Pain Management

Question 1

define dependence

Answer 1

withdrawal at cessation

Question 2

define tolerance

Answer 2

more med needed for analgesic effect

Question 3

define addiction

Answer 3

impaired functioning

Question 4

define pain

Answer 4

unpleasant sensory/emotional experience associated with tissue damage

Question 5

WHO level 1 (mild) pain meds

Answer 5

NSAIDS
ASA
Acetaminophen

Question 6

Max dose of tylenol

Answer 6

3000mg in 24 hrs

1500-2000 if liver dz

Question 7

WHO level 2 (moderate) pain meds

Answer 7

percocet
tramadol
norco/vicodin
tylenol 3

Question 8

what is percocet?

Answer 8

oxycodone + acetaminophen

Question 9

what is norco/vicodin

Answer 9

hydrocodone + acetaminophen

Question 10

what is tylenol 3

Answer 10

30mg codeine + acetaminophen

Question 11

rank the 4 level 2 pain meds in terms of potency

Answer 11

1. percocet
2. norco/vicodin
3. tramadol
4. tylenol 3

Question 12

mechanism of tramadol

Answer 12

mu agonist

5-HT/NE inhibitor activity

Question 13

tramadol contraindications

Answer 13

SSRIs/MAOIs b/c of serotonin syndrome

Question 14

why don’t some people respond to codeine

Answer 14

some people don’t have enough enzyme activity to convert it to the active metabolite

Question 15

6 choices for level 3 (severe) pain

Answer 15

1. morphine
2. hydromorphone/dilaudid
3. oxycodone
4. fentanyl
5. methadone
6. demerol/meperidine

Question 16

safest level 3 med for liver/kidney failure

Answer 16

fentanyl

Question 17

downside of methadone

Answer 17

very long acting - may not see side effect for up to 7 days ; prolonged QT/torsades ; respiratory depression

Question 18

use of demerol/meperidine

Answer 18

post-op rigors
heme/onc post-transfusion
not for pain

Question 19

what type of pt can tolerate meperidine?

Answer 19

young/healthy person who is not on an MAOI

Question 20

side effects of meperidine

Answer 20

tachycardia (atropine derivative)

inc cns excitability/seizures

Question 21

contraindications of meperidine

Answer 21

renal insufficiency

Question 22

define adjuvant

Answer 22

drug to manage pain not primarily used as analgesic

Question 23

adjuvants for neuropathic pain

Answer 23

benzos, gabapentin, tcas, flexeril/cyclobenzaprine, lidocaine patch (post-herpetic neuralgia)

Question 24

morphine clearance

Answer 24

renally

consider starting at .5mg instead of 1-2mg

Question 25

another name for norco?

Answer 25

vicodin

Question 26

PEG assessment scale stands for

Answer 26

Pain average (1-10)
Enjoyment (amt of interference with)
General activity (amt of interference with)

Question 27

if total opioid dose is 50+ mg equivalent of morphine daily, also consider offering pt

Answer 27

naloxone

Question 28

avoid giving pt what equivalent dose of morphine on a daily basis

Answer 28

avoid 90+ mg equivalent of morphine daily

Question 29

frequency of evaluating patient on opioids

Answer 29

within 1-4 wks of initial rx or after dose escalation. otherwise q3 months

Question 30

what test should you do annually and before starting opioids?

Answer 30

urine drug screen

Question 31

what med should you avoid in pt on opioids

Answer 31

benzos

Question 32

IV NSAID = ?

Answer 32

ketorolac (effects kidneys so give for max 5 days)

Question 33

characteristics of transdermal fentanyl

Answer 33

lipophilic, diffusion gradient with depot of med in subq adipose tissue