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Palliative Exam > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Celiac Plexus blocks from where to where?

A

lower esophagus - splenic flexure

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2
Q

Stellate ganglion block for what indications?

A

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

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3
Q

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

A

Pancreatic cancer pain
Hypotension
L1

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4
Q

Superior Hypogastric blocks from where to where?

A

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

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5
Q

Ganglion Impar/Walther blocks what?

A

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

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6
Q

Cancer pain from vertebral fractures, what is alternative treatment?

A

Kyphoplasty proven to be efficacious.

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7
Q

Spinal cord stimulation indication?

A

Neck, back, arm, leg, or migraines

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8
Q

Phenelzine drug class?

A

MAOIs antidepressants

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9
Q

MOA of TCAs?

A

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

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10
Q

SE of TCA? What should be checked before starting?

A

Anticholinergic, sedation. Check EKG.

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11
Q

MOA of corticosteroids?

A

Inhibits arachidonic acid-prostaglandin pathway.

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12
Q

SE of long term steroids?

A

PUD!! weight gain, edema, hyperglycemia

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13
Q

MOA of clonidine and tizanidine?

How can clonidine be administered?

A

A-2 agonist.

Neuraxial (intrathecal)

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14
Q

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

A

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

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15
Q

Odd SE of carbamazepine?

A

Aplastic Anemia

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16
Q

MOA of gabapentin and pregabalin?

A

Inhibit voltage gated Ca channels.

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17
Q

MOA of Lamotrigine?
Indications?
Severe adverse SE?

A

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

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18
Q

MOA of Topamax?

Common SE?

A

Increase response to GABA

Causes weight loss!

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19
Q

MOA of Valproic Acid?

Common lab abnormalities?

A

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

20
Q

Bisphosphonate indications?
Severe SE?
MOA?

A

Metastatic bone pain.
Osteonecrosis of jaw.
Inhibit osteoClast activity

21
Q

NMDA antagonist drugs? (3)

A

Methadone, ketamine, dextromethorphan

22
Q

Indication for ketamine?

SE?

A

Refractory neuropathic pain and depression.

CNS=see thing, hear things, feel things

23
Q

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

A

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

24
Q

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

A

dyspnea, delirium, oral intake, and edema.

25
Q

What is best pain assessment for neonates?

A

CRIES

26
Q

What is best pain assessment for 3 years or older?

A

Six Faces Scale

27
Q

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

A

True

28
Q

Why is morphine not suitable for outpt epidural injections?

A

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

29
Q

What is bioavailability of morphine?

A

10-45%

30
Q

What is MOA of Methadone? 3

A

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

31
Q

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

A

21 days

32
Q

Behavioral Pain Scale is used for what type of pts?

A

Critically ill pts on mech vent.

33
Q

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

A

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

34
Q

What does Brief Pain Index measure?

A

Rapid assessment of pain effect on function.

35
Q

How is visual analogue scale used?

A

Uses numbers to describe pain on a continuum.

36
Q

Which trimester is safest for pain meds?

A

First trimester.

37
Q

What trimester should NSAIDs be avoided in?

A

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

38
Q

What pain scale can be used for pts with dementia?

A

PAINAD

39
Q

True/False

Intercostal nerve blocks should be at least 2 levels due to overlapping nerves.

A

True.

40
Q

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

A

Tramadol, Codeine, hydrocodone.

41
Q

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

A

naltrexone

42
Q

Which route of opioids can cause respiratory depression the fastest?

A

Neuraxial.

43
Q

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

A

1 mcg fentanyl : 2 mg of morphine.

44
Q

Tx for myclonus opioid toxicity?

A

Tx with benzos, opioid rotation, and IV fluids

45
Q

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

A

opioids.

Palliative Exam (4 decks)

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