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Therapeutics IV > Pain Management - Block 4 > Flashcards

Pain Management - Block 4 Flashcards

1
Q

What is the definition for pain?

A

An unpleasant sensory and emotional experience associated with potential tissue damage

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2
Q

What are the causes on cancer pain?

A
  1. Bone pain from CSF
  2. Surgery
  3. Phantom pain
  4. ADRs of chemo and radiation
  5. Procedures and testing
  6. Cancer itself:
    * Tumor can press onf nerves, bones, organs
    * Spinal compression
    * Bone metasasis
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3
Q

What are the types of nociceptive pain?

A

Somatic: sharp, well-localized, throbbing
* Surgery, bone mets, fractures, cuts

Visceral: ill defined, aching, cramping
* Compression, infiltration

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4
Q

Describe the presentation of neuropathic pain?

A

Burning or shooting pain, numbness
* Diabetic neuropathy, chemo, radiation

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5
Q

What is breakthrough pain?

A
  1. Flare of pain that can happen at anytime
  2. Non-predicatable
  3. Quick onset
  4. Last as long as hours
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6
Q

Who is tx for breakthrough pain different from other pain?

A

Not controlled by regular pain meds
* Requires additional dose or alternative therapy

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7
Q

What are the goals for pain management?

A
  1. Analgesia (optimize)
  2. Activities (optimize)
  3. ADR (minimize)
  4. Aberrant drug taking (Avoid)
  5. Affect (relationship between pain and mood)

Screen patients at every contact

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8
Q

When should you consider hospitalization for pain?

A

Acute, severe pain or pain crisis

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9
Q

Tx for persistant cancer pain? Breakthrough?

A

Scheduled or long-acting analgesics

Breakthrough pain with supplemental doses of short-acting analgesics

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10
Q

What is steady state?

A

stable drug dose routinely administered for period -> 5 t1/2

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11
Q

What do you want to know when assessing your patient’s pain?

A
  • Location
  • Intensity
  • Does it interfere with ADLs
  • Timing
  • Description
  • Aggravating/alleviating factors
  • Other symptoms?
  • What is current pain regimen?
  • Response to current regimen
  • Breakthrough pain
  • Prior history of pain meds?
  • Special considerations
  • Assess for abuse/misuse/diversion
  • Psychosocial support
  • Risk factors for undertreatment
  • Medical History
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12
Q

What are patient-specific variables you need to consider when managing someone’s pain?

A
  1. Age
  2. Sex
  3. Pharmacogenomics
  4. Duration and history of opioid exposure
  5. Level/stability of pain control
  6. Interacting meds
  7. Comorbid conditions
  8. Liver and kidney function

All of these factors impact pharmacokinetics and pharmacodynamics

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13
Q
A
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14
Q

Recommended opioids for renal impairment?

A

Fentanyl and Methadone (safe with adjustment)
Hydrocodone/oxycodone, hydromorphone (Cautiously, adjust dosage)
Codeine, tramadol, meperidine, morphine (not recommended)

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15
Q

Opioids metabolized by CYP3A4?

A

Fentaly, oxycodone, tramadol

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16
Q

Opioids metabolized by CYP2D6?

A

Codeine, hydrocodone

17
Q

Opioids metabolized by glucoronidation?

A

Hydromorphone, oxymorphone, morphine

18
Q

Side effects of opioids?

A

GI: constipation, n/v
CNS: sedation, dz, respiratory depression
Allergies: hives, rash, difficulty breathing
Cutaneous: itching

19
Q

Opioid for opioid naive patients with moderate/severe pain?

A
  1. Morphine
  2. Hydromorphone
  3. Oxycodone IR
  4. Hydrocodone
20
Q

What is gold standard for opioids?

A

Morphine

21
Q

How does cross tolerance differ in patients for stable or uncontrolled pain?

A

Stable: dose reduce by 25-50%
Uncontrolled: no dose reduction or slight dose increase

22
Q

What is equianalgesic?

A

Two different opioids or different routes of the same opioid, that provide approximately the same degree of pain relief

23
Q

Indications for fentanyl?

A

Only for opioid-tolerant patients. DO NOT use in opioid naïve patient

24
Q

Counseling for fentanyl?

A

Apply 1 patch q72h, must remove old patch, discard appropriately

25
Q

Indication for methadone?

A

Detox and maintenance treatment in opioid addicted patients: once daily dosing

26
Q

BBW of methadone?

A

Life threatening QT prolongation and arhthmias

27
Q

How do you convert one opioid to another?

A
28
Q

Non-opioid tx for pain?

A
  • Acetaminophen
  • NSAIDs
  • Antidepressants
  • Steroids
  • Antihistamines
  • Anti-anxiety
  • Stimulants and amphetamines
  • Anticonvulsants
  • Cannabinoids/marijuana
29
Q

Indication and CP for APAP?

A

Mild to moderate pain

CP: hepatic metabolism
* maximum daily dose ≤ 4g
* consider decreasing to < 3g daily

30
Q

Indication and CP for NSAIDs?

A

Indication:Nociceptive pain, low back, mild to moderate pain

CP: renal metabolism, GI and cardiac ADRs
* Risk increases with age and dose
* If one NSAID ineffective for patient, consider using a different NSAID.

31
Q

Indication and CP for muscle relaxers?

A

Indication: pain from spasticity
CP: sedating

32
Q

Indication and CP for Anticonvulsants?

A

Indication: Neuropathic pain conditions
CP: cognitive slowing, weight gain, and edema

33
Q

Indication and CP for TCAs and SNRIs?

A

Indication: Neuropathic pain conditions ± anxiety/depression
CP: Confusion, uririnary retention, QTc prolongation

34
Q

Indication and CP for topical agents?

A

Indication: Minor arthritis, backache, muscle and joint pain
CP: stinging, burning, itching
* Make sure to wash hands and avoid eye contact

35
Q

Key consideration for pain management?

A
  • If higher doses of opioids needed, switch combination products to single products
  • Opioid rotation can be considered if pain not adequately treated
  • Prescription monitoring program (PMP)
  • Route of administration
  • Onset and duration of action
35
Q

Non pharm for pain?

A
  • Physical therapy/manipulation
  • Distraction/relaxation training
  • Massage
  • Heat/ice
  • Transcutaneous electrical nerve stimulation (TENS)
  • Acupuncture/acupressure
  • Aromatherapy

Therapeutics IV (39 decks)

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