Pain Management Flashcards
What are the types of pain?
- Nociceptive: noxious stimulus either somatic or visceral
- Inflammatory: tissue damage despite the nociceptive defense
- Neuropathic: damage to or dysfunction of peripheral or central nervous system
- Functional: pain sensitivity due to an abnormal processing or function of the CNS in response to stimuli
What are the clinical presentations of pain?
- Acute
- Chronic malignant
- Chronic non-malignant
What drugs are used for mild to moderate pain?
- NSAIDs
- Acetaminophen
- Codeine
- Tramadol
What drugs are used for Patient-Controlled IV delivery?
- Morphine
- Hydromorphone
- Fentanyl
- Methadone
What analgesic is not recommended for routine dosing and why?
- Meperidine
- Metabolite normeperidine has half life of 15-20hrs and if it accumulates can cause dysphoria, myoclonus, and seizures
- Mixed agonist-antagonist: ceiling effect
What is used to manage opioid induced pruritis?
- Hydroxyzine
- Diphenhydramine
What is used to manage opioid induded constipation?
- Stimulant laxative: Castor oil, Bisacodyl, Senna
- Combination with stool softener: Docusate/Glycerin, Mineral oil
Managing opioid induced nausea/vomiting?
- Hydroxyzine: first generation H1 antagonist
- Metoclopramide: 5-HT4 agonist, vagal and central 5-HT3 antagonist, D2 antagonist
- Prochlorperazine: D2 antagonist
- tolerance within few days
Managing opioid induced sedation?
- Methylphenidate: releasing agent cause NE release from presynaptic terminal
- Modafiinil: pschostimulant that inhibits NET and DAT increasing synaptic concentrations of NE, dopamine, serotonin, glutamte, while decreasing GABA
Managing opioid indeuced respiratory depression?
- Naloxone
- tolerance develops quickly
What can be used for several neuropathic pain syndromes?
- Antidepressants: TCAs and SNRIs
- Anticonvulsants: Gabapentin & Pregabalin; Carbamazepine & Oxcarbazepine
Gabapentin & Pregabalin MOA, AE?
MOA: block voltage gated calcium channels > decrease release of glutamte, NE, and substance P
AE: dizziness, somnolence, peripheral edema
Carbamazepine & Oxcarbazepine MOA, AE, Uses?
MOA: block voltage gated sodium channels
AE: drowsiness, dizziness, N/V, leukopenia (Carbamazepine), aplastic anema
Uses: Carbamazepine is DOC for trigeminal neuralgia
Topical therapies and there uses?
- Lidocaine patches: peripheral neuropathy particularly postherpetic neuralgia
- Capsaicin patches: depletes substance P from terminals of afferent C fibers also for postherpetic neuralgia
- Clonidine: orally, transdermally, or intraspinally for pain in sympathetically maintained pain
Glucocorticoids uses?
- Dexamethasone: DOC
- Prednisone and Methylprednisolone
Uses: acute nerve compression, increased intracranial pressure, bone pain, visceral pain, anorexia, nausea, depressed mood
Other indications can improve appetite, nausea, malaise, and overall quality of life
Bisphosphonates uses?
- Zoledronate
- Pamidronate
Uses: bone metastasis and multiple myeloma
