pain (rogers) pt 1 Flashcards
why does pain matter
- number __ reason patients seek care
- interferes with quality of life and ___
- annual cost in US exceeds 500 billion $
- opioid epidemic
- 1
- productivity
subjective questions to ask to assess pain:
PQRSTU
- palliative or precipitating factors
- quality of pain
- region (location)
- severity
- time
- impact of pain on yoU
objective information to assess pain
behavior
physiological
- dilated pupils
- palness
- sweating
- tachycardia
- tachypnea
acute: < ___ months
chronic: > ___ months
- noiceptive (tissue)
- neuropathic (nerve)
- mixed
3
3
treatment approach (WHO)
1) non-opioid +/- an adjuvant analgesic
2) opioid for mild-moderate pain, + non-opiod, +/- adjuvant analgesic
3) opioid for moderate-severe pain, + non-opioid, +/- adjuvant analgesic
- step ___ if resolving or toxicity
- step ___ if increasing pain
-
down
up
step 1 drugs
non-opioids (2)
adjuvant therapies (6)
step 1) non-opioid analgesics
acetaminophen (Tylenol)
- analgesic and antipyretic
available forumlations
- tablet, capsule, chewable tablet, liquid/gel, IV solution, suppository
recommended dosing:
- adults: ___ - ___ mg PO Q4-6H PRN
- max: ___ - ___ g/day (< ___ g/day in liver disease)
- pediatrics: ___ - ___ mg/kg PO Q4H PRN (max dose ___ mg/kg/day or less than ___ - ___ g/day
SE
- hepatotoxicity (acute liver failure most likely with > ___ g/dose)
- 325-1000
- 3-4, 2
- 3-4
- 10-15, 75, 3-4
- 10
step 1) non-opioid analgesics
acetaminophen (Tylenol)
clinical pearls
- gold standard for ___ due to fewer SE in geriatric patients than ___
- educate patients about max daily doses, including ___ products
- injection is expensive (often restricted use)
- osteoarthritis, NSAIDs
- combo
step 1) non-opioid analgesics - NSAIDs
anagesic, antipyretic, and anti-___
SE
- GI ___ (black box wanring)
- nephrotoxicity
- fluid ___
- increased ___ events (black box warning)
clinical pearls
- take with ___
- caution use in ___ patients due to increased side effects (Beer’s list)
- avoids systemic NSAIDs in patients with cardiac history (can use ___ NSAIDs)
- avoid in severe ___ disease or ___
- inflammatory
- bleeding
- retention
- CV
- food
- geriatics
- topical
- liver, CKD
NSAIDs: ASA
available forulations
- chewable tablet, tablet, EC tablet, capsule, ER capsule, suppository
recommended dosing
- adults: ___ - ___ mg PO q4-6h PRN (max __ g/day)
- pediatrics: AVOID ( ___ syndrome)
clinical pearls
- avoid using for pain in patients taking ___ or ___
- some formulations available OTC
- 325-1000, 4
- Reye’s
- blood thinners, antiplatelets
Reye’s syndrome
- rare but serious condition that causes swelling in the ___ and ___
- associated with children/teens using ASA when they have a ___ infection such as flu or chickenpox (with ot without fever)
- brain liver
- viral
NSAIDs: ibuprofen
available formulations
- capsule, tablet, chewable tablet, suspension, IV solution
recommended dosing
- adults: ___ - ___ mg PO q __ - __h prn (max ___ mg/day)
- pediatrics (>6 months): __ - __ mg/kg PO q4-6H prn (max ___ mg/kg/day or ___ mg, whichever is less)
clinical pearls
- some formulations available OTC
- 200-800, 6-8, 3200
- 5-10, 40, 2400
NSAIDs: diclofenac
available formulation
- capsule, tablet, IV solution, suppository, topical gel, topical solution, opthalmic solution, patch
recommended dosing
- adults: ___ mg PO q __ h or __ - __ g applied topically QID
clinical pearls
- minimal ___ side effects with topical gel
- some formulation availbe OTC
- 50, 8, 2-4
- systemic
NSAIDs: naproxen
available formulations
- capsule, tablet, DR/ER tablet, suspension
recommended dosing
- adults: ___ - ___ mg PO q __ - __ h (max ___ mg/day)
clinical pearls
- some formulations available OTC
- 220-500, 6-12, 1000
NSAIDs: ketorolac (Toradol)
available formulations
- tablet, IV/IM solution, nasal spray, opthalmic solution
recommended dosing
- adults: __ - __ mg IM/IV q6h prn or ___ mg PO q6h prn
- pedratrics: ___ mg/kg/dose IM/IV q6h prn
clinical pearls
- maximum duration is ___ days (parenteral and oral)
- increased risk of GI ___ when used longer
- oral dosing is intended as a ___ or IM of IV therapy
- 15-30, 10
- 0.5
- 5
- bleeding
- contiuation
