Pain Part 2

Question 1

Strong agonists

Answer 1

Fentanyl
Hydromorphone
Methadone
Morphine
Tramadol

Question 2

Mild-to-moderate agonists

Answer 2

Codeine
Hydrocodone
Oxycodone
Propoxyphene

Question 3

Mixed Agonist-Antagonists

Answer 3

Buprenorphine
Butorphanol
Nalbuphine
Pentazocine

Question 4

Buprenorphine duration of action

Answer 4

SL: 6-12 hours
IM: 6 hr

Question 5

Antagonists

Answer 5

Naloxone (Narcan)
Naltrexone

Question 6

Naloxone duration of action

Answer 6

IV: 30-120 min

Question 7

Multimodal Pain Management

Answer 7

Utilize various mechanisms of action to target pain at different receptors

Goal: smallest possible doses = less adverse effects

Goal: reduce opioid requirement

Question 8

Central effects of opioids

Answer 8

Drowsiness
Mental slowing
Euphoria
Respiratory depression
Orthostatic hypotension

Question 9

peripheral effects of opioids

Answer 9

Constipation
Nausea/vomiting
Urinary retention
Bronchospasm

Question 10

Opioid-Induced Hyperalgesia

Answer 10

Compensatory increase in glutamate pathways, which promotes pain responses by stimulating NMDA receptors

Patients simply may not respond to opioids even before tolerance develops

Question 11

PCA loading dose

Answer 11

Establish analgesia

Question 12

PCA demand dose

Answer 12

Self-administered dose
Can track “successful” vs total demands to determine if parameters areappropriate for patient

Successful = self-administered outside of lockout interval

Unsuccessful = dose attempted during lockout interval

Question 13

PCA lockout interval

Answer 13

Required interval between doses

Question 14

PCA interval limits

Answer 14

limits usually set for max amount of drug in a 1 or 4 hr period- is a safety feature but if not calculated correctly can lead to the patient being undertreated for a period of time
total dose per limit

Question 15

PCA background infusion

Answer 15

Small, continuous dose maintains background analgesia

Useful when the patient is asleep or unable to activate the pump

May lead to over sedation and increased side effects

Question 16

Epidural (PCEA)

Answer 16

Typically inserted in the epidural space at a certain level of the spinal cord

More effective (using less drug), but more difficult to place and manage than IV

Question 17

Skeletal Muscle Relaxants

Answer 17

Used to treat various conditions associated with hyperexcitable skeletal muscle

Can work synergistically with rehabilitation to reduce muscle spasms and spasticity

Ultimately, the goal is to normalize excitability, to decrease pain, and improve motor function

Question 18

Antispasm Drugs

Answer 18

These medications cause generalized CNS sedation, which leads to skeletal muscle relaxation, but also carries a risk for drowsiness and dizziness

Best used as an adjunct for short-term relief of spasms caused by acute musculoskeletal injuries

Long-term use can lead to tolerance and physical dependence issues that maymimic those of opioid users

Question 19

Antispasm Drugs MOA

Answer 19

central acting medications,

Increase sedation in the CNS  global decrease in CNS excitability  generalized sedation  muscle relaxation

Question 20

Baclofen

Answer 20

Antispasticity drug,

Can be administered via intrathecal pump,
Fewer side systemic effects
- Greater efficacy with smaller doses due to localized administration

Question 21

Tizanidine MOA

Answer 21

alpha 2 agonist, Decreases release of excitatory neurotransmitters resulting in decreased excitatory input to the alpha motor neuron

Question 22

Baclofen adverse effects

Answer 22

Drowsiness (transient), generalized weakness
Elderly: Confusion and hallucinations
Abrupt withdrawal can cause withdrawal symptoms (dependence)
Tolerance risk (requiring increased doses for same effect)

Question 23

Diazepam adverse effects

Answer 23

Use limited by sedative effects, generalized weakness
Tolerance risk

Question 24

Tizanidine adverse effects

Answer 24

Sedation, dizziness

Question 25

Commonly used anti-spasm drugs

Answer 25

Carisoprodol, cyclobenzaprine, diazepam, and methocarbamol, not long-acting drugs, have to be taken multiple times daily