PHARM - Controlled Substances & Acute Pain Management Flashcards
schedule I substances are defined as?
those with a high potential for abuse and NO accepted medical use in the US
schedule II substances are defined as?
drugs with a high abuse potential with
- a severe liability for psychic / physical dependance
- but are approved for mecidical use in the US
which drugs are Schedule I?
- marijauna
- MDMA (ecstasy)
- methaqualone (quaaludes)
- mescaline (peyote)
- LDS
- heroin
which drugs are Schedule II?
- opioides:
- codeine
- morphine
- oxycodone
- hydromorphine
- hydrocodone
- fentanyl
- meperidine
- meth
- methadone
- methamphetamine
- methylphenidate
- dextoamphetamine
- phenylcyclidine (PCP)
which drugs are schedule V?
- diphenyoxylate
- pregabalin
what four criteria must be met for a presciption to be legitimate?
four criteria
- prescriber registered
- patient desires medication for a legitimate medical need
- practitioner must establish this legitimate need through assessments using pertinent medical diagnostic modalities
- easonable correlation between drug prescribed and patients need
a proper prescription for a controlled substance includes what information?
- date
- patients - full name, address
- practitioners - full name, address, signature, DEA registration #
- the drug - name, strength, dosage, quantity, # of refills, directions, substitutions
in what situation would a provider need to document the reasoning of the prescription on the prescription?
if they are prescribing a opoids for acute pain that is going to exceed a 7-day limit
schedule II drug limitiations
- quantity allowed?
- refills allowed?
- length of validity of prescription?
- quantitiy: absolute max is 90 days - beyond 30 day supply, reason must be given*
- refills: no refilled allowed
- length of prescription validity: 6 months
schedule III & V drug limitiations
- quantity allowed?
- refills allowed?
- length of validity of prescription?
- quantity: 90 day supply
- refills: maximum of 5 refills in 6-motths
- length of prescription validity: 6 months
which types of interventions are preferred for chronic pain?
- non-pharmaceutical
- if pharmaceutical, non-opioid
physicians should initiate opioid therapy with which types of opioids?
- immediate release > extended release
- lowest effective dosage
- quantitiy needed to cover only the expended duration (m/c 3 or less days)
before continuing opioid prescription as a chronic treatment, physicians should take which keys steps?
- review pts hx of controlled substance (PDMP data)
- drug test urine
after intiating chronic opioid therapy, physicians should made which periodic assessments?
at what intervals?
- assess benefits vs harms: within 1-4 weeks of intiation, then at least every 3 months thereafter
- review PMDP data: every prescription or every 3 months
- consider urine testing annually
physicians should always avoid prescribing opioids with what drugs?
benzodiazepines
how should physicians manage opioid use disorder?
offer / arrange evidence based treatment, which is typically medication assisted treatment: (with buprenorphine or methadone) + behavioral therapies
postoperative pain can increase risk of…?
explain why.
- DVT - d/t stress-induced _hypercoagulable stat_e (any operation)
- myocardiac ischemia - d/t stess-iduced catecholamine release (any operation)
- pneumonia & hypomexia - d/t stress-induced hypoventilation (if operation was to upper abdomen / thorax)
why is it important control acute post-operative pain?
poorly controlled acute post-operative pain is an important predictive factor for the development of chronic postoperative pain
what is the best way to manage acute postoperative pain?
with a multimodal treatment pain
what is the best way to inflammatory pain?
NSAIDS
nerve blocks to which regions can reduce pain in the
- T6-sacral area?
- UE?
- LE?
- T6- sacrum: thoracic / lumbar epidural
- UE: brachial plexus
- LE: sciatic, femoral, popliteal, ankle
neuraxial anesthesia
- benefits
- risks
- benefits
- decreased cognitive AES
- possibly enhanced pain control
- risks:
- post-dural HA
- hematoma
- abcess
which drugs are examples of neuraxial anesthetics?
- spinal: bupivicaine
- epidural: bupivicaine / ropivacaine
peripheral nerve blocks
- benefits
- risks
- benefits
- lower opioid supplementation
- improved sleep quality
- increased pain relief / control
- risks:
- hematoma
- abcess
an interscalene nerve block is beneficial for post-operative pain following which procedures?
- shoulder surgery
- arm surgery
a _transversus abdominus nerv_e block can be benificial for post-operative pain following which surgeries?
- certain abdominal surgeries
- C-section
- exploratory laparotomy
- ventral hernia repair
a popliteal nerve block can be benificial for post-operative pain following which surgeries?
- foot surgery
- ankle surgery
a femoral nerve block can be beneficial for post-operative pain following which operations?
knee surgery
ketamine
has what role in post-operative pain management?
how does it work?
-
opioid sparing treatment
- work by antagonizing NDMA receptors
- this blunts a phenomonen where opioids actually induce hyperalgesia in patients receiving intra operative opioids
