Pain Management Flashcards
3 major sedatives and their reversal agent
Diazepam
Lorazepam
Midazolam
Reversal: flumazenil
Length of sedative actions
Diazepam > lorazepam > midazolam
which sedative is metab in the liver?
Diazepam
Which sedative is best for those in hepatic or renal failure?
Lorazepam
Which sedative is fastest acting, lipohilic, and superior in amnesia?
Midazolam
4 As of pain assessment
Analgesia
ADLs
adverse events
Aberrant behavior
Hyperalgesia
Exaggerated pain response to mildly noxious mechanical or thermal stimulus
Allodynia
Painful response to an ordinarily non-noxious stimulus
Who should not get acetaminophen?
Hepatic dz pts
Who should avoid NSAIDs?
GI dz, renal dz, coagulopathy
Short acting opioids (PO)
Percocet (oxy+acetaminophen)
Oxycodone
Dilaudid (hydromorphone)
Short acting opioids (IV)
Morphine sulfate
Fentanyl
Dilaudid (hydromorphone)
LA/ER opioids (PO)
OxyContin (oxycodone) MS Contin (ER morphine)
TD long acting meds
Buprenorphine
Fentanyl patch
Which patients should you be careful with in using morphine sulfate?
Impaired elimination in renal failure –> respiratory depression
Codeine
Metabolized into morphine, but with 1/10 potency, ineffective in 10% of whites
Schedule 1 drugs
highest abuse potential
Illegal/research only
Ex. Heroin, ecstasy, marijuana, LSD
Schedule 2 drugs
High abuse potential
No refills and paper rx only
Ex. Morphine, cocaine, Vicodin, oxy, dilaudid, fentanyl
Schedule 3 drugs
Moderate abuse
5 RF max, verbal okay
Tylenol w. Codeine, anabolic steroids, testosterone
Schedule 4 drugs
Mod/low abuse
5 RF max, verbal okay
Xanax, Valium ambien, Ativan
Schedule 5 drugs
Limited abuse potential
5 RF max, verbal okay
Cough meds, lyrica, robitussin
Tx for respiratory depression in opioids
Nalaxone
Tx for delirium/CNS effects in opioids
Rule out other meds
Try opioid rotation
Decrease doses
Tx for GI disturbances/constipation
Metocloperamide (Reglan)
Ondansetron (Zofran)
Movantik/relestor: for constipation (opioid antagonist in the gut)
Tx for pruritis with opioids
Diphenhydramine
How much should you decrease daily dosing when weaning a patient off narcotics?
10-25% of the total every isit
How to treat opioid o/d
Halo one – give 1-2 mL (0.04 mg-0.08 mg) IV q 3-5 minutes
If no change after 0.2 mg, consider other causes
Which drugs are used for PCA
Morphine sulfate
Hydromorphone
Fentanyl
When to increase bolus dose of PCA?
if 3+ doses/hour and pain is not controlled. Upward titration of 25-50% indicated
Basal rate calculations in PCA
1/3 of total hourly requirement in opiate naive
2/3 of hourly requirement for chronic pain or cancer pts
Absolute contraindications to epidural and spinal regional anesthesia
Refusal Allergy Uncorrected hypovolemia Infection at insertion Coagulopathy raised ICP
