Pain Management Flashcards
define dependence
withdrawal at cessation
define tolerance
more med needed for analgesic effect
define addiction
impaired functioning
define pain
unpleasant sensory/emotional experience associated with tissue damage
WHO level 1 (mild) pain meds
NSAIDS
ASA
Acetaminophen
Max dose of tylenol
3000mg in 24 hrs
1500-2000 if liver dz
WHO level 2 (moderate) pain meds
percocet
tramadol
norco/vicodin
tylenol 3
what is percocet?
oxycodone + acetaminophen
what is norco/vicodin
hydrocodone + acetaminophen
what is tylenol 3
30mg codeine + acetaminophen
rank the 4 level 2 pain meds in terms of potency
- percocet
- norco/vicodin
- tramadol
- tylenol 3
mechanism of tramadol
mu agonist
5-HT/NE inhibitor activity
tramadol contraindications
SSRIs/MAOIs b/c of serotonin syndrome
why don’t some people respond to codeine
some people don’t have enough enzyme activity to convert it to the active metabolite
6 choices for level 3 (severe) pain
- morphine
- hydromorphone/dilaudid
- oxycodone
- fentanyl
- methadone
- demerol/meperidine
safest level 3 med for liver/kidney failure
fentanyl
downside of methadone
very long acting - may not see side effect for up to 7 days ; prolonged QT/torsades ; respiratory depression
use of demerol/meperidine
post-op rigors
heme/onc post-transfusion
not for pain
what type of pt can tolerate meperidine?
young/healthy person who is not on an MAOI
side effects of meperidine
tachycardia (atropine derivative)
inc cns excitability/seizures
contraindications of meperidine
renal insufficiency
define adjuvant
drug to manage pain not primarily used as analgesic
adjuvants for neuropathic pain
benzos, gabapentin, tcas, flexeril/cyclobenzaprine, lidocaine patch (post-herpetic neuralgia)
morphine clearance
renally
consider starting at .5mg instead of 1-2mg
