Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall 2024 > Pain Management Overview > Flashcards

Pain Management Overview Flashcards

1
Q

What is the first step to pain management?

A

Self management and optimized treatment of comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the second step to pain management?

A

Non-pharmacologic options like accupuncture, physical therapy, stretching, yoga, etc. in addition to step 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the third step to pain management?

A

Non-opioid pharmacotherapy + first 2 options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the final option for pain management?

A

Opioid therapy + first 3 options; this should be the last choice and should be avoided if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should opioids be used in acute pain?

A

avoided if mild to moderate, limit duration and dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How should opioids be used in chronic pain?

A

Avoid initiation of opioid if at all possible; if they are already taking them, discuss continuation vs tapering vs suboxone vs buprenorphine (always keep quality of life in mind)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is COX1

A

maintains homeostasis and is always present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is COX2

A

For inflammation; mostly only present after cell injury/inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is released during injury?

A

Arachidonic acid is released upon injury to phospholipid membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does arachidonic acid do in case of a cut?

A

Activates Cox1 and Cox2 which activates prostaglandin (Cox2) and leads to fever, pain, and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does arachidonic acid do in the GI tract?

A

Activates Cox1 which ultimately causes increased platelet aggregation and decreased acid production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does arachidonic acid do in the kidneys?

A

Activates Cox1 which ultimately increases renal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does NSAIDs inhibit?

A

Cox1 and Cox2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do NSAIDs increase the risk of

A

GI bleeds and renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the benefit of a Cox2 NSAID?

A

Does not block Cox1 so less likely to have GI bleed and renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the MOA of aspirin?

A

Irreversible inhibition of Cyclooxygenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does aspirin inhibit?

A

high dose aspirin inhibits Cox2 (325mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can acetaminophen be given?

A

Oral or IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the max dose of acetaminophen and why?

A

4 grams per day; Hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does Cox1 activate?

A

Thromboxane A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some examples of Cox1 and Cox2 inhibitors?

A

Ibuprofen, naproxen, diclofenac, ketorolac, etodolac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is an NSAID that is a Cox2 inhibitor at low dose but Cox1 at higher doses

A

Meloxicam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a selective Cox2 inhibitor (no Cox-1 inhibition)

A

Celecoxib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Are all NSAIDs the same with their inhibition?

A

No; there is a spectrum; Keterolac is most Cox1 selective and Celecoxib is most Cox2 selective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a concern with prescribing NSAIDs?

A

40% of people use prescription and OTC NSAIDs together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the three warnings with NSAIDs?

A

GI, CVD, Renal

27
Q

What are CI with NSAIDs?

A

Sulfa allergy with Celecoxib; CABG

28
Q

What are BBW with NSAIDs?

A

CVD risk; GI risk

29
Q

Can NSAIDs be used in pregnancy?

A

AVOID if at all possible

30
Q

What are the drug-drug interactions with NSAIDs?

A

Anticoagulants, antiplatelets, ibuprofen+aspirin

31
Q

What is a benefit to topical NSAIDs?

A

Limited systemic absorption, local site, avoid GI/kidneys

32
Q

What is an example of topical NSAIDs?

A

Diclofenac gel (Voltaren)

33
Q

What are some other topical pain relievers??

A

Lidocaine patches, Capsaicin, Menthol, Methyl Salicylate, Camphor

34
Q

What is pregabalin mostly used for?

A

Neuropathic pain, seizures, fibromyalgia

35
Q

What is gabapentin mostly used for?

A

PHN, seizures, RLS

36
Q

What are some adverse effects of gabapentin/pregabalin?

A

Weight gain/edema, Sedation, suicidal thoughts/behaviors

37
Q

How should gabapentin/pregabalin be dosed? Why?

A

START LOW, GO SLOW (300mg/75mg); sleepiness, adverse effects

38
Q

Does gabapentin have any special dosing?

A

Yes, renal dosing

39
Q

Which med is more potent?

A

Pregabalin is 6x as potent as gabapentin

40
Q

How can antidepressants be used for chronic pain?

A

Neuropathic (Duloxetine, TCA); diabetic peripheral neuropathy, chemo induced peripheral neuropathy

41
Q

What is the difference between opioid/opiate?

A

Opiate = naturally occurring: Morphine, Codeine, Metabolites
Opioids = any substance that binds to theh opioid receptor

42
Q

What are the naturally occurring opioids?

A

Morphine and codeine

43
Q

What is the breakdown of codeine?

A

Codeine to morphine/hydrocodone then both to hydromorphine

44
Q

How is heroin different than morphine?

A

Heroin breaks down into 6-MAM then into morphine

45
Q

What are the synthetic opioids?

A

Methadone (breaks down to EDDP) and fentanyl (breaks down to norfentanyl)

46
Q

What substances will people likely also be allergic to if allergic to morphine?

A

Hydrocodone, Oxycodone, Buprenorphine (could potentially prescribe fentanyl or meperidine)

47
Q

What is the receptor for opioids?

A

Mu receptorWh

48
Q

What is the benefit of buprenorphine?

A

Binds more strongly to Mu receptor than morphine/oxycodone/hydrocodone and will “steal” the binding site - better pain relief

49
Q

What is the MOA of opioids?

A

Interact with mu, delta, kappa opioid receptors which relieve pain; causes sedation, anxiety reduction, and euphoria

50
Q

What are some things to remember with opioids?

A

Action depends on location of receptors; increases dopamine receptors; tolerance eventually occurs

51
Q

Explain the tolerance development of opioids

A

Your body creates more pain receptors so it maintains the ability to feel pain. It takes more opioid to achieve pain relief and block all of the new receptors. If dose is increased, cycle begins again

52
Q

What makes Buprenorphine better than opioids?

A

Tolerance does not build; doors remain slightly opened

53
Q

How should you approach opioid conversions?

A

Assess the patient, calculate total daily dose use of opioids, determine which opioid planning to switch to, individualize dose, follow-up and reassess

53
Q

What are the conversion calculation steps?

A
  1. Calculate the 24-hour current dose
  2. Use equianalgesic ratio
  3. Calculate new dose using ratio
  4. Reduce dose 50% for cross tolerance
54
Q

What to remember when initiating opioid therapy?

A

Avoid if possible; Immediate release opioids preferred with initiation

55
Q

What is a concern with initiating with extended release opioids?

A

Increased risk of overdose at initiation

56
Q

What are the FDA recommendations for extended-release opioids?

A
  1. Pain severe enough that require around the clock treatment
  2. Patients requiring long term opioid therapy
  3. DO NOT USE as PRN therapy!
57
Q

What to keep in mind with opioid dosing?

A

Use lowest effective dose, do not make dose adjustments until steady state is reached (5 half lives)

58
Q

Who to give naloxone?

A

Dispense with new opioid starts and dispense to patients with opioid use disorder or opioid use disorder in remission

59
Q

What is a concern with naloxone?

A

When it wears off opioid may rebind and cause more issues; get person to hospital after administering naloxone

60
Q

What should be avoided with opioids?

A

Sedated meds - alcohol and ESP BENZOS

61
Q

What are some warnings of tramadol

A

Seizures disorders - do not use!!!

62
Q

What is left to review

A

Last few slides/summary

Fall 2024 (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions