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P2 E1 SG > Pain Mgmt 2 > Flashcards

Pain Mgmt 2 Flashcards

1
Q

What is the opioid antagonist?

  • Synthetic
  • No histamine release
  • IV route
  • If no response within __ mins, repeat dose
  • Onset is slightly longer if given IM
A

Naloxone (Narcan)

  • 5
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2
Q
  • Is a chronic pain
  • Treatment options

–Anticonvulsants

–Tricyclic antidepressants

–Serotonin–norepinephrine reuptake inhibitors

–Opioids

–Topical analgesics

A

Neuropathic Pain

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3
Q

Which drug?

  • Chronic Pain - Anticonvulsants
  • Mechanism: May decrease neuronal excitatory neurotransmitters & nociception through voltage gated Ca channels specifically possessing the alpha-2-delta-1 subunit
A

Gabapentin (Neurontin)

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4
Q

Which drug for chronic pain?

  • ADE:
    • fatigue
    • headache
    • abnormality in thinking
    • amnesia
A

Chronic Pain Anticonvulsants

Gabapentin

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5
Q

Which drug for chronic pain-anticonvulsants?

  • Binds to alpha2-delta subunit of voltage-gated calcium channels within the CNS, inhibiting excitatory neurotransmitter release
  • Although structurally related to GABA, it does not bind to GABA or benzodiazepine receptors

•Exerts antinociceptive and anticonvulsant activity*

  • Decreases symptoms of painful peripheral neuropathies
  • May also affect descending noradrenergic and serotonergic pain transmission pathways from the brainstem to the spinal cord
A

Prebgabalin (Lyrica)

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6
Q

Which drug for chronic pain-anticonvulsants?

–Peripheral edema

–Weight gain

–Tremor

–Dizziness, ataxia

(no amnesia, no fatigue, no HA)

A

Prebgabalin (Lyrica)

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7
Q

Serotonin/Norepinephrine reuptake inhibitor antidepressants and _____

  • Block the reuptake of serotonin and norepinephrine enhancing pain inhibition
A

Tricyclic antidepressants

(for chronic pain)

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8
Q

What med decreases nerve stimulation?

A

Topically applied local analgesic / anesthetics

  • Lidocaine patches
  • NSAIDs patches: flector, voltarin
  • OTC-Salonpas, Tiger balm

(for chronic pain)

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9
Q

Which drug for chronic pain?

–Potent inhibitor of neuronal serotonin and norepinephrine reuptake**

–Weak inhibitor of dopamine reuptake

–No significant activity for muscarinic cholinergic, H-1 histaminergic, alpha-2 adrenergic receptors, or MAO-inhibitory activity

A

Duloxetine (Cymbalta)

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10
Q

What are 3 ADE’s of Duloxetine?

A
  • Xerostomia (dry mouth)
  • Insomnia
  • Agitation

(AID)

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11
Q
  • Treatment for mild pain?
  • Always consider what?
A
  • Acetaminophen and/or NSAID
  • Around the clock regiments
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12
Q
  • Treatment for moderate pain?
  • Always consider what?
A
  • Combination opioid & acetaminophen or NSAID
  • Around the clock regimens
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13
Q
  • Treatment for severe pain?
  • Always consider what?
A
  • Opioid analgesics
  • Around the clock regimens
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14
Q

Use what route for analgesics whenever possible?

A

PO

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15
Q

What 4 opioids should you avoid/exercise caution?

A
  • Codeine
  • Meperidine
  • Agonist / Antagonist agents
  • Tramadol
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16
Q

Regional Analgesia

  • Administered local anesthetics can provide relief of _____
  • Positioned by ____ or ______
  • _____ in the form of a patch has proven effective in treating focal neuropathic pain
  • Regional application of local anesthetics relieve pain by blocking ______
A
  • both acute & chronic pain
  • injection or topically
  • Lidocaine
  • nerve impulses
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17
Q

ADEs of Regional Analgesia

  • High plasma concentrations lead to what?
A

Signs of CNS excitation & CNS depression

  • dizziness
  • tinnitus
  • drowsiness
  • disorientation
  • muscle twitching
  • seizures
  • respiratory arrest

(DDD MRTS)

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18
Q

Regional Analgesia

  • What are the CV effects? (7)
A
  • Myocardial depression
  • Hypotension
  • Decrease CO
  • Heart block
  • Bradycardia
  • Arrhythmias
  • Cardiac arrest
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19
Q

What are the 3 disadvantages of Regional Analgesia?

A
  • need for skillful technical application
  • need for frequent administration
  • highly specialized follow up procedures
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20
Q

Local Anesthetics

  • What are the names of 3 Esters?
A
  • Procaine
  • Chloroprocaine
  • Tetracaine

(1 i)

21
Q

Local Anesthetics

  • Name the 5 amides
A
  • Mepivacaine
  • Bupivacaine
  • Lidocaine
  • Prilocaine
  • Ropivacaine

(2 I’s)

22
Q

Intraspinal Opioids

  • What are the 4 opioids for the Epidural Route?
A
  • Morphine
  • Hydromorphone
  • Fentanyl
  • Sufentanil
23
Q

Intraspinal Opioids

  • What are the 2 opioids for Subarachnoid/Intrathecal route
A
  • Morphine
  • Fentanyl
24
Q

Which intraspinal opioid has the quickest onset of pain relief?

A

Fentanyl (5 mins)

25
Q

Which intraspinal opioid has the longest duration of pain relief?

A

Morphine

26
Q

Which drug for Intrathecal/Subarachnoid Therapy?

MOA:

  • Selectively binds to N-type voltage-sensitive calcium channels located on the nociceptive afferent nerves of the dorsal horn in the spinal cord
  • Blocks the excitatory neurotransmitter release and reduces sensitivity to painful stimuli
  • No action on the mu receptor
A

Ziconotide

27
Q

What are the “more serious” ADEs of Ziconotide for Intrathecal Therapy (4)

A

Neurocognitive:

  • Confusion
  • Dizziness
  • Hallucinations
  • Urinary retention
28
Q

What are the “less serious” of Ziconotide for Intrathecal therapy? (4)

A
  • Sedation
  • Somnolence
  • Nausea
  • HA
29
Q
  • What is 1st line therapy for both localized & diffuse neuropathic and nociceptive pain
  • Is used in place of an opioid for those pts intolerant to opioid
  • ONLY administered intrathecally
  • 1st line for treating intractable cancer pain (localized & diffuse)
A

Ziconotide for Intrathecal therapy

30
Q

How should Acute, Subacute, and Chronic low back pain be treated initially?

A

Nonpharm therapy

  • heat
  • massage
  • acupuncture
  • CBT
  • mindfulness based stress reducations to physical therapy
31
Q

2 treatments for acute low back pain

A
  • NSAIDs
  • Skeletal muscle relaxants
32
Q

What is 1st and 2nd line for chronic low back pain?

A

1st: NSAIDs

2nd: Duloxetine & Tramadol

33
Q

Which med is NOT recommended in Fibromyalgia?

A

Opioids

34
Q

Acetaminophen & NSAIDs are rarely effective in which type of pain?

A

Neuropathic Pain

35
Q

1st line for Neuropathic pain? (4)

A
  • TCAs (tricyclic antidepressants)
  • SNRIs (duloxetine)
  • AEDs (pregab, gaba)
  • 5% lidocaine patch
36
Q

2nd line tx for neuropathic pain (2)

A
  • Central analgesics
  • Opioids
37
Q

3rd line tx for neuropathic pain?

A
  • Capsaicins
38
Q

2 resources for prescribing opioids

A
  • www.agencymeddirectors.wa.gov
  • www.ncbi.nlm.nih
39
Q

Heroin

  • Derived from ____
  • ***Name for it?***
  • Acetyl group facilitates what?
  • Metabolized to what?
  • Urine Drug Screen for Heroin can be positive for ___ and ____
  • 3 contaminants?
A
  • poppy
  • Diacetylmorphine
  • crossing BBB (blood brain barrier)
  • Morphine
  • UDS: Morphine & Codeine
  • quinine, scopolamine, strychnine
40
Q

True or Pseudo opioid allergy?

  • IgE mediated
  • T-cell mediated
  • Bronchospasm
  • Angioedema
A

True

41
Q

True or Pseudo opioid allergy?

  • histamine release from cutaneous mast cells
  • non-immunologic effect
  • Sxs: itching, flushing, sweating
A

Pseudoallergy

42
Q

True or Pseudo opioid allergy?

  • Hives
  • Tachycardia
  • Hypotension
A

Pseudo, but are also seen w/ true

(so both?)

43
Q

Pseudoallergy depends on what?

A

the concentration of the opioid at the mast cell

  • potency
  • dose
  • route of administration
44
Q

Choosing an Analgesic (A or B)?

  • Flushing, itching, hives, sweating, mild hypotension
A

A

45
Q

Choosing an Analgesic. (A or B)

  • Severe hypotension
  • Rash
  • Breathing, speaking, swallowing difficulties
  • Swelling of face, lips, mouth, pharynx, or larynx
A

B

46
Q

A

  • Sxs due to:_____
  • Result of histamine release
  • Give the patient _____ (____, ____)
  • Avoidance of what 3 meds?
  • What is the high potency drug least likley to release histamine?
  • What is the lowest potency drug which would cause histamine release?
  • If needed, concurrent administration of _____.
A
  • pseudoallergy
  • non-opioid analgesics (acetaminophen, NSAIDs)
  • codeine, morphine, meperidine
  • Fentanyl = highest
  • Meperidine = lowest
  • Antihistamine
47
Q

B

  • This pt may have experienced _____
  • Give non-opioid: acet / NSAIDs
  • Give an opioid in a different chemical class, ____ or ____
A
  • a true allergy
  • Phenylpiperidines (meperidine, fentanyl, sufentanil, remifentanil
  • Diphenylheptanes (methadone, propoxyphene)
48
Q

What group?

  • Hydrocodone
  • Oxycodone
  • Nalbuphine
  • Butorphanol
  • Levorphanol
  • Pentazocine
A

Morphine

P2 E1 SG (11 decks)

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