Pain management Flashcards
Prior to surgery what NSAID type drug must be stopped 7 days in advanced? Why?
What other drugs can be given instead?
Stop (Acetylsalicylic acid) Aspirin 7 days prior to prevent anti-platelet functions
Replace with Acetaminophen (Tylenol) instead
What NSAID class does ibuprofen fall under
Propionic acids
Ketorolac (Toradol) falls under which class of drugs? How long do they last?
Pyrrolacetic Acids
Max of 5 days
How is Ketorolac (Toradol) normally administered?
Parenterally
Celecoxib falls under what drug class?
COX-2 inhibitor
What apecial instructions do you ned to give to cardiace patients taking Celecoxib
A before C
aspirin should be given before celecoxib
ADE with NSAIDS?
Upper GI bleeding
Acute Renal failure
**ask if patient is taking any meds that might cause these
ADE with Acetaminophen?
What needs to be monitored?
ADE: Hepatotoxicity
Monitor: ALT/AST Liver synthesis tests -PT/INR or Albumin Acetaminophen serum concentration
What needs to be monitored while taking NSAIDS
Complete blood count, stool guaiac (if symptoms such as black tarry stools, warrant)
What benefits does taking NSAIDS like acetaminophen/aspirin provide while taking with opoids
Boosts the effects of opioids, therefore reducing the dosage needed
What opioid class does Morphine fall under?
Is it naturally made or synthetic?
Phenanthrenes
Naturally occuring
What response does injecting morphine naturally cause in the body?
Histamine release
What is the dosing equivalents between IM and PO morphine?
Why is IM dosing lower than PO dosing
IM: 10
PO: 30
IM avoids the first pass effect so is more potent
What is the drug of choice usually for severe pain?
Morphine
Drug of choice for mild/moderate pain
NSAIDS
Codeine, Hydrocodone, Oxycodone falls under which opioid drug class
Which is naturally occurring?
Phenanthrenes
Codeine = natural
What is codeine used to treat?
Which enzyme is codeine dependent on for metabolism in the body?
Mild to moderate pain and cough suppression
CYP 450 2D6
What opioid class do Meperidine and Fentanyl fall under?
Phenylpiperidines
What is the drug dose equivalent between Meperidine and Fentanyl?
Meperidine 100
Fentanyl 0.1
Which drug produces an active metabolite known as Normeperidine?
What effects does this cause on the body
Meperidine
tremors, myoclonus, and seizures
and Mydriasis
Should Fentanyl be used as a transdermal patch in acute pain?
No, designed to give a dose for a longer duration
When taking Fentanyl as a trasnmucosal, intranasal and sublingual dose what instructions ned to be followed?
Start with lowest dose despite daily opioid intake
What opioid class does methadone fall under
Diphenylheptanes
What complications or side effects can Mehtadone cause
Sedation
QT Prolongation
How often are you allowed to titrate dosing with methadone?
Avoid dose titrations more frequently than every 2 weeks
What drug class does Pentazocine (Talwin) fall under?
What other medications is added with these drugs to avoid abuse potential?
Agonist-Antagonist or Partial Agonists
Narcan
What drug class does Buprenorphine fall under?
Agonist-Antagonist or Partial Agonists
When taking Pentazocine or Buprenorphine what effect does it have on Naloxene
Naloxone may not be effective in reversing respiratory depression
What opioid drug class does Tramadol fall under
Decreasing dosage is necessary for which population?
Central analgesics
Renal impairment and the elderly
What adverse effect are we most worried about with opioid use?
Respiratory depression (slowing things down) Constipation
Sleep apnea or COPD
Which adverse drug effects will decrease over time while taking opioids?
Sedation
Nausea and vomiting
High dose opioid use will cause what to occur in males?
Hypo-testosterone/Hypogonadism
Who should avoid taking Codeine?
Children and breastfeeding women
What drug class does Naloxone (Narcan) fall under?
Opioid Antagonist
What is the downfall with given Naloxene to treat opioid abuse/overdose
Requires repeat dosing since some opioids can outlast duration of Naloxene
What two drugs are most effective for Neuropathic pain
Tremedol
Methadone
MOA of Gabapentin (Anticonvulsant drug)
may decrease neuronal excitatory neurotransmitters and nociception through voltage-gated calcium channels specifically possessing the alpha-2-delta-1 subunit
slide 62
slide 62
What adjunctive therapy can be used to treat Chronic pain?
What is their method of action
Tricyclic antidepressants
Serotonin
Norepinephrine reuptake inhibitor antidepressants
block the reuptake of serotonin and norepinephrine enhancing pain inhibition
MOA of Duloxetine for chronic pain?
Potent inhibitor of neuronal serotonin and norepinephrine reuptake
Regional Analgesias and their ADE?
High plasma concentrations
Cardiovascular effects - myocardial depression, hypotension, decreased cardiac output, heart block, bradycardia, arrhythmias, and cardiac arrest.
What is the MOA of Ziconotide?
Selectively binds to N-type voltage-sensitive calcium channels located on the nociceptive afferent nerves of the dorsal horn in the spinal cord
Blocks the excitatory neurotransmitter release and reduces sensitivity to painful stimuli
ADE of Ziconotide?
Confusion, dizziness, hallucinations
Urinary retention
What medication is used to treat Fibromyalgia? Which is not recommended?
Acetaminophen
Opioids
What is a Pseudoallergy when taking opiods?
Histamine released from mast cells but
NOT an immunologic response
Itching, flushing, sweating
If a patient is experiencing a possible psedoallergy what can be done to reduce these side effects?
- Use of non-opiod analgesic
- Avoid codeine, morphine and merepiridine, drugs associated with pseduoallergies
- Use a more potent opioid to reduce histamine release
- Use an antihistamine (H1/H2 blocker)
- Dose reduction
If a patient is actually experiencing an allergy from opioids what can be done to reduce these side effects
A non-opioid analgesic
An opioid in a chemical class different from the one to which the patient reacted, with close monitoring
What the difference in location between Somatic and Visceral pain?
How do these types of pain differ when they occur?
Somatic- arising from skin, bone, joint, muscle, or connective tissue
Present as throbbing pain and localized
Visceral - internal organs.
Pain feeling as if it is coming from other structures (referred) or as a more localized phenomenon
