeine
2. NSAIDS/APAP/ASA
Opioid for mild to moderate pain (can also be used for severe)
1. Hydrocodone
2. Oxycodone
3. Pentazocine
4. Butorphanol
5. Nalbuphine
6. Buprenorphine

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

What are the medications to use for severe pain (7-10)

A

DOC = morphine
1. Fentanyl (for quick on and off)
2. Hydromorphone
3. Oxymorphone
Severe chronic = methadone

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

How to pick the correct medication for pain

A
  1. What is the patients pain level
  2. Base the pick off of the pain ladder
    *choose one that can provide adequate analgesia
  3. What interventions are planned for the patient
  4. What medication has the best pharmacokinetic profile for the patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the acute pain management principles

A
  1. Begin at typical starting dose
  2. Continue analgesics around the clock
    *PRN opioids for breakthrough pain (always have BTP option)
  3. Reserve IV infusion for opioid tolerant patients
  4. Include APAP and NSAIDs in pain management unless CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What pain meds are used in the ED for severe or localized pain

A

Severe
1. IV opioids (fentanyl, morphine)
2. Ketamine (IV, IM, IN)
3. Ketorolac IV
Localized pain
1. Local anesthetic for painful local injuries
2. Regional blocks

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

What pain meds are used in the ED for breakthrough pain, and other options

A

Breakthrough pain
1. Oral opioids (Oxycodone, hydrocodone, tramadol)
Unless CI
1. NSAIDS
2. Acetaminophen

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

What is the acute treatment for musculoskeletal pain

A
  1. Multimodal analgesia, NSAID, APAP
  2. Use lowest effective IR opioid for shortest duration
  3. No ER opioids
  4. Consider local/regional block anesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the clinical pearls of treating a musculoskeletal injury

A
  1. Opioids are ineffective and NOT recommended for chronic mechanical low back pain
  2. Opioids should be limited and restricted to only a short duration for low back pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the first line tx and opioid therapy for chronic pain

A

First line
1. Nonpharmacolgic and nonopioid pharmacolgic therapy
Opioid therapy
1. Use nonpharmacologic therapy and non opioid pharmacological therapy

17
Q

What should you avoid for chronic pain

A
  1. Benzodiazepines
18
Q

How to choose the best medication

A
  1. Opioids are last resort, timed limited trial
  2. Balance the potential risk/benefits with attention to risk factors for misuse and abuse
    *substance abuse disorder
19
Q

How to minimize risk for people with chronic pain

A
  1. Avoid opioid pain medication and benzodiazepines together whenever possible
  2. Offer medication assisted treatment with buprenorphine or methadone
20
Q

How to appropriately follow up and discontinue meds

A
  1. Reassess benefits and risk when increasing dosage to >50MME/day
    *avoid increases to >90MME/day
  2. Re-evaluate within 1-4 weeks for starting or increasing
  3. Re-evaluate at minimum every 3 months
21
Q

When should you consider tapering an opioid?

A

When your patient
1. Request it
2. Does not have improvement in pain at least 30% improvement
3. On dosages >50MME/day
4. Shows signs of substance use disorder
5. Shows early warning signs for overdose risks such as confusion, sedation, or slurred speech

22
Q

How to taper an opioid

A
  1. Go slow
  2. 10% decrease per month, if taking opioid >1year
    *10% per week may work for those who have only taken for weeks to months
  3. Lowest dose then extend the interval between doses (stop when taken <1x/day)
23
Q

In chronic pain management, at WHAT total morphine milligram equivalent per day do the risk of therapy start to outweigh potential pain control benefits?

A

50 MME/day

24
Q

What is the problem with high dose opioids

A

Higher dosage = higher risk of overdose and death
1. Doses at or above 50MME/day at least double the risks for overdose
2. Dose base on IBW (ideal body weight)

25
Q

What are the opioid cross-sensitivities

A

Phenanthrenes (morphine-like)
*morphine
*codeine
*oxycodone
Phenylpiperidines (meperidine-like)
*meperidine
*fentanyl

**risk of cross-sensitivity in patients with allergies is greater when medications are form the same family

26
Q

How to calculate TDD

A
  1. Determine the total daily amount of each opioid being taken
  2. Convert each total daily amount of each opioid to MME
    *multiple by conversion factor
  3. Add all opioid together to get the total daily dose
27
Q

What should you not use to calculate the MME

A
  1. Do not use the RAW calculated MMEs to determine dosage when converting one opioid to another
28
Q

What is the first line treatment for neuropathic pain

A
  1. TCA
  2. SNRIs
    *duloxetine / venlafaxine
  3. Gabapentanoids
  4. Topical
    *2 and 3 preferred
29
Q

What is the second line treatment for neuropathic pain

A
  1. Tramadol
  2. Combination (gabapentanoid + either TCA or SNRI)
30
Q

What is a key side effect of Neurontin that may lead to it’s discontinuation by a patient despite it’s positive effects on neuropathic pain?

A

Weight gain

Pharm Spring 2023 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions