Periop. pain mgmt

Question 1

barriers to effective pain mgmt

Answer 1

• lack of ed.
• inadequate assessment
• underestimation of reqirements
• pt. variability
• concern that will mask injury
• fear of SE
• single modality

Question 2

3 temporal clues to origin of pain

Answer 2

1. acute
2. chronic
3. acute on chronic

Question 3

keys with meds assessment

Answer 3

• accuracy and detail very important
• must re-order the meds PT was on before they came in
• look for conflicts with illness

Question 4

diff. between intolerance and allergy

Answer 4

allergy is worse

- might be able to give drugs that are intolerant to and help deal with the side effects

Question 5

3 general types of pain mgmt

Answer 5

1. non-pharm
2. pharma
   - meds
   - precedures
3. surgical

Question 6

3 steps on WHO analgesic ladder

Answer 6

1. NSAIDs/ tylonol
2. opiods
3. more/stronger opiods

Question 7

MOA of NSAIDs

Answer 7

COX2- blocker - block prostaglandins involded in pain and inflammation
- ceiling effect

Question 8

patients not to give NSAIDs

Answer 8

GI
bleedign issues
- renal/hepatic dys
- cardiac
- asthma
- bone healing
- allergy

Question 9

tylenol affects

Answer 9

• first line therapy
• maybe block prostaglandins in CNS
• max dose 4g/day from all sources

Question 10

most commonly prescribed in hospital

Answer 10

opiods

Question 11

3 good opiod choices

Answer 11

1. hydromorphone
   - better tolerated
   - low cost
2. oxycodone
   - good SE
   - $$
3. fentanyl
   - potent but short acting
   - IV must be given montitored
   - transdermal patch

Question 12

2 poor opiod choices

Answer 12

1. codeine
   - depends on metaboization
2. meperidine (demerol)
   - neurotoxic metabolite

Question 13

opiod SE

Answer 13

• nausea
• sedation
  resp distress
• pruritis
• constipation
• urin retention

Question 14

3 opiod formulations

Answer 14

1. short acting
   - need frequent dosing
2. long acting
   - more steady state
   - helpful for severe or chronic pain
3. patient controlled
   - rapid titiration
   - locus of control
   - less SE and better pain control

Question 15

common adjunct

Answer 15

gabapentin

- anti-epileptic used in neuro pain, postherpetic neuralgia

Question 16

what is multimodal analgesia

Answer 16

using more that one drug together

- better analgesia with less SE

Question 17

2 SE tha can be managed well

Answer 17

1. nausea/vomiting
   - odansetron
   - gravol
   Pruritis
   - diphenhydramine (benadryl)

Question 18

point of regional ana

Answer 18

local to block nerve impulses to specific region

Question 19

2 neuraxial techniques

Answer 19

1. spinal (subarachnoid)

2. epi dural

Question 20

3 benefits of thoracic epi for abdo surg

Answer 20

1. blocks sym to gut - fasted bowel return
2. blocks somatic to abdo wall - less pain and faster ambulation
3. imporve outcomes and shorter stays

Question 21

what is drug for opiod reversal

Answer 21

naloxone - antagonist

Question 22

what is key when giving naloxone

Answer 22

• must be diluted- don’t want to take out all analgesia

- 1ml naloxone with 9lm saline

Question 23

what is acute pain service

Answer 23

• consult team in hosp.
• advice and diff. to manage cases
• once involved, only they give pain meds

Question 24

steps in unarousable patient

Answer 24

1. sternal rub
2. ABC
3. Code blue