Pain: Rogers Flashcards
What is Pain?
- An unpleasant sensory and emotional experience associated with actual tissue damage
What are the assessments of pain?
- Subjectively and Ojectively
What are the subjective assessments of pain?
- PQRSTU
- P: palliative and precipitating
- Q: quality
- R: region
- S: severity
- T: time
- U: impact on yoU
What are the objective assessments of pain?
- Behavioral and Physiological Changes
How do we classify pain?
- Acute [<3 Months]
- Chronic [>3 Months; Tissue and/or Nerve]
What are the goals of therapy for pain?
- Correct the underlying cause
- Minimize the pain
- Improve QOL
- Limit the side effects
What are some of the non-pharmacological treatments for pain?
- Physical manipulation, Heat or Ice, Massage, Acupuncture, Exercise]
What is the treatment approach for pain?
- Step 1: non-opioids +/- add on
- Step 2: opioid + non-opioids +/- add on
- Step 3: opioid + non-opioids +/- add on
What are some of the non-opiods that are used?
- Acetaminophin and NSAIDS
What is aceteminophen used for?
- Reduce fever and pain
What is the dosage forms for acetaminophen?
- Tablet, capsule, chewable tablet, liquid, IV, Suppository
What is the dosing for acetaminophin?
- Adults: 325-1000mg PO q4-6h PRN
- Children: 10-15 mg PO q4h PRN
What are the side effects for acetaminophen?
- Hepatotoxicity
What are the clinical pearls for acetaminophen?
- GOLD STANDARD for osteoarthritis
- MAX DOSE = 3-4 g
What are the side effects for NSAIDs?
- GI Bleeding, Nephrotoxictity, fluid retention, increase cv events {BLACK BOXED WARNING]
What are NSAIDs used for?
- Reduce pain, fever and inflammation
What are some of the clinical pearls for NSAIDs?
- Caution in elderly
- AVOID: cardiac history
- AVOID: liver disease
What are the dosage forms for aspirin [bayer]?
- Chewable tablet, tablet, EC tablet, Capsule, ER capsule, Suppository
What is the dosing for aspirin?
- Adults: 325-1000 mg q4-6h PRN
- Children: AVOID
What are the dosage forms for Ibuprofen?
- Capsule, tablet, chewable tablet, suspension, IV
What is the dosing for ibuprofen?
- Adults: 200-800 mg PO q6-8h PRN
- Peds: 5-10 mg/kg PO q4-6h PRN
What are the dosage forms for Diclofenac?
- Capsule, tablet, XR tablet, Packet, Gel, cream, patch, eye drops
What is the dosing for diclofenac?
- Adult: 50 mg PO q8h or 2-4 G applied topically 4 times/day
What are the dosage forms for naproxen?
- capsule, tablet, DR tablet, ER tablet, suspension
What is the dosing for naproxen?
- Adult: 220-500 mg PO q6-12h
What are the dosage forms for Ketorolac?
- Tablet, IV/IM, Nasal spray, Eye drops
What is the dosing for kertorolac?
- Adults: 15-30 mg IV/IM q6h PRN or 10 mg PO q6h PRN
- Peds: 0.5 mg/kg/dose IM/IV q6h PRN`
What is the clinical pearls for ketorolac?
- MAX duration is 5 days: increases GI bleeding
What are the dosage forms for celecoxib?
- Capsule, solutions
What is the dosing for celecoxib?
- Adult: 200 mg PO BID
What is the clinical pearls for celecoxib?
- COX 2 seletctive = less GI toxciity
What are some of the add on therapies that are use in pain?
- Gabapentinods, SNRIs, TCAs, Muscle relaxents, Antiepilptics, Topical agents
What is the use of the Gabapentinoids [Gabapentin & Pregabalin]?
- Fibromyalgia, Neuropathies, Post-op pain
What are the dosage forms for gabapentinoids [Gabapentin & Pregabalin]
- tablets, capsule, ER tablet, liquid
What is the dosing for the gabapentinoids [Gabapentin & Pregabalin]?
- Gabapentin: 100-300 mg PO TID
- Pregabalin: 75 mg PO BID
What are the side effects of the gabapentinoids [Gabapentin & Pregabalin]?
- Sedation, dizziness, Edema
What is the clinical pearls for the gabapentinoids [Gabapentin & Pregabalin]?
- Renally adjusted
- Used in combo
- Pregabalin C-V and Gabapentin nothing
What is the uses for the SNRIs?
- Fibromyalgia, Neuropathy