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Clin Specialties - Surgery > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Conscious or IV sedation

A

mild sedative and pain meds; may not remember it

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2
Q

What are commonly used sedatives?

A

Diazepam (Valium)
Lorazepam (Ativan)
Midazolam (Versed)

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3
Q

Diazepam (Valium)

A

long acting
metabolized in the liver –not be be used in pts with Cirrhosis
not conductive to procedural sedation

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4
Q

Lorazepam (Ativan)

A

Think OTL
Outside the liver
better for pts with renal or hepatic failure
intermediate acting (H20 soluble)

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5
Q

Midazolam (Versed)

A

FASTEST acting d/t lipophilic
superior in amnesic effects
ideal for short term procedures or ED

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6
Q

What is the sedative reversal drug we can give?

A

Flumazenil

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7
Q

Chronic pain

A

3-6 months or more

pain that goes beyond the expected period of healing

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8
Q

Pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

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9
Q

Nociceptive pain

A

proportionate with identifiable tissue damage

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10
Q

Neuropathic pain

A

may be abnormal, unfamiliar, pain, probably caused by dysfunction in peripheral or central nervous system

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11
Q

Subjective vs objective pain assessment

A

Subjective - OPQRST

Objective - VAS/numerical scale/Wong-Baker faces

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12
Q

4As to ask/assess for all pts on pain meds

A

Analgesia
ADLs
Adverse events (from the drugs)
Aberrant behavior (drug seeking behavior?)

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13
Q

allodynia

A

a non-noxious stimuli now produces pain (mechanical or thermal)

“when i put my socks on i feel pain”
might be hypersensitivity caused by opioids

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14
Q

Hyperalgesia

A

exaggerated pain response to mildly noxious mechanical or thermal stimulus

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15
Q

What is the max dose per day of acetaminophen?

A

4gm/day

but try NOT to use that much per day

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16
Q

Where is tylenol metabolized?

A

liver

don’t use in pts with hepatic disease

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17
Q

Toradol (ketorolac)

A

STRONG anti-inflammatory

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18
Q

Opiate

A

nonsynthethic agent

alkaloids derived from the opium poppy (morphine sulfate, codeine, heroin)

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19
Q

Opioid

A

opiates + synthetic substances

aka narcotics

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20
Q

What is the difference between dependence and addiction?

A

dependence - physical dependence - physiological adaption to a drug/substance which leads to withdrawal when abruptly stopped

addiction - a pattern of drug use characterized by aberrant behaviors, compulsive

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21
Q

Abuse

A

early stages of both dependence and addiction

using drugs for euphoric effects

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22
Q

Misuse

A

using drugs for a purpose other than prescribed

ex. percocet so you can sleep at night

23
Q

Opioid therapy

A

centrally acting on mu receptor in CNS (also located in GI)

24
Q

Long active opioids

A

oxycontin (PO)
MS contin (PO)
buprenorphine (TD)
fentanyl patch (TD)

25
Morphine sulfate
most commonly rx'd opioid in hospital 2 metabolites after conjugation: -MS6 (active) -MS3 (inactive) impaired elimination in RENAL failure pts -- may lead to prolonged respiratory depression
26
Hydromorphine
aka dilaudid preferred in elderly and in renal pts d/t better SE profile and better tolerated low cost, IV and PO
27
Oxycodone/Hydrocodone
Good SE profile | PO only
28
Tramadol
now schedule 4 codine analog use with caution in hx of EtOH or drug dependence if codedine doesn't work then tramadol won't work either
29
Codeine
metabolized into morphine --with 1/10th the potency ineffective in 10% of caucasians
30
Exalgo
long acting hydromorphone (dialudid) this is new (10 years ago there was no such thing as long acting hydromorphone)
31
Nucynta
only FDA approved narcotic for neuropathy | short and long acting forms
32
Schedule 1 drugs
no medical use illegal or research only highest abuse potential. heroin ecstasy Mary jane LSD
33
Schedule 2 drugs
NO refills! No calling it refills! Paper rx only. high abuse potential. ``` morphine codeine (depending on the form can be schedule 2, 3, or 5) vicodin oxycontin adderall ritalin demerol dilaudid fentanyl ``` all oxycodone containing products (percocet) are schedule 2!
34
What is the biggest differences between schedule 2 and 3?
For 3 you can call in prescription and get refills there are no refills for schedule 2 and you can not call them in
35
Schedule 3 drugs
5 refills max moderate abuse potential. verbal orders okay tylenol with codeine anabolic steroids testosterone
36
Schedule 4 drugs
5 refills max verbal orders okay mod/low abuse potential ``` xanax valium amien TRAMADOL ativan ```
37
Schedule 5 drugs
5 refills max limited abuse potential verbal orders okay cough medications lyrica robitussin AC motofen
38
ALL oxycodone containing products like percocet are schedule ____
2
39
What are the side effects of opioids?
respiratory depression/arrest delirium/CNS effect GI disturbances/constipation pruritis
40
Naloxone
0.04mg/ml increments IV | used to opioid OD with respiratory depression/arrest
41
PCA
patient controlled analgesia basal - small, constant dose PRN - pt has the ability to add more pain med as they need morphine, dilaudid most common (also fentanyl)
42
How is the basal rate different between acute and chronic or CA pain?
acute pain = 1/3 of the total expected hourly | chronic or CA pain = 2/3 of the expected
43
TENS unit
transcutaneous electrical nerve stimulation uses faster pathway to get to the brain uses gate control theory
44
Gate control theory
only certain amount of pain fibers reach the brain at any given time TENS works by using different fibers to compete and get to the brain faster to decrease the perceived pain
45
Short acting opioids
PO: dilaudid, oxycodone, percocet IV: diluadid, morphine, fentanyl
46
If you are converting between different opioids, if ever you have doubt, convert to ____first.
Morphine milligram equivalents (MME)
47
If a pt on opioids is experiencing delirium or CNS effects what should you do?
try opioid rotation decrease dose +/-naloxone
48
If a pt on opioids is experiencing GI disturbances or contipations what should you do?
metocloperamide (reglan) Ondansetron (Zofran) Movantik/telestor (for OIC - opioid induced constipation)
49
What are absolute contraindications of neuroaxial blockade?
``` allergy coagulopathy hypovolemia raised ICP SSI ```
50
Which stays in the CSF longer, morphine or fentanyl?
Morphine | slower systemic absorption
51
OIC tx
opioid induced constipation stool softener + stimulant laxative Docusate/senna if 24 hours without improvement add polyethylene glycol (Miralax) or naloxegol (Movantik) high fiber diet + fluids
52
What fibers is TENS activating?
activation of A beta sensory fibers thus decreasing noxious stimulus from 'c' fibers through spinal cord/brain
53
IV:PO morphine sulfate ratio?
1:3 | 40mg IV = 120mg PO

Clin Specialties - Surgery (11 decks)

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