Pain Management Flashcards
What areas of the brain are affected by pain?
LATERAL AREA of brain involved with sensory components of pain (location, intensity, quality) and the LIMBIC FOREBRAIN- involved with emotional and cognitive aspect of pain
which drugs are used as first line agents in a PCA pump (patient- controlled analgesia)?
morphine or hydromorphone (schedule 2 drugs)
which ROA may result in more sedation?
IV infusion
which drugs can be administered rectally?
morphine and oxycodone
*morphine works faster
What is the max. dosage for non-opioids such as Tylenol?
3000-4000 mgs/ day
what class of drug is best choice for bone pain?
NSAIDs (but is not 1st choice after surgeries)
which adjuvant drug should you consider using with neuralgias?
anti-depressants
Which receptors do you block/activate to block pain?
block NMDA and AMPA receptors (which cause pain when stimulated by glutamate)
stimulate GABA and mu receptors (to cause analgesia)
which adjuvant drugs block NMDA receptor and Ca2+ ch blockers?
pregabalin**
ketamine
amantadine
which adjuvant drugs block AMPA, Na+ channel blockers?
gabapentin**
tegretol**
lidocaine, melixitine
which drugs block glutamate?
gabapentin*
and clonidine
which adjuvants are GABA agonists?
baclofen
benzos
which adjuvatns are NE- reuptake inhibitors?
TCA **
tramadol
duloxetine
which are your substance P inhibitors?
topical capsaicin
What is STEP 1 of WHO step ladder?
non-opioid + adjuvant
what is step 2 of WHO step ladder?
opioid + nonsteroidal + adjuvant (+ laxative)
what are some step 2 opioids?
- codeine or tylenol with codeine
- hydrocodone or acetaminophen with hydrocordone
- oxycodone
what is step 3 on WHO ladder?
opioid (morphine) + nonsteroidal + adjuvant
for step 3 opioids, there is no ceiling effect to opioids.
true
what are some step 3 opioids?
morphine
hydromorphone
methadone
how often are fentanyl patches changed?
every 3 days
what is the best for breakthrough pain? and why?(fastest form of pain relief)
transmucosal fentanyl-it is the only opioid that is lipophilic; all others are hydrophilic
which drug may have addiction potential?
ultram - use in caution with patients on SSRI
when are corticosteroids used as adjuvants?
- control headache
- N/V in cancer patients
- pain assoc with spinal tumors
side effects of opioids?
- sedation or euphoria
- constipation
- respiratory depression
- nausea/vomiting
which is the least potent?
codeine and hydrocodone- 0.15
*morphine- 1.0
What does rule of 2s and 8s refer to?
(use of PCA pump)
- 2 refers to amt of analgesic in mgs or micrograms
- 8 refers to time in minutes for drug to reach max. concen in blood
what is “lockout”
min. time in minutes btwn consecutive doses
what is interval dose?
subsequent dosages
if patient is not getting adequate control on pain pump, what do you do?
double dose every 8 min.
what is the most potent narcotic?
sublimaze (fentanyl)- potency is 100
