Pain Management - Adams Flashcards
What is the best tool to access a child’s level of pain?
1st best: self reporting using a face scale
2nd best: assessment by parent
3rd best: nurse assessment
How do you evaluate pain in a patient?
Assume patient self-reporting is the best method to assess pain
Numeric scale works well in adults if no cognitive dysfunction
In children, parents are better at accurately rating pain then the physician. Faces scale or poker chip tool work well.
How do you evaluate which Non-narcotic pain medication to use when treating pain?
They all are co-analgesics and can enhance pain relief even if a narcotic is being used.
They all may diminish bone formation, healing, and remodeling.
ASA = Acetaminophen = ~5mg oxycodone for analgesia
~ all equal
***Decide based on side effects.
What is a safe amount of Ibuprofen to take per day to avoid side effects?
Ibuprofen ≤ 1200 mg/day has a risk of GI bleed equal to placebo
-Can take 40mg TID without concern
What are the two most common narcotic pain medications? How do you differentiate between the two?
Hydrocodone vs. Oxycodone
They are equally effective if given at appropriate dose:
Oxycodone is 1/3 stronger than hydrocodone
5 mg of oxycodone = 7.5 mg of hydrocodone
Both are Class II
How much Codeine is in Tylenol #3?
Tylenol T3 = 30mg of Codeine
Is codeine a good pain medication option for patients with pain?
No, 10% of the population can not metabolize codeine to its active opioid and therefore receive no benefit
Codeine has been shown to add
What do you do if a patient receiving IV Morphine/Hydromorphone develops an itchy red arm?
Give Benadryl and keep administering the drug.
-Morphine causes histamine release from the mast cells, but will not cause anaphylaxis.
What is the dose equivalents of Hydromorphone and Fentanyl to 10 mg of Morphine IV?
Morphine 10 mg IV = Hydromorphone 1.4 mg IV = Fentanyl 100 mcg IV
What is an acceptable starting dose of Morphine?
5 mg Morphine IV
Which has faster onset Morphine or Fentanyl?
Fentanyl, Faster onset than Morphine by ~5 minutes
BUT, Dosage is different (100 mcg) IV = 10 mg Morphine IV
What is the main side effect of Morphine that you should be concerned about?
Causes histamine release which can produce hypotension
What other pain medication will a patient have an allergy to if they have an allergic reaction with Morphine
They will also have an allergy to hydromorphone (Dilaudid).
If a patient has pain and nausea/vomiting, what is the best NSAID to use?
Ketorolac IV
Why is tramadol (Ultram) a good option for pain management in a patient with a history of narcotic abuse?
It has an opioid-like effect yet has a low abuse potential
Some studies have found it to be less effective than codeine and hydrocodone when used in pain management in acute pain
It works on different sites than NSAIDs. There are studies which have shown synergistic effects.
