Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adult Clinical Medicine > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Common barriers to the use of opioids in advanced illnesses

A
  1. patient/family fears of addiction,
  2. side effects, and tolerance;
  3. provider lack of knowledge and fears of adverse effects; and
  4. issues around cost and access
  5. Everyones pain is different and may express pain differently depending on culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Key features of addiction include

A
  1. psychological dependence
  2. narcotic abuse despite harm, and
  3. drug-seeking behaviors that result in social losses (job loss, divorce, etc…).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

___ refers to withdrawal symptoms with the discontinuation of opioids.

A

Physical dependence

*Patients should be reassured that their pain will be effectively managed and that they will not experience withdrawal (rather, their medications will be tapered as with anti-depressants or anti-hypertensive medications).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The best predictor for current addiction is ___

A

prior addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

To assess pain, use the pneumonic__:

A
  • WILDA
  • Words
  • Intensity (1-10 scale)
  • Location
  • Duration
  • Aggravating/Alleviating factors

*Trust patients: pain is subjective and patient report is most useful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are types of pain and words used to describe it?

A
  1. Neuropathic (shooting, hot/burning, electric, cold, numbness, radiates)
  2. Visceral (dull, difficult to localize, cramps, squeezing)
  3. MSK (achy, sore, localized, sharp, throbbing)
    4.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you assess intensity of pain

A
  • ask about CURRENT pain 1-10 scale

- ask about acceptable pain level (not often zero)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treat constant pain with ___, whereas intermittent or incident pain is better treated with ___

A

round-the-clock analgesia

short-acting agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the WHO 3-tiered approach to pain management

A

Moderate (4-6): opioid combo

Step 1 (: (ASA, APAP, NSAIDs, +/- Adjuvants)

Step 2: (Codeine, hydrocodone, oxycodone, Dihydrocodeine, tramadol, +/- adjuvants)

Step 3: (Morphine, hydromorphone, methadone, levophanol, fentanyl, oxycodone, +/- non-opiods)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When starting someone on opioids ALWAYS start them on:

A

short acting then can switch to long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are short acting opiods

A
  1. Oxycodone/acetaminophen (percocet)
  2. Hydrocodone/acetaminophen
  3. Hydromorphone (dilaudid)*
  4. Oxycodone*
  5. immediate release morphine*
  6. Fentanyl (lollipop)
    Tramadol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Commonly used long acting opiods

A
  1. Long-acting morphine* (MSContin, Oramorph)
  2. fentanyl patch* (Duragesic)
  3. OxyContin* (oxycodone SR)– lasts 12 hrs
  4. methadone –> has a lot of DDI (less frequently used)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Max Tylenol (acetaminophen) per day

A

3-4g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

While patients who are “pseudoaddicted” demonstrate behaviors suspicious for addiction, they are not addicted to opioids. Rather, they exhibit these behaviors in response to __

A

un- or under-treated pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Key intervention for pseudoaddiction

A

effective therapy for these patients’ pain results in the extinction of the addictive behaviors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

__ refers to a physiologic adaptation (typically occurring over weeks to months) where increased opioid doses are required to achieve the same analgesic response.

A

Tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

While tolerance is a real phenomenon, abrupt increases in pain should first prompt:

A
  • a reassessment of pain and underlying disease,
  • a search for medication changes,
  • drug interactions, or non-compliance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you respond to someone who is concerned for addiction when using opioids for chronic pain

A
  1. normalize that a lot of people are worried about addiction, can you tell me what you mean by addiction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Differentiate between addiction, tolerance, and dependence

A
  • Addiction: psychological dependence on a substance that has a negative impact on life
  • Tolerance: body requires a higher dose to achieve the same effects
  • Dependence: Your body needs it to maintain physiological homeostasis and stopping results in withdrawals (occurs w/ steroids, antiHTN, opioids)
  • tx: can taper, this happens w/ a lot of meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you titrate opiods

A
  1. Increase dose 25-50% for mild/moderate pain, 50-100% for severe pain
  2. Adjust short-acting (Q4 hr) agents each dose as needed
  3. Adjust longer-acting agents (Q12 hr) every 24-48 hrs as needed
  4. Adjust fentanyl (Duragesic) patch or methadone no more than every 3 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Withdrawal sx from opioids

A
  1. nausea/vomiting
  2. diarrhea
  3. muscle aches
  4. flu-like sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you choice an opioid

A
  1. avoid meperidine (Demerol) or propoxyphene (Darvocet) due to weak analgesic properties and toxic metabolites.
  2. While morphine and oxycodone are safe and effective for most patients, fentanyl and hydromorphone are better choices in patients with significant renal and/or liver disease.
  3. Avoid using fentanyl patches in acute pain syndromes, fever, or cachexia.
23
Q

Tolerance to opioid-induced side effects such as nausea and sedation is advantageous and typically occurs over a period of 3-7 days. Patients do not develop tolerance to __

A

constipation

24
Q

Non-pharmacologic approaches to pain are diverse and include:

A

acupuncture, TENS, massage, meditation, exercise, physical therapy, whirlpool therapy, heat, cold, behavioral or cognitive therapy, and others.

*Recognize that pain is felt by persons – and persons can experience pain on physical, emotional and spiritual levels. As such, effective treatments must often include interventions that target these varied domains.

25
Q

How do you screen for high risk of addiction w/ opioids

A
  1. Hx of addiction (opioids, illicit drugs, alcohol)
  2. Fhx of addiction (opioids, illicit drugs, alcohol)
  3. M>F
  4. Mental illness (depression, bipolar, schizophrenia)
  5. Hx of sexual abuse for women

*if high risk, must do a contract and possibly random drug screen

26
Q

How do you dose breakthrough pain?

A

Dose breakthrough pain 10*-15% of the total 24 hr dose given Q2 hr (PO/PR), or Q10-15 min (IV)

27
Q

Side effects of opioids

A
  1. constipation
  2. drowsiness/foggy
  3. nausea
  4. respiratory depression
  5. itchy (not a true allergy w/o rash)
  6. mental acuity issues

*can develop a tolerance of SE in 1 week EXCEPT constipation

28
Q

Remember to always start a ___ with any chronic opioid regimen

A

bowel regimen

29
Q

Describe a good bowel regimen for someone on opioids

A
  • A stool softener alone is not effective.
  • Start with a bowel stimulant such as senna 2 tabs QD/BID +/- docusate (Colace) 100 mg BID or bisacodyl 5 or 10 mg PO QD.
  • Colace: softener
  • Stimulant: Senna
  • prune have a natural senna too it but need a lot!
30
Q

Do not recommend ___ for someone on opioids

A

Fiber

31
Q

What should you do if side effects persist?

A
  1. Use opioid rotation,
  2. adjuvant medications,
  3. dopamine antagonists (nausea) and/or
  4. methylphenidate (sedation)
32
Q

Adjuvant medications for bone pain include

A
  1. NSAIDs
  2. steroids
  3. radiation therapy
  4. bisphosphonates
  5. calcitonin and
  6. others
33
Q

Adjuvant medications for neuropathic pain include:

A
  1. tricyclic antidepressants (TCAs ex. Nortriptylline)
  2. gabapentin (anticonvulsant)
  3. valproate
  4. carbamazepine (anticonvulsant)
  5. topical lidocaine and
  6. SSRIs (Venlafaxine,
34
Q

Once starting, keep a log on how many opioids you are taking per day
-if someone is taking oxycodone 5mg, 8x day and you are switching to oxycotin for long term coverage, they should be on __

A

20mg BID
PLUS oxycodone 5mg q3hrs prn

*give them a short acting too (anyone on a long acting need to be on a short acting too)

35
Q

___ may help to provide additional relief thereby reducing concurrent opioid doses.

A

Adjuvant agents

36
Q

Avoid for acute pain management, fever, cachexia

A

Fentanyl patch

37
Q

What meds are safe for renal failure

A
  1. oxycodone (safer than morphine)
  2. hydromorphone (except at higher doses)
  3. fentanyl (also safe in hepatic failure) (BEST CHOICE)
38
Q

If a short acting dose is not working at all, it is safe to increase ___

A

50-100%

39
Q

what meds should you avoid in renal failure

A
  1. Morphine**
40
Q

Weak opioid, helpful for mild/moderate pain

A

Tramadol

41
Q

What meds are in:

  1. Norco
  2. Percocet
  3. Tylenol #3
A
  1. Norco: (hydrocodone + acetaminophen)
  2. Percocet (oxycodone + acetaminophen)
  3. Tylenol #3 (codeine + acetaminophen)
42
Q

What is the morphine equivalence of oxycodone

A

Morphine 30mg

Oxydone 20mg

43
Q
  • Both short-acting and long-acting effects
  • Very inexpensive
  • More difficult to use due to long half life – recommend avoiding unless experienced or using with the support of a pain or palliative care specialist
A

Methadone

44
Q

Strongest of the combined opioid/APAP regimens

A

Oxycodone/APAP= percocet

45
Q

How do you manage pruritis on an opioid

A
  1. diphenydramine

2. Nalbuphine

46
Q

How do you manage nausea on an opioid

A
  1. Ondansetron
  2. Prochlorperazine
  3. Metoclopramide
  4. Phenergan
47
Q

how should you treat mild pain

A

-rated (1-3/10) is treated with a nonopioid (e.g., acetaminophen or NSAID) ± adjuvant analgesics.

48
Q

how should you treat moderate pain

A

-(rated 4-6/10) is treated with a short- acting, immediate release opioid with slow titration, + nonopioid, ± adjuvant analgesics.

49
Q

how should you treat severe pain

A

(rated 7-10/10) is treated with a short–acting, immediate release opioid with rapid titration,
± nonopioid, ± adjuvant analgesics.

50
Q

What meds should you avoid in liver failure?

A

ALL!

  • Fentanyl is best choice
  • Go LOW and start SLOW (q6hrs), be hesitant on starting long acting
51
Q

Reduce dose by ___% in the elderly; by __% in hepatic or renal impaired patients

A

25-50%- elderly

25-hepatic or renal impaired

52
Q

Describe the approximate equianalgesic conversion of morphine among routes of adminstration

A

oral 300 : parenteral 100: Epidural 10: intrathecal 1

53
Q

Describe the parameters of PCAs

A
  1. Drug
  2. Demand- what you get when you press the button (safe part)
  3. Basal- what you get if you don’t press the button (continuous)– dangerous part (keeps going if OD)
  4. Lockout- how often you can press it (usually 10 min)

Adult Clinical Medicine (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions