Pain Management

Question 1

3 major sedatives and their reversal agent

Answer 1

Diazepam
Lorazepam
Midazolam
Reversal: flumazenil

Question 2

Length of sedative actions

Answer 2

Diazepam > lorazepam > midazolam

Question 3

which sedative is metab in the liver?

Answer 3

Diazepam

Question 4

Which sedative is best for those in hepatic or renal failure?

Answer 4

Lorazepam

Question 5

Which sedative is fastest acting, lipohilic, and superior in amnesia?

Answer 5

Midazolam

Question 6

4 As of pain assessment

Answer 6

Analgesia
ADLs
adverse events
Aberrant behavior

Question 7

Hyperalgesia

Answer 7

Exaggerated pain response to mildly noxious mechanical or thermal stimulus

Question 8

Allodynia

Answer 8

Painful response to an ordinarily non-noxious stimulus

Question 9

Who should not get acetaminophen?

Answer 9

Hepatic dz pts

Question 10

Who should avoid NSAIDs?

Answer 10

GI dz, renal dz, coagulopathy

Question 11

Short acting opioids (PO)

Answer 11

Percocet (oxy+acetaminophen)
Oxycodone
Dilaudid (hydromorphone)

Question 12

Short acting opioids (IV)

Answer 12

Morphine sulfate
Fentanyl
Dilaudid (hydromorphone)

Question 13

LA/ER opioids (PO)

Answer 13

OxyContin (oxycodone)
MS Contin (ER morphine)

Question 14

TD long acting meds

Answer 14

Buprenorphine

Fentanyl patch

Question 15

Which patients should you be careful with in using morphine sulfate?

Answer 15

Impaired elimination in renal failure –> respiratory depression

Question 16

Codeine

Answer 16

Metabolized into morphine, but with 1/10 potency, ineffective in 10% of whites

Question 17

Schedule 1 drugs

Answer 17

highest abuse potential
Illegal/research only
Ex. Heroin, ecstasy, marijuana, LSD

Question 18

Schedule 2 drugs

Answer 18

High abuse potential
No refills and paper rx only
Ex. Morphine, cocaine, Vicodin, oxy, dilaudid, fentanyl

Question 19

Schedule 3 drugs

Answer 19

Moderate abuse
5 RF max, verbal okay
Tylenol w. Codeine, anabolic steroids, testosterone

Question 20

Schedule 4 drugs

Answer 20

Mod/low abuse
5 RF max, verbal okay
Xanax, Valium ambien, Ativan

Question 21

Schedule 5 drugs

Answer 21

Limited abuse potential
5 RF max, verbal okay
Cough meds, lyrica, robitussin

Question 22

Tx for respiratory depression in opioids

Answer 22

Nalaxone

Question 23

Tx for delirium/CNS effects in opioids

Answer 23

Rule out other meds
Try opioid rotation
Decrease doses

Question 24

Tx for GI disturbances/constipation

Answer 24

Metocloperamide (Reglan)
Ondansetron (Zofran)
Movantik/relestor: for constipation (opioid antagonist in the gut)

Question 25

Tx for pruritis with opioids

Answer 25

Diphenhydramine

Question 26

How much should you decrease daily dosing when weaning a patient off narcotics?

Answer 26

10-25% of the total every isit

Question 27

How to treat opioid o/d

Answer 27

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

Question 28

Which drugs are used for PCA

Answer 28

Morphine sulfate
Hydromorphone
Fentanyl

Question 29

When to increase bolus dose of PCA?

Answer 29

if 3+ doses/hour and pain is not controlled. Upward titration of 25-50% indicated

Question 30

Basal rate calculations in PCA

Answer 30

1/3 of total hourly requirement in opiate naive

2/3 of hourly requirement for chronic pain or cancer pts

Question 31

Absolute contraindications to epidural and spinal regional anesthesia

Answer 31

Refusal 
Allergy
Uncorrected hypovolemia
Infection at insertion
Coagulopathy
raised ICP