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Geriatrics and Genetics > Pain Management > Flashcards

Pain Management Flashcards

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1
Q

How is pain assessed in practice?

A

Biological/ neurophysiological aspect - pain intensity - pain score/ scale
Functional interference - acute pain is DrEAMS and chronic pain
Psychological distress

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2
Q

What is step 1 for pain management?

A

Aspirin
Paracetamol
NSAID

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3
Q

What is step 2 for pain management?

A

Dihydrocodeine
Codeine
Hydrocodone
Tramadol

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4
Q

What is step 3 for pain management?

A

Morphine
Oxycodone
Methadone
Levorphanol
Fentanyl

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5
Q

What is involved in pain sensation?

A

Peripheric detection
Axonal transmission
Spinal modulation
Descending inhibitory pathways
Perception and interpretation

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6
Q

What principles should intraoperative pain management follow?

A

Promotion of early functional return
Multimodal analgesia
Opioid sparing analgesia techniques
PROSPECT recommendations
Need to be individualised

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7
Q

What are types of multimodal analgesia?

A

Locoregional analgesia
Ketamine
Magnesium sulfate
Alpha-2 agonists
Paracetamol
Non-steroidal anti-inflammatory drugs

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8
Q

What is the perioperative pain management approach?

A

1 - classify the patient if prior opioid use
2 - assess for risk modifiers
3 - define perioperative risks of ORAEs
4 - employ risk based management plan

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9
Q

What is first line for pain management moderate to severe postoperative/ post-trauma pain?

A

2 regular non-opioids and one opioid
Paracetamol and ibuprofen
+/- locoregional analgesia
+ opioid

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10
Q

What is second line for pain management moderate to severe postoperative/ post-trauma pain?

A

Ketamine if severe or nefopam to decrease opioid induced sedation

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11
Q

What is third line for pain management moderate to severe postoperative/ post-trauma pain?

A

Gabapentin and discussion with patient
Antiemetic or clonidine for nausea and for opioid withdrawal

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12
Q

What are types of CYP2C9?

A

Acenocoumarol and warfarine

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13
Q

What are types of CYP2D6?

A

Codeine and tramadol

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14
Q

What are types of CYP3A4?

A

Oxycodone and rifampicin

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15
Q

What can be done to prevent postoperative opioid related harm?

A

Pre-operative opioids
Reliance on pain scores
Long acting opioids
Over emphasis on opioids for discharge opioid prescription
Repeat prescriptions

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Geriatrics and Genetics (10 decks)

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