Pain management Flashcards
A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time is known as ___.
tolerance
A state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist is known as ___ ___.
physical dependence
A primary, chronic, neurobiologic disease, w/genetic, psychosocial, and environmental factors influencing its development and manifestations is known as ___. Characterized by behaviors that include: impaired control over ___ use, ___ use, continues used despite ___, and ___.
addiction, drug, compulsive, harm, craving
An iatrogenic misinterpretation caused by undertreatment of pain that is misidentified by the clinician is inappropriate drug-seeking behavior is known as ___. The behavior ceases when adequate pain relief is provided.
pseudoaddiction
Induced inadvertently by medical treatment or procedures of a physician is known as ___.
iatrogenic addiction
The pain pathway has 4 processes that include: ___, ___, ___, and ___.
transduction, transmission, perception of pain, modulation
The pain pathway begins at the ___ ___, travels to the ___ ___ and up to the ___ of the brain, where it causes descending modulation.
peripheral tissues, spinal cord, hypothalamus
___ and ___ help to reduce pain post-operatively and reduce the need for opioids.
NSAIDS, COX-2’s
___ ___ and ___ block the pain before it even begins.
nerve blocks, anticonvulsants
Opioids do not work on pain itself, they work on the ___ of pain to diminish it.
perception
___, ___, and ___ work to block the pain as well.
tricyclic antidepressants, selective norepinephrine reuptake inhibitors, and anticonvulsants
Noriceptive pain (aka ___), is well-___ and is characterized as ___, ___, and ___. ___ in origin. Responsive to ___, ___, ___, ___ ___. Examples include: ___-___ pain, ___, ___ bones, ___ metastasis, ___.
somatic, localized, dull achy, tender, muscloskeletal, opioids, NSAIDS, steroids, muscle relaxants, post-op, sprains, broken, bone, arthritis
Nociceptive pain (aka ___), involves ___ organs. Is ___-localized and characterized by ___, __, and ___. May refer to other ___. Usually responsive to ___. Examples include: ___, ___-related, bowel ___, liver or brain ___.
visceral, solid, poorly, pressure, tight, crampy, areas, opioids, pancreatitis, constipation, obstruction, cancer
Neuropathic pain may be peripheral, central, sympathetically. Characterized as ___, ___, ___, and ___. ___ responsive to opioids, but may respond to TCA’s, anticonvulsants, or other anesthetics. Examples include: ___, ___, ___ from strokes, ___ neuralgia, ___ limb pain, ___ neuropathy from diabetes or chemo.
sharp, shooting, stabbing, burning, poorly, shingles, sciatica, pain, trigeminal, phantom, peripheral
The most important took for assessing pain is the pt’s ___-___.
self report
Use the ___ method for assessment of pain, which stands for ___, ___, ___, ___, and ___.
WILDA, words, intensity, location, duration, aggravating/alleviating factors
Non-opioids include ___, ___, and ___/___.
acetaminophen, ASA, NSAIDS/COX-2’s
Unless contraindicated, any analgesic regiment should include a ___ medication, even if pain is severe enough to require the addition of an ___.
non-opioid, opioid
___ mg is the limit in a 24hr period for acetaminophen.
4,000mg
___ is the non-opioid of choice for pt’s w/renal disease.
acetaminophen
Acetaminophen can cause excessive ___ for pt’s on warfarin. Can also cause moderate ___ in b/p.
anticoagulation, increase
ASA should be avoided in ___.
children
ASA inhibits ___ aggregation. Common s/e is ___ and ___.
platelet, gastritis, bleeding
Non-selective NSAIDS are useful in pain that involves ___. Adverse effects include ___, ___, and ___.
inflammation, GI, renal, CV
Non-selective NSAIDS include:
ketorolac (Toradol), ibuprofen (Motrin/Advil), naproxen (Naprosyn)
Ketorolac needs to be limited to ___ days d/t precipitating ___ failure.
5, renal
Celecoxib (aka ___) is a COX-2 selective NSAID and works as an analgesic. Great thing about it is that is doesn’t have any effect on ___ or the ___ tract.
Celebrex, platelets, GI
celecoxib (Celebrex) is indicated for relief of ___, ___ ___, and ___ ___.
osteoarthritis, RA, acute pain
Adjuvant/Coanalgesic meds are used for ___ pain, rather than ___ pain and help pt’s who are ___. Caution w/the addition of ___ effects.
chronic, acute, suffering, sedating
Antidepressants, anticonvulsants, corticosteroids, benzodiazepines, antihistamines, analeptics, and muscle relaxants are all known as selected ___/___ meds.
adjuvant/coanalgesic
___ are typically used for chronic pain. Examples include med groups of: ___, ___, ___, and ___.
antidepressants, TCA, SSRI, SNRI, atypical
TCA’s include:
amitriptyline (Elavil), nortyptyline (Pamelor)
SSRI’s include:
fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro)
SSRI’s have less analgesic effect than ___, but also fewer s/e.
TCA’s
SNRI’s include:
duloxetine (Cymbalta), venlafaxine (Effexor)
Anytime a pt c/o numbness, tingling, burning, pressure, hot, or cold sensations, an ___ medication is good tx.
anticonvulsant
Anticonvulsants include:
gabapentin (Neurontin), cabamazepine (Tegretol), valproate (Depakote), clonazepam (Klonopin), phenytoin (Dilantin), topiramate (Topamax), lamotrigine (Lamictal), pregabalin (Lyrica)
___ is typically used for trigeminal neuralgia.
cabamazepine (Tegretol)
___ is used for migraines.
topiramate (Topamax)
Corticosteroids include:
prednisone, dexamethasone, methylprednisolone
Corticosteroids are used for acute ___ compression, soft-tissue ___, anorexia, ___ pressure, and help to decrease ___. Biggest s/e is ___ ___.
nerve, infiltration, intracranial, inflammation, weight gain
NO ___ cocktails!!
benzo
Benzo’s include:
diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), clonazepam (Klonopin)
Benzo’s are useful for: ___ spasms, ___, ___ attacks
muscle, anxiety, panic
Antihistamines include:
hydroxyzine (Atarax/Vistaril), diphenhydramine (Benadryl)
Analeptics/Stimulants used for ___ sedation and have s/e of jitteriness and anxiety.
opioid
Analeptics/Stimulants include:
caffeine, methylphenidate (Ritalin), dextroamphetamine (Dexadrine), modafinil (Provigil)
Skeletal muscle relaxants are purely used for ___ ___. They are indicated for ___-term use and should only be used for ___-___ days.
muscle spasms, short, 5-6
Skeletal muscle relaxants include:
diazepam (Valium), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), tizanidine (Zanaflex)
Combination opioids have limited use in ___ pain.
chronic
Combination weak opioids for mild to moderate pain include: codeine hydrocodone oxycodone propoxyphene tramadol
Tylenol #3, Fioricet Lortab, Vicodin Percocet, Percodan Darvocet Ultram, Ultracet
Codeine is highly ___. 10% of ppl lack the enzyme needed to make it effective.
constipating
Codeine by itself is considered a schedule ___, whereas in comb such as Tylenol #3, it is a schedule ___.
II, III
Pt’s can easily become dependent on ___.
butalbital
Hydrocodone is a schedule ___ and is ___. Not available as a single agent. Equal in analgesic effect to ___.
III, refillable, morphine
Can not drink alcohol while taking ___.
hydrocodone
Oxycodone is the only combination opioid that is a schedule ___, so must have a written Rx.
II
Propoxyphene (Darvocet) has a long half-life of 30-36 hrs and can accumulate w/___ doses. It is a ___ stimulant and can produce ___ edema. It is not recommended for the ___ and is structurally r/t ___.
repeated, CNS, pulmonary, elderly, methadone
___ has both opioid and nonopioid modes of action. It is classified as a non-narcotic analgesic.
Tramadol
Tramadol weakly inhibits the reuptake of ___ and ___, similar to TCA’s. May cause withdrawal symptoms if given to a pt on other ___. Lowers ___ threshold.
serotonin, norepinephrine, opioids, seizure
Do not give tramadol w/___, can cause serotonin syndrome.
antidepressants
Single agent (strong) opioids are used for ___-___ pain and have no ___ dose.
moderate-severe, maximum
Single agent (strong) opioid include:
morphine, hydromorphone, meperidine, methadone, oxycodone, fentanyl, oxymorphone, tapentadol
___ is considered the “gold standard” for IV pain medication.
Morphine
Short-acting morphine is ___ or ___. Long-acting morphine includes:
MSIR, Roxanol-T, MS Contin, Oramorph-SR, Avinza, Kadian
Long-acting morphine is taken every ___-___ hrs.
8-12
___ is less sedating than other opioids. Has a shorter duration than ___.
Hydromorphone, Morphine
___ is not a good choice for pain management. It is more likely than other opioids to cause ___ in post-op pts. Should not be used for more than ___ hrs.
Meperidine, delirium, 48
Use ___ w/great caution in elderly d/t long ___-___.
methadone, half-life
Methadone has a half-life up to ___ hrs.
120
Oxycodone only available in ___ formulation. Better for ___/belly pain. Equal in analgesic effect to ___.
oral, visceral, Morphine
Long-acting oxycodone is known as ___. Important not to give at same time as ___-acting opioid.
oxycontin, short
___ is well-tolerated in all populations. It is ___ times stronger than Morphine and is faster-acting and of ___ duration than other opioids.
Fentanyl, 100, shorter
Fentanyl, if given too fast or in large doses can cause ___ ___ syndrome and pt’s die. Not used well for ___-___ pts.
rigid chest, post-op
Fentanyl duragesic patch is used for ___ or ___ pain only. Avoids ___ pass effect through liver. Onset of action is ___ hrs and then left on for ___ hrs.
persistent, chronic, first, 12, 72
___ is a transmucosal Fentanyl and is for ___ breakthrough pain if IV Fentanyl is not available.
Actiq, severe
___ is long-acting oxymorphone and is dosed every ___ hrs. Instruct to take ___ hr before meals or ___ hrs after.
Opana ER, 12, 1, 2
___ works primarily on ascending and descending pathways. ___ ___ can occur if given w/SNRI’s, SSRI’s, TCA’s, and MAOI’s.
Tapentadol, serotonin syndrome
Tapentadol (aka ___) and is dosed every ___ hrs for ___ pain. Is a schedule ___ and must have a written Rx and no ___.
Nucynta, 4, acute, II, refills
Long-acting opioids for \_\_\_ pain include: morphine oxycodone methadone fentanyl oxymorphone hydromorphone
chronic MS Contin, Oramorph Oxycontin Dolophine Duragesic Opana ER Exalgo
Benefits of long-acting opioids include: avoid ___ and ___, improves ___, pt’s use ___ medication and report ___.
peaks, valleys, functionality, less, satisfaction
Around-the-clock (ATC) used for ___ or ___ pain. PRN is on an ___-___ basis for ___ pain.
persistent, chronic, as-needed, rescue
For dose adjustment/titration, for moderate pain (4,5,6) increase by ___-___%. For severe pain (7,8,9,10), increase by ___-___%.
30-50, 50-100
For dosing duragesic, convert ALL opioids in ___hr period to oral morphine. Divide in half, then apply closest patch size.
24
Methadone should not be dosed ___, should be every ___ hrs.
TID, 8
Important to use a ___ approach for opioids. Do gradual titration once pain goal is met.
multimodal
True or False: You should have a written opioid agreement or controlled substance agreement w/any pt starting on opioids.
True
Collect and document ___ history including history of ___, ___, or ___ abuse, and ___ that are currently being prescribed.
psychiatric, sexual, physical, verbal, medications
Get a pt consent to perform a ___ ___ drug test and ___ counts.
random urine, pill
6 steps for safety:
1) Never take a prescription ___ unless it is prescribed to you
2) Do not take pain medication w/___.
3) Do not take ___ doses than prescribed. Even after effects have worn off.
4) Use of other ___ or ___ meds can be dangerous.
5) Avoid using prescription ___ to help you fall asleep.
6) ___ up prescription painkillers.
painkiller alcohol more sedatives, anti-anxiety painkillers lock
The Pain Assessment and Documentation Tool (PADT) documents the 4 A’s, which are:
analgesia, activity, adverse events, aberrant behavior
REMS stands for:
Risk Evaluation Mitigation Strategies
PMP’s are a way to ___ monitor prescription meds. Highly effective tool for reducing prescription ___ ___.
electronically, drug abuse
CAGE, TICS, DAST, RAFFT, SOAPP are all ___ to assess pt’s pain.
tools
___ is not used for severe pain.
tramadol/ultram
___ (aka Nucynta) indicated for acute pain relief. Is a schedule __.
Tapentadol, II
