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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
Q

Morphine sulfate

A

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
Q

Hydromorphine

A

aka dilaudid
preferred in elderly and in renal pts d/t better SE profile and better tolerated
low cost, IV and PO

27
Q

Oxycodone/Hydrocodone

A

Good SE profile

PO only

28
Q

Tramadol

A

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
Q

Codeine

A

metabolized into morphine –with 1/10th the potency

ineffective in 10% of caucasians

30
Q

Exalgo

A

long acting hydromorphone (dialudid)

this is new (10 years ago there was no such thing as long acting hydromorphone)

31
Q

Nucynta

A

only FDA approved narcotic for neuropathy

short and long acting forms

32
Q

Schedule 1 drugs

A

no medical use
illegal or research only
highest abuse potential.

heroin
ecstasy
Mary jane
LSD

33
Q

Schedule 2 drugs

A

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
Q

What is the biggest differences between schedule 2 and 3?

A

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
Q

Schedule 3 drugs

A

5 refills max
moderate abuse potential.
verbal orders okay

tylenol with codeine
anabolic steroids
testosterone

36
Q

Schedule 4 drugs

A

5 refills max
verbal orders okay
mod/low abuse potential

xanax
valium
amien
TRAMADOL
ativan
37
Q

Schedule 5 drugs

A

5 refills max
limited abuse potential
verbal orders okay

cough medications
lyrica
robitussin AC
motofen

38
Q

ALL oxycodone containing products like percocet are schedule ____

A

2

39
Q

What are the side effects of opioids?

A

respiratory depression/arrest
delirium/CNS effect
GI disturbances/constipation
pruritis

40
Q

Naloxone

A

0.04mg/ml increments IV

used to opioid OD with respiratory depression/arrest

41
Q

PCA

A

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
Q

How is the basal rate different between acute and chronic or CA pain?

A

acute pain = 1/3 of the total expected hourly

chronic or CA pain = 2/3 of the expected

43
Q

TENS unit

A

transcutaneous electrical nerve stimulation

uses faster pathway to get to the brain

uses gate control theory

44
Q

Gate control theory

A

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
Q

Short acting opioids

A

PO: dilaudid, oxycodone, percocet
IV: diluadid, morphine, fentanyl

46
Q

If you are converting between different opioids, if ever you have doubt, convert to ____first.

A

Morphine milligram equivalents (MME)

47
Q

If a pt on opioids is experiencing delirium or CNS effects what should you do?

A

try opioid rotation
decrease dose
+/-naloxone

48
Q

If a pt on opioids is experiencing GI disturbances or contipations what should you do?

A

metocloperamide (reglan)
Ondansetron (Zofran)
Movantik/telestor (for OIC - opioid induced constipation)

49
Q

What are absolute contraindications of neuroaxial blockade?

A 
allergy
coagulopathy
hypovolemia
raised ICP 
SSI
50
Q

Which stays in the CSF longer, morphine or fentanyl?

A

Morphine

slower systemic absorption

51
Q

OIC tx

A

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
Q

What fibers is TENS activating?

A

activation of A beta sensory fibers thus decreasing noxious stimulus from ‘c’ fibers through spinal cord/brain

53
Q

IV:PO morphine sulfate ratio?

A

1:3

40mg IV = 120mg PO

Clin Specialties - Surgery (11 decks)

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