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Surgery > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Goal of Peri-Operative Pain Management

A

Have the patient comfortable when they awaken from anesthesia

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2
Q

SE of Peri-Operative Pain

A 
Thromboembolic complications
Pulmonary complications
Increased length of hospitalization
Hospital readmission for further pain management 
Needless suffering
Impairment of QOL
Development of chronic pain
Respiratory depression
Brain injury
Neurologic injury
Sedation
Circulatory depression
N/V
Pruritis
Urinary retention
Impairment of bowel function
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3
Q

What must we always document?

A

Pain intensity
Effects of pain therapy
SE caused by therapy

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4
Q

Factors to Consider When Approaching a Patient with Pain

A 
Type of surgery
Expected severity of postoperative pain
Underlying medical conditions
Risk:benefit ratio for the available techniques
Patient's preferences
Patient's previous experience with pain
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5
Q

How to Prepare the Patient Medication Wise for Surgery

A

Adjust/continue meds that may provoke withdrawal symptoms
Reduce anxiety & pain
Patient & family education

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6
Q

Patient & Family Education Prior to Surgery

A

Addiction
Adverse effects of meds
Optimal use of PCA pump

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7
Q

Perioperative Techniques for Pain Management

A

Central regional opioids analgesia
Patient controlled analgesia with systemic opioids
Peripheral regional analgesia

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8
Q

Epidural Administration of analgesia

A

Injection outside of the dura

Can be placed anywhere along the spine

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9
Q

Intrathecal/spinal Administration of Anesthesia

A

Injection through the dura directly into the SAF

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10
Q

Benefits of Central Regional Opioid Analgesia

A

Improved pain relief when preincisional morphine is administered

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11
Q

Risks of Central Regional Opioid Analgesia

A

Increased pruritus

Increase urinary retention post up

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12
Q

How long can a single dose of intrathecal morphine provide pain relief for?

A

18-24 hours

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13
Q

When is a PCA indicated?

A

Moderate to severe post op pain

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14
Q

Benefits of PCA Pumps

A

Decreased delay in patient access to pain medication

Decreased likelihood of overdose

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15
Q

When is a PCA pump discontinued?

A

When the patient can take oral medications

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16
Q

What medications can be given via a PCA pump?

A

Fentanyl
Hydromorphone
Morphine

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17
Q

Multiple Techniques for Pain Management

A

2+ drugs by different mechanisms
Opioid + NSAIDs
Central + regional meds

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18
Q

Peripheral Regional Techniques

A

Peripheral nerve blocks
Intra-articular blocks
Infiltration of incisions

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19
Q

When should a nerve block be performed?

A

Pre-operative

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20
Q

Patients at Risk for Inadequate Pain Control

A 
Pediatrics
Geriatrics
Critically ill
Cognitively impaired
Others with difficulty communicating
21
Q

3 Most Common IV Analgesics

A

Morphine
Hydromorphone (Dilaudid)
Fentanyl

22
Q

How must opioids be given when postoperative?

A

IV

In a highly supervised environment

23
Q

Where are all opioids metabolized?

A

Through the liver

24
Q

Morphine

A

Rapid onset
Peak: 1-2 hours
Duration: 4-5 hours
IV 1-3 mg Q 5 minutes

25
Q

SE of Morphine

A

Sedation
Respiratory depression
Hypoxemia

26
Q

Renal Insufficiency & Morphine

A

Active metabolites may accumulate

Neurotoxicities: myoclonus, confusion, coma, death

27
Q

Relative Contraindication of Morphine

A

Severe renal disease

28
Q

Hydromorphone (Dilaudid)

A

Onset: 30 minutes
4-6 times more potent than morphine
0.2-1 mg q 2-3 hours

29
Q

Fentanyl

A 
100 times more potent than morphine
More lipid soluble than morphine
Rapid onset
Improved penetration of blood-brain barrier
Shorter duration of action
30
Q

When is fentanyl used?

A

Moderate pain
Moderate to severe pain
Pain control in ventilated patients

31
Q

When is meperidine (demorol) indicated?

A

Short term management of acute pain

32
Q

Contraindications of Meperidine (Demarol)

A

MAOIs

33
Q

SE of Meperidine (Demorol)

A

Lowers seizure threshold

Dysphoric effect

34
Q

General Opioid SE

A 
Somnolence
Depression of respiratory drive
Hypotension
Urinary retention
N/V
Slowing of GI transit
Histamine release
35
Q

Signs of Histamine Release from Opioids

A 
Flushing
Tachycardia
Hypotension
Pruritus
Bronchospasm
36
Q

Oral Opioids for Post-Operation

A

Oxycodone
Hydrocodone
Hydropmorphone
Morphine

37
Q

Most Common Oxycodone Medication

A

Oxycodone/acetaminophen (Percocet)

38
Q

Most Common Hydrocodone Medication

A

Hydrocodone/acetaminophen (Lortab or Vicodin or Norco)

39
Q

Short Acting Opioids

A

Fentanyl

40
Q

Moderate Action Opioids

A

Morphine
Codeine
Hydropmorphone
Oxycodone

41
Q

Medications that are Safer in Renal Impairment

A

Hydromorphone
Oxycodone
Fentanyl

42
Q

Opioid Reversal Agent

A

Naloxone (Narcan)

43
Q

MOA of Naloxone (Narcan)

A

Reversal of respiratory depression

44
Q

Non-Opioid Adjunctive Medications

A 
NSAIDs
Ketamine
Lidocaine
Magnesium
IV acetaminophen
45
Q

Why is ketamine use limited?

A

Hallucinations

46
Q

What does ketamine reduce?

A

Hyperalgesia

Opioid tolerance

47
Q

Contraindication of Acetaminophen

A

Hepatic failure

48
Q

When is lidocaine most effective?

A

After major abdominal surgery

Surgery (20 decks)

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