Pain Management Flashcards

Question

ADEs FOR NSAIDS (4)

Answer 1

1. Edema/fluid retention 2. Acute kidney damage * Risk with ketorolac * Avoid in patients with renal dysfunction 3. Abdominal pain 4. GI bleed (rare but can occur especially at high doses)

Answer 2

Not used regularly in pediatrics due to association with Reye’s Syndrome

Answer 3

1. Irreversibly bind to COX-1 and COX-2 enzymes via acetylation decreasing effects of prostaglandins and Thromboxane A2 2. Analgesia, anti-inflammatory, anti-pyretic 3. Anti-platelet activity

Answer 4

Anti-platelet activity

Answer 5

1. Not first line therapy for pain 2. Different levels of potency and efficacy 3. May be used in combination with non-opioids at reduced doses without loss of analgesic effect 4. Long term, chronic use may result in dose tolerance and need for dose increases

Answer 6

1. Effective for mild-to-moderate pain with or without a non-opioid 2. Eg. nalbuphine 3. If inadequate pain control, change to a stronger opioid

Answer 7

1. Analgesic effect derived from pro-drug being metabolized to morphine 2. Often given in combination with acetaminophen 3. FDA warning for children < 18 years 4. Avoid use in children April 2015

Answer 8

``` Manage moderate to severe pain o Morphine o Hydromorphone o Fentanyl o Methadone o Oxycodone o Hydrocodone ```

Answer 9

- Widely studied in infants and children - Narcotic analgesic that stimulates brain opioid receptors - Increases venous capacitance, caused by release of histamine and central suppression of adrenergic tone - Decrease GI secretions and motility

Answer 10

Converted in the liver to two metabolites that are renally excreted - Morphine-6-glucuronide (active) - Morphine-3-glucuronide (inactive)

Answer 11

- 10-20 hours in preterm neonates - 6 hours in neonates and infants up to 3 mos - 2.9 hours in infants 6 months to 2.5 years - 1-3 hours in children 6-9 years

Answer 12

- More potent than morphine - Used in opioid-tolerant patients who require larger than usual doses of opioids for pain relief - Binds to opiate receptors in the CNS

Answer 13

- Synthetic opoid narcotic analgesic that is 50-100 times more potent than morphine - High lipid solubility and rapidly penetrates the CNS - Metabolized extensively in the liver and excreted by the kidneys - Half-life highly variable: 2-21 hours

Answer 14

Long-acting narcotic analgesic - Moderate to severe pain unresponsive to non-narcotics - Treatment of neonatal abstinence syndrome and opioid dependence Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering perception of and response to pain

Answer 15

Oral – within 30-60 minutes | Parenteral – within 10-20 minutes

Answer 16

Half life: 4-62 hours | Metabolized in the liver, eliminated via the kidneys

Answer 17

Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain No injectable form

Answer 18

Localized therapy - Act on peripheral sensory nerves or pain modulators following dermal penetration ``` Reduce systemic toxicity Effective for acute procedural pain Effective in reducing pain from dermatologic procedures, venipuncture, etc. • EMLA • LMX4 • Buffered lidocaine ```

Answer 19

12 hrs on/ 12 hrs off Patches can be cut Caution with toxicity in little kids Local pain only

Answer 20

- Not true analgesics in pharmacological sense; however, contribute significantly to pain relief - May be used alone or in combination with analgesics Examples: o Anticonvulsants o Sedatives/hypnotics/anxiolytics

Answer 21

Reduce neuronal excitability Used for neuropathic pain • Gabapentin • Carbamazepine

Answer 22

- Block reuptake of neurotransmitters - Rapid onset of analgesic effect - Used to reduce anxiety, as muscle relaxant and pre-medication for painful procedures Diazepam Lorazepam Midazolam

Answer 23

Reduce central sympathetic output and increase firing of inhibitory neurons Clonidine - Sedation and analgesia without respiratory compromise