Pain mgmt in EOL

Question 1

5 ways to assess pain in mild to mod cog impairment

Answer 1

1. direct quesry
2. caregiver report
3. use terms sysnonymous with pain
4. ask about present pain
5. ask about and observe pain behaviors

Question 2

3 verbal descriptor scales

Answer 2

1. verbal descriptor scal
2. present pain inventory
3. faces scale

Question 3

what is best assessment in mild to mod impariment

Answer 3

the one the PT can use

- use the same one and be consistent

Question 4

3 direct observation in in severe cog. impariment

Answer 4

1. facial expressions
2. vocalizations
3. body movement/guarding

Question 5

how to assess in severe cog impairment

Answer 5

• no optimal pattern

- if reason for pain present, treat empirically

Question 6

what is optimal endpoint for pain mgmt

Answer 6

• not NO pain
• acheives acceptable level of releif
• preserves function and alertness
• less SEs

Question 7

5 principles of pain mgmt

Answer 7

1. educate patient and family
2. investigate wisely and effectively
3. do not delay> treat immed
4. use pain diary if possible
5. use step wise approach to pain meds

Question 8

2 main non opiods

Answer 8

1. tylenol

2. NSAIDS

Question 9

2 issues

Answer 9

1. ceiling effect

2. may have issues with full doses for renal PTs etc

Question 10

5 common myths about opiods that they rarely cause

Answer 10

1. resp depression
2. addiction in this pop
3. sig. tolerance
4. cause death
5. nausea the requires quitting them

Question 11

6 main opiods

Answer 11

1. codeine and combos
2. morphine
3. hydromorphone
4. oxycodone
5. fentanyl
6. methadone

Question 12

2 that have a max dose

Answer 12

1. oxycocet
2. tylenol 1-4
   both due to aceto

Question 13

how to choose opiod

Answer 13

• past experience
• clincian comfort-
• certain conditions

Question 14

3 not to use

Answer 14

1. propoxyphene
2. pentazocine
3. demerol

Question 15

2 less desired in liver failure and replacement

Answer 15

1. codeine
2. methadone
   use: oxy, morphine, hydro, fentanyl

Question 16

** what to avoid in renal failure and what to use

Answer 16

avoid
- morphine
- codeine
- meperidine
- oxy
use (inactive metabolites)
- fentanyl
- methadone

Question 17

5 non PO routes

Answer 17

1. IV/SC
2. transdermal (fentanyl)
3. rectal
4. microcapsule (for PEG and tube)
5. liquids

Question 18

3 principlies to follow

Answer 18

1. tirrate dose to releif
2. be aware of SE
3. always consider adjuvant modalities

Question 19

what is opiod conversion table

Answer 19

codeine - 100mg PO
morphine - 10mg PO = 5mg IV
oxy - 5mg PO
hydro - 2mgPO/1mgIV

Question 20

what is breakthrough dose

Answer 20

dose available between regular doses

Question 21

how much to give for breakthrough

Answer 21

q1h, prn

10-20% of daily dose or 50% of q4h dose

Question 22

what is longer term condideration

Answer 22

if pain stable, give a longer acting form

- keep same breakthrough dose

Question 23

how to titrate up

Answer 23

simply add up amount of daily dose and all breakthrough doses taken and this tell you how much to titrate up the daily dose

Question 24

how to Tx consipation

Answer 24

• prevent rather than Tx
• Senna
• NOT fiber and bulking agents

Question 25

meds for nausea

Answer 25

1. halperidol
2. prochlorperazine
   NOT gravol