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Ortho > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Drug Choices for PCA Pumps

A

Morphine
Fentanyl
Dilaudid

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2
Q

Other Pain Management Options for Inpatients

A

Toradol IM/IV
Morphine IM/IV
Dilaudid IM/IV
Demerol/Phenergen IM

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3
Q

Acute Pain Management of Post-Operative Pain

A

Narcotic + non-narcotic medication

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4
Q

Points of Pain Contracts

A

Pain med- amount- time period
Drug testing
Providers (primary & secondary)
Ancillary Services

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5
Q

Ancillary Services for Chronic Pain

A 
Behavioral health
Biofeedback
PT
OT
Hypnosis
Osteopathic manipulation
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6
Q

Most Commonly Prescribed Narcotics

A 
Codeine
Hydrocodone
Oxycodone
Tramadol
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Fentanyl
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7
Q

What are narcotics commonly in combination with?

A

Acetaminophen (APAP)

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8
Q

Use of Schedule I Drugs

A

Illegal
Restricted to research
No accepted medical use

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9
Q

Examples of Schedule I Drugs

A 
Hallucinogens
Heroin
Peyote
Coca
Psilocybin mushrooms
Marijuana
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10
Q

Schedule II Regulations

A

Requires prescription
30 days of medication with no refills
Psychological or physical dependence
Verbal orders not allowed

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11
Q

Examples of Schedule II Drugs

A 
Codeine
Hydrocodone
Hydromorphone
Morphine
Cocaine
Fentanyl
Methadone
Meperidine
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12
Q

Schedule III Regulations

A

Requires a prescription
Moderate abuse potential
Max: 5 refills
Verbal orders allowed

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13
Q

Examples of Schedule III Drugs

A 
Benzphetamine
Clortemine
Ketamine
Pentobarbital
Secobarbital
Sulfomethane
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14
Q

Schedule IV Regulationss

A

Requires a prescription
Low abuse potential
Max of 5 refills
Verbal orders allowed

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15
Q

Examples of Schedule IV Drugs

A 
Alprazolam
Barbital
Clonazepam
Lorazepam
Midazolam
Phenobarbital
Diazepam
Tramadol
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16
Q

Schedule V Drug Regulations

A

OTC with restrictions or requires a prescription

Low abuse potential

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17
Q

Examples of Schedule V Drugs

A

Robitussin AC
Lyrica
Lomotil
Potiga

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18
Q

Codeine/APAP

A 
Opioid agonist
Used as antitussive as well
Schedule II
Good for pediatric patients
Cost: $15 for 30 tabs
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19
Q

Hydrocodone

A

Opioid agonist
Many combo formulations (with APAP)
Schedule II
Cost: $55 for 30 tabs

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20
Q

Examples of Hydrocodone Variations

A

Lorcet (10/650)
Vicodin (5/500)
Norco (5/325, 7.5/325, 10/325)
Lortab (5/500, 7.5/500, 10/500)

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21
Q

Oxycodone

A

Combo drug or not
Opioid agonist
Schedule II
Cost: $100 for 30 tabs

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22
Q

Examples of Oxycodone

A

Percocet (combo)

OxyContin

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23
Q

Tramadol (Ultram)

A

Binds to opioid receptors & inhibits norepinephrine/serotonin reuptake
Schedule IV
Cost: $60 for 30 tabs

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24
Q

APAP Combo of Tramadol

A

Ultracet

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25
Q

Hydromorphone (Dilaudid)

A 
Opioid agonist
High abuse potential
Highly sedative
Taper to D/C
Schedule II
Cost: $30 for 20 tabs
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26
Q

Meperidine (Demerol)

A 
Opioid agonist
Very sedative
Seizure risk over time & dose
Avoid abrupt cessation
Schedule II
Cost: $30 for 20 tabs
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27
Q

SE of Meperidine (Demerol)

A

N/V

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28
Q

Fentanyl (Duragesic)

A 
Chronic pain
Opioid tolerant patients
Major abuse potential
Responsible patients or caregiver to administer
Schedule II
Cost: $100 for 5 patches
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29
Q

How long does a fentanyl patch last?

A

3 days

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30
Q

NSAIDS

A

Good for orthopedics
Anti-inflammatory
Caution: concomitant anti-coagulation
Slow fracture healing

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31
Q

Warnings of NSAIDs

A

CV risk
GI bleeding
Kidney risk

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32
Q

MOA of Acetic Acid Group

A

Inhibit cyclooxygenase, reducing prostaglandin & thromboxane synthesis

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33
Q

Examples of Medications in Acetic Acid Group

A

Diclofenac
Etodolac
Indomethacin
Ketorolac

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34
Q

What is the acetic acid group of medications effective of treating?

A

Arthritis associated pain

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35
Q

Examples of Propionic Acids

A

Naproxen

Ibuprofen

36
Q

MOA of Propionic Acids

A

COX 1 and COX 2 inhibitor

Mess with prostaglandins

37
Q

SE of Propionic Acids

A

GI issues

Kidney issues

38
Q

COX2 Inhibitor

A

Celebrex

39
Q

Contraindication of COX2 Inhibitors

A

Sulfa allergy

40
Q

Oral Steroids

A

Medrol-dose pack

41
Q

Injectable Steroids

A

Triamcinalone (Kenalog)
Celestone (betamethasone)
Depo-medrol (methylprenisolone)

42
Q

Aim of Muscle Relaxants

A

Produce a decrease in muscle tone and involuntary movement without loss of voluntary motor function or consciousness

43
Q

MOA of Muscle Relaxants

A

Alters the balance of synaptic excitation and inhibition of motor neuron receives

44
Q

Indications of Muscle Relaxants

A

Acute, painful musculoskeletal conditions of local origin
Adjunct to rest and PT
Relief of acute painful musculoskeletal conditions which include muscle spasm secondary to trauma, radiculopathy, musculoskeletal strain or sprain, herniated intervertebral disc & muscle spasm of OA

45
Q

Muscle Relaxant Effects

A

CNS depressants

Well absorbed with quick effects

46
Q

When should you be cautious when prescribing muscle relaxants?

A

Renal insufficiency
Hepatic insufficiency
Elderly

47
Q

SE of Long Term Use of Muscle Relaxants

A 
Leukopenia
Thrombocytopenia
Hemolytic anemia
Bleeding agranulocytosis
Withdrawal
48
Q

How are muscle relaxants commonly used with for abusive purposes?

A

Alcohol

Opioids

49
Q

What populations are muscle relaxants not recommended in?

A

Pregnancy

Children

50
Q

Guidelines for Muscle Relaxants

A

Muscle relaxant + analgesic agent preferred
Most effective therapy: drugs + PT
SE: drowsiness, HA, dizziness, blurred vision, dry mouth
NSAIDs where pain predominates
Diazepam should be considered in anxiety ridden patients

51
Q

Possible Mode of Action of Carisoprodol (Soma)

A

Doesn’t directly relax muscles

MOA may be related to sedative properties

52
Q

Length of Time to Use Carisoprodol (Soma)

A

Not longer than 10-14 days

53
Q

SE of Carisoprodol (Soma)

A 
Drowsiness, dizziness
Vertigo, ataxia
N/V
Hiccups
Epigastric distress
Tremor, agitation
Headache, insomnia
Tachycardia
Postural hypotension
Facial flushing
54
Q

Contraindications of Carisoprodol (Soma)

A

Porphyria: inherited porphobilinogen deaminase mutation

55
Q

Precautions with Carisoprodol (Soma)

A

Seizures

56
Q

MOA of Cyclobenzaprine (Flexeril)

A

Relieves skeletal muscle spasm of local origin without interfering with muscle function

57
Q

Contraindications of Cyclobenzaprine (Flexeril)

A

Concurrent use with MAOIs
Acute phase of MI
Arrhythmias
Heart block

58
Q

SE of Cyclobenzaprine (Flexeril)

A 
Drowsiness
Dry mouth
Fatigue
Headache
Constipation
Abdominal pain
Acid regard
Dizziness
Nausea
59
Q

Use of Diazepam (Valium)

A

Centrally acting skeletal muscle relaxant

60
Q

MOA of Diazepam (Valium)

A

Depresses muscle excitability indirectly by potentiating the effects of synaptic inhibition medication by GABA

61
Q

MOA of Methocarbamol (Robaxin)

A

CNS depression

No direct action on contractile mechanism of striated muscle

62
Q

What medication is good for the elderly, fall risk individuals, or individuals with mental status issues?

A

Methocarbamol (Robaxin)

63
Q

Other Muscle Relaxant Medications

A

Metaxalone (Skelaxin)
Tizanidine (Zanaflex)
Baclofen (Lioresal)

64
Q

What is the most common use for Tizanidine (Zanaflex)?

A

Chronic muscle issues

65
Q

What is Baclofen (Lioresal) used for?

A

Treat spasms associated with spinal cord injuries

66
Q

Order off Pharmacologic Medications for Ortho Pain

A 
NSAIDs
Muscle relaxants
Narcotics
Steroids
TCA's
GABA analog (gabapentin, valproic acid)
OTC: glucosamine, omega 3's
67
Q

Non-Pharmacologic Treatment of Ortho Pain

A 
Ice/heat
Patient handouts on stretches/exercises
Consider PT/OT
Consider plain films then MRI
Osteopathic manipulation or chiropractor
Behavioral health for chronic pain
Biofeedback, hypnosis, or anti-inflammatory diet
Splint, bracing, or immobilization
68
Q

Treatment of Grade I Ankle Sprains

A

NSAIDS

69
Q

Treatment of Grade II-III Ankle Sprains

A

NSAIDs during the day

Narcotic at night to sleep

70
Q

SE of Vicodin

A 
Constipation
Shallow breathing, slow heartbeat
Feeling light-headed, fainting
Confusion, fear, unusual thoughts or behavior
Seizure (convulsions)
Problems with urination
Nausea
Epigastric pain
Itching
Loss of appetite
Dark urine
Clay colored stools
Jaundice
71
Q

Define Fibromyalgia

A

Widespread musculoskeletal pain accompanied by fatigue, sleep, memory & mood issues

72
Q

Risk Factors for Fibromyalgia

A

Genetics
Rheumatic diseases
Physical, emotional, or sexual trauma

73
Q

Classes of Medications to Treat Fibromyalgia

A

Pain relievers
Antidepressants
Anti-seizure drugs

74
Q

Pain Relievers in Fibromyalgia

A 
OTC
Acetaminophen (Tylenol)
Ibuprofen (Motrin, Advil)
Naproxen (Aleve)
Tramadol (Ultram)
75
Q

Antidepressants in Fibromyalgia

A

Amitriptyline (noc for sleeping)

Duloxetine (Cymbalta)

76
Q

Alternative to Amitriptyline for Fibromyalgia

A

Cyclobenzaprine (Flexeril)

77
Q

Anticonvulsants in Fibromyalgia

A

Gabapentin

Pregabalin

78
Q

What is combination treatment in fibromyalgia directed at reducing?

A

Chronic widespread pain
Fatigue
Insomnia
Cognitive dysfunction

79
Q

What is reflex sympathetic dystrophy characterized by?

A

Severe pain
Swelling
Limited ROM
Skin changes

80
Q

Inciting Events for Reflex Sympathetic Dystrophy

A

Soft tissue injury
Fractures
MI
CVA

81
Q

Medications for Reflex Sympathetic Dystrophy

A 
Capsaicin cream
Prednisone
NSAIDs
Propranolol
Terzosin
Prazosin
Opioids: severe pain
82
Q

Characteristics of Drug Seeking Behavior

A

Requests for early refills
Multisourcing
Intoxicated behaviors
Pressuring behaviors

83
Q

“Reasons” for Requesting for Early Refills

A 
"I took too many"
"Lost the prescription"
"Washed it with the laundry"
"Spilled it in the toilet"
"Pharmacist shorted the count"
"My sorry ass brother-in-law stole them"
84
Q

Multi sourcing and Drug Seeking Behavior

A

Visiting multiple physicians
Recruiting surrogates to obtain meds
Purchasing drugs from illicit drug dealers or over the internet

85
Q

Intoxicated Behaviors and Drug Seeking Behavior

A

Slurred or disinhibited calls to the office
Presenting to pharmacies under the influence
ED visits for repeated falls, other traumatic injuries, accidental overdose

86
Q

Pressuring Behaviors and Drug Seeking Behavior

A

Begging or pleading
Excessive compliments
Breaching boundaries
Threats of harm to self or others

Ortho (22 decks)

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