Pain Management Flashcards
Celiac Plexus blocks from where to where?
lower esophagus - splenic flexure
Stellate ganglion block for what indications?
Herpes zoster of face, complex regional syndrome of upper extremity, Reflex Sympathetic Dystrophy
Most common indication for Celiac plexus block?
Most common side effect?
What lumbar level?
Pancreatic cancer pain
Hypotension
L1
Superior Hypogastric blocks from where to where?
Descending colon to rectum. Penis, perineum, bladder, vagina, ovaries.
Ganglion Impar/Walther blocks what?
Similar to Sup. Hypogastric, perineal, vagina, prostate, coccyx.
Cancer pain from vertebral fractures, what is alternative treatment?
Kyphoplasty proven to be efficacious.
Spinal cord stimulation indication?
Neck, back, arm, leg, or migraines
Phenelzine drug class?
MAOIs antidepressants
MOA of TCAs?
inhibit reuptake of serotonin and norepinephrine, NMDA antagonist, A-2 agonist
SE of TCA? What should be checked before starting?
Anticholinergic, sedation. Check EKG.
MOA of corticosteroids?
Inhibits arachidonic acid-prostaglandin pathway.
SE of long term steroids?
PUD!! weight gain, edema, hyperglycemia
MOA of clonidine and tizanidine?
How can clonidine be administered?
A-2 agonist.
Neuraxial (intrathecal)
Baclofen MOA?
Indications (disease specific)?
Weird indication?
GABA derivative
Spastic movement/spinal cord injury
Can treat hiccups!
Odd SE of carbamazepine?
Aplastic Anemia
MOA of gabapentin and pregabalin?
Inhibit voltage gated Ca channels.
MOA of Lamotrigine?
Indications?
Severe adverse SE?
Inhibits voltage gated Na channels
DM neuropathy, trigeminal neuralgia, migraines
SJS, TEN, DRESS
MOA of Topamax?
Common SE?
Increase response to GABA
Causes weight loss!
MOA of Valproic Acid?
Common lab abnormalities?
Blocks Na channels and increase GABA by stopping degradation.
Elevated Transaminases
Bisphosphonate indications?
Severe SE?
MOA?
Metastatic bone pain.
Osteonecrosis of jaw.
Inhibit osteoClast activity
NMDA antagonist drugs? (3)
Methadone, ketamine, dextromethorphan
Indication for ketamine?
SE?
Refractory neuropathic pain and depression.
CNS=see thing, hear things, feel things
Pt on methadone for opioid addiction comes in for acute pain management 2/2 to trauma, what is management?
Continue home methadone regimen and use different opioid to manage acute trauma pain.
What 4 symptoms and PPS is utilized in Palliative Prognostic Index to predict mortality in cancer pts receiving palliative care only (no cancer treatment)?
dyspnea, delirium, oral intake, and edema.
What is best pain assessment for neonates?
CRIES
What is best pain assessment for 3 years or older?
Six Faces Scale
True or False? There is no opioid screening tool validated for palliative care patients?
True
Why is morphine not suitable for outpt epidural injections?
Epidural injection has bimodal distribution and can have peak later on.
What is bioavailability of morphine?
10-45%
What is MOA of Methadone? 3
Mu-opioid agonist, NMDA antagonist, and inhibit MOA reuptake
How many days before able to use the same site for transdermal buprenorphine patch?
21 days
Behavioral Pain Scale is used for what type of pts?
Critically ill pts on mech vent.
Which pain scale/questionnaire is best utilized for detailed description and quality of pain?
McGill Pain Questionnaire. Select 7 words that best describe their pain.
What does Brief Pain Index measure?
Rapid assessment of pain effect on function.
How is visual analogue scale used?
Uses numbers to describe pain on a continuum.
Which trimester is safest for pain meds?
First trimester.
What trimester should NSAIDs be avoided in?
Late second and third, can cause premature closure of ductus arteriousus.
What pain scale can be used for pts with dementia?
PAINAD
True/False
Intercostal nerve blocks should be at least 2 levels due to overlapping nerves.
True.
According to WHO, what is considered step 2 and mild opioids?
Tramadol, Codeine, hydrocodone.
What is considered first line treatment of mild opioid misuse disorder?
naltrexone
Which route of opioids can cause respiratory depression the fastest?
Neuraxial.
What is recommended ratio to use when converting morphine to fentanyl?
1 mcg fentanyl : 2 mg of morphine.
Tx for myclonus opioid toxicity?
Tx with benzos, opioid rotation, and IV fluids
What can be used as adjunct in tx of refractory postherpetic neuralgia? After tx with gabapentin and lidocaine patch?
opioids.
