Periop. pain mgmt Flashcards
1
Q
barriers to effective pain mgmt
A
- lack of ed.
- inadequate assessment
- underestimation of reqirements
- pt. variability
- concern that will mask injury
- fear of SE
- single modality
2
Q
3 temporal clues to origin of pain
A
- acute
- chronic
- acute on chronic
3
Q
keys with meds assessment
A
- accuracy and detail very important
- must re-order the meds PT was on before they came in
- look for conflicts with illness
4
Q
diff. between intolerance and allergy
A
allergy is worse
- might be able to give drugs that are intolerant to and help deal with the side effects
5
Q
3 general types of pain mgmt
A
- non-pharm
- pharma
- meds
- precedures - surgical
6
Q
3 steps on WHO analgesic ladder
A
- NSAIDs/ tylonol
- opiods
- more/stronger opiods
7
Q
MOA of NSAIDs
A
COX2- blocker - block prostaglandins involded in pain and inflammation
- ceiling effect
8
Q
patients not to give NSAIDs
A
GI bleedign issues - renal/hepatic dys - cardiac - asthma - bone healing - allergy
9
Q
tylenol affects
A
- first line therapy
- maybe block prostaglandins in CNS
- max dose 4g/day from all sources
10
Q
most commonly prescribed in hospital
A
opiods
11
Q
3 good opiod choices
A
- hydromorphone
- better tolerated
- low cost - oxycodone
- good SE
- $$ - fentanyl
- potent but short acting
- IV must be given montitored
- transdermal patch
12
Q
2 poor opiod choices
A
- codeine
- depends on metaboization - meperidine (demerol)
- neurotoxic metabolite
13
Q
opiod SE
A
- nausea
- sedation
resp distress - pruritis
- constipation
- urin retention
14
Q
3 opiod formulations
A
- short acting
- need frequent dosing - long acting
- more steady state
- helpful for severe or chronic pain - patient controlled
- rapid titiration
- locus of control
- less SE and better pain control
15
Q
common adjunct
A
gabapentin
- anti-epileptic used in neuro pain, postherpetic neuralgia
