Pain tx

Question 1

PQRSTU neumonic

Answer 1

-subjective questions
-Precipitating factors
-Quality of pain
-Region
-Severity
-Time
-U (impact on U)

Question 2

Objective pain assessment

Answer 2

-behavioral changes
-dilated pupils
-paleness
-sweating
-tachycardia/pnea

Question 3

Pain intensity scales

Answer 3

-verbal (no to severe)
-numeric
-visual (no to severe)
-wong-baker FACES

Question 4

Chronic pain classification

Answer 4

> 3months
-nociceptive (tissue)
-neuropathic
-mixed

Question 5

nonpharma pain tx

Answer 5

-exercise
-acupuncture
-heat/ice
-physical manipulation
-surgery/correction/avoidance
-massage

Question 6

Analgesic ladder

Answer 6

1. non-opioid +/- adjuvant analgesic
2. opioid + nonopioid +/- adj analgesic for mild to severe

Question 7

non-opioids

Answer 7

-acetaminophen
-NSAIDs

Question 8

adjuvant therapies

Answer 8

-Gabapentinoids
-SNRIs
-TCAs
-skeletal muscle relaxants
-antiepileptics
-topicals

Question 10

Acetaminophen pearls

Answer 10

-hepatotoxicity
-acute liver failure associated w >10g dose
-better for osteoarthritis bc less side effects in older people
-educate about combo products
-inj is expensivee

Question 11

NSAIDs pearls

Answer 11

-analgesic, antipyretic, anti-inflammatory
-GI bleed (box warning)
-nephrotoxicity
-fluid retention
-inc CV events (box warning)
-take wf
-caution in old ppl
-avoid in pt w cardiac hx
-avoid in severe liver disease or CKD

Question 12

Aspirin dosing

Answer 12

-chew, tab, EC, cap, suppository
-325-1000mg PO q4-6h PRN (max4g/day)
-AVOID in kids

Question 13

Aspirin pearls

Answer 13

-AVOID in kids (reye’s)
-AVOID in pt taking blood thinners/antiplatelets
-some OTC

Question 14

Reye’s syndrome

Answer 14

-rare, serious
-brain and liver swelling
-kids and teens using aspirin when they have viral infections such as flu or chickenpox (w or w/o fever)

Question 15

Ibuprofen dosing

Answer 15

-cap, tab, chew, suspension, IV
-200-800mg PO q6-8h PRN
-max 3200mg/day
-kids: 5-10mg/kg (max 40mg/kg or 2400mg, whichever is less)

Question 16

Diclofenac dosing

Answer 16

-cap, tab, IV, suppository, GEL, topical and ophtalmic solution, patch
-50mg PO q8h or 2-4g topically 4x/day
-less systemic side effects w topical gel

Question 18

Ketorolac dosing

Answer 18

-tab, IV/IM, nasal spray, ophthalmic solution
-15-30mg IV/IM q6h
-10mg PO q6h
-kids: 0.5mg/kg IM/IV q6h

-max 5 days (IV+oral) bc GI bleed
-oral is continuation of IM/IV

Question 19

Celecoxib dosing

Answer 19

-cap, solution (less common)
-200mg PO BID
-cox-2 selective = less GI toxicity

Question 20

Gabapentinoids use

Answer 20

-gabapentin and pregabalin
-fibromyalgia
-neuropathies
-post-op pain

Question 21

Gabapentinoid dosing

Answer 21

-tab, cap, ER, liquid
-gabapentin: 100-300mg PO TID (max 3600mg/day)
-pregabalin: 75mg PO BID (max 600mg/day)

Question 22

gabapentinoid pearls

Answer 22

-sedation, dizziness, edema
-adj renal dose
-titrate up to limit sedation
-combo to dec requirements of other analgesics
-pregabalin is schedule V (gabapentin is not)