Pain Management

Question 1

Acetaminophen most effective analgesic dose?

Answer 1

1000mg

Question 2

Acetaminophen monitoring

Answer 2

LFTs (hepatic function)

Question 3

True or false: NSAIDs may be combined with prophylactic heparin or enoxaparin

Answer 3

True

Question 4

NSAID monitoring

Answer 4

Hgb/Hct, Plt, signs of bleeding

Question 5

Which gabapentanoid is associated with fewer adverse effects?

Answer 5

Pregabalin

Question 6

Which classes of antidepressants may be used to treat chronic neuropathic pain or fibromyalgia?

Answer 6

SNRIs, TCAs

Question 7

What is the onset of effect for SNRIs used to manage pain?

Answer 7

2-4 weeks

Question 8

Adverse effects of SNRIs

Answer 8

Increased BP, sedation, insomnia, nausea, anorexia, dizziness

Question 9

Adverse effects of TCAs

Answer 9

Anti-muscarinic (Can’t see, can’t see, can’t poop, can’t spit), orthostatic hypotension, QTc prolongation

Question 10

When should TCAs be administered?

Answer 10

Bedtime

Question 11

Difference between spasticity and spasm

Answer 11

Spasticity: disorder of motor neurons, increased muscle tone and stiffness
Spasm: localized, involuntary of muscle spasm arising from trauma, muscle strain, or cramping

Question 12

Which two of the following medications are often used to address issues with spasticity?
a. Cyclobenzaprine
b. Methocarbamol
c. Tizanidine
d. Carisoprodol
e. Baclofen

Answer 12

c. Tizanidine
e. Baclofen

Question 13

Which of the following medications can be used to address issues with both spasticity and spasm?
a. Methocarbamol
b. Tizanidine
c. Carisoprodol
d. Baclofen

Answer 13

b. Tizanidine

Question 14

Appropriate dosing range of subdissociative ketamine

Answer 14

0.1– 0.3 mg/kg/hr

Question 15

Sub-dissociative ketamine precautions/CI

Answer 15

AMS, exacerbation of psychosis in schizophrenia, pregnancy

Question 16

Which of the following is metabolized into inactive metabolites?
a. Morphine
b. Hydromorphone
c. Oxycodone
d. Hydrocodone

Answer 16

b. Hydromorphone

Question 17

Which of the following is structurally different from the others?
a. Fentanyl
b. Hydromorphone
c. Hydrocodone
d. Morphine

Answer 17

a. Fentanyl

Question 18

Morphine is metabolized into which two metabolites?

Answer 18

M3G (can buildup and lead to nephrotoxicity) and M6G (less active)

Question 19

Methadone dosing for chronic pain

Answer 19

Very small doses given 2-3 times a day starting as low as 2.5mg

Question 20

First line treatment for acute sickle cell crisis

Answer 20

Opioid therapy with consideration given to baseline opioid use

Question 21

What is chronic pain?

Answer 21

Persistent or recurring pain >3 months

Question 22

True or false: Long acting opioids should be used PRN

Answer 22

False. They should be scheduled