Pain Management

Question 1

Celiac Plexus blocks from where to where?

Answer 1

lower esophagus - splenic flexure

Question 2

Stellate ganglion block for what indications?

Answer 2

Herpes zoster of face, complex regional syndrome of upper extremity, Reflex Sympathetic Dystrophy

Question 3

Most common indication for Celiac plexus block?
Most common side effect?
What lumbar level?

Answer 3

Pancreatic cancer pain
Hypotension
L1

Question 4

Superior Hypogastric blocks from where to where?

Answer 4

Descending colon to rectum. Penis, perineum, bladder, vagina, ovaries.

Question 5

Ganglion Impar/Walther blocks what?

Answer 5

Similar to Sup. Hypogastric, perineal, vagina, prostate, coccyx.

Question 6

Cancer pain from vertebral fractures, what is alternative treatment?

Answer 6

Kyphoplasty proven to be efficacious.

Question 7

Spinal cord stimulation indication?

Answer 7

Neck, back, arm, leg, or migraines

Question 8

Phenelzine drug class?

Answer 8

MAOIs antidepressants

Question 9

MOA of TCAs?

Answer 9

inhibit reuptake of serotonin and norepinephrine, NMDA antagonist, A-2 agonist

Question 10

SE of TCA? What should be checked before starting?

Answer 10

Anticholinergic, sedation. Check EKG.

Question 11

MOA of corticosteroids?

Answer 11

Inhibits arachidonic acid-prostaglandin pathway.

Question 12

SE of long term steroids?

Answer 12

PUD!! weight gain, edema, hyperglycemia

Question 13

MOA of clonidine and tizanidine?

How can clonidine be administered?

Answer 13

A-2 agonist.

Neuraxial (intrathecal)

Question 14

Baclofen MOA?
Indications (disease specific)?
Weird indication?

Answer 14

GABA derivative
Spastic movement/spinal cord injury
Can treat hiccups!

Question 15

Odd SE of carbamazepine?

Answer 15

Aplastic Anemia

Question 16

MOA of gabapentin and pregabalin?

Answer 16

Inhibit voltage gated Ca channels.

Question 17

MOA of Lamotrigine?
Indications?
Severe adverse SE?

Answer 17

Inhibits voltage gated Na channels
DM neuropathy, trigeminal neuralgia, migraines
SJS, TEN, DRESS

Question 18

MOA of Topamax?

Common SE?

Answer 18

Increase response to GABA

Causes weight loss!

Question 19

MOA of Valproic Acid?

Common lab abnormalities?

Answer 19

Blocks Na channels and increase GABA by stopping degradation.
Elevated Transaminases

Question 20

Bisphosphonate indications?
Severe SE?
MOA?

Answer 20

Metastatic bone pain.
Osteonecrosis of jaw.
Inhibit osteoClast activity

Question 21

NMDA antagonist drugs? (3)

Answer 21

Methadone, ketamine, dextromethorphan

Question 22

Indication for ketamine?

SE?

Answer 22

Refractory neuropathic pain and depression.

CNS=see thing, hear things, feel things

Question 23

Pt on methadone for opioid addiction comes in for acute pain management 2/2 to trauma, what is management?

Answer 23

Continue home methadone regimen and use different opioid to manage acute trauma pain.

Question 24

What 4 symptoms and PPS is utilized in Palliative Prognostic Index to predict mortality in cancer pts receiving palliative care only (no cancer treatment)?

Answer 24

dyspnea, delirium, oral intake, and edema.

Question 25

What is best pain assessment for neonates?

Answer 25

CRIES

Question 26

What is best pain assessment for 3 years or older?

Answer 26

Six Faces Scale

Question 27

True or False? There is no opioid screening tool validated for palliative care patients?

Answer 27

True

Question 28

Why is morphine not suitable for outpt epidural injections?

Answer 28

Epidural injection has bimodal distribution and can have peak later on.

Question 29

What is bioavailability of morphine?

Answer 29

10-45%

Question 30

What is MOA of Methadone? 3

Answer 30

Mu-opioid agonist, NMDA antagonist, and inhibit MOA reuptake

Question 31

How many days before able to use the same site for transdermal buprenorphine patch?

Answer 31

21 days

Question 32

Behavioral Pain Scale is used for what type of pts?

Answer 32

Critically ill pts on mech vent.

Question 33

Which pain scale/questionnaire is best utilized for detailed description and quality of pain?

Answer 33

McGill Pain Questionnaire. Select 7 words that best describe their pain.

Question 34

What does Brief Pain Index measure?

Answer 34

Rapid assessment of pain effect on function.

Question 35

How is visual analogue scale used?

Answer 35

Uses numbers to describe pain on a continuum.

Question 36

Which trimester is safest for pain meds?

Answer 36

First trimester.

Question 37

What trimester should NSAIDs be avoided in?

Answer 37

Late second and third, can cause premature closure of ductus arteriousus.

Question 38

What pain scale can be used for pts with dementia?

Answer 38

PAINAD

Question 39

True/False | Intercostal nerve blocks should be at least 2 levels due to overlapping nerves.

Answer 39

True.

Question 40

According to WHO, what is considered step 2 and mild opioids?

Answer 40

Tramadol, Codeine, hydrocodone.

Question 41

What is considered first line treatment of mild opioid misuse disorder?

Answer 41

naltrexone

Question 42

Which route of opioids can cause respiratory depression the fastest?

Answer 42

Neuraxial.

Question 43

What is recommended ratio to use when converting morphine to fentanyl?

Answer 43

1 mcg fentanyl : 2 mg of morphine.

Question 44

Tx for myclonus opioid toxicity?

Answer 44

Tx with benzos, opioid rotation, and IV fluids

Question 45

What can be used as adjunct in tx of refractory postherpetic neuralgia? After tx with gabapentin and lidocaine patch?

Answer 45

opioids.