PHRM845-FINAL EXAM Flashcards by Meghan Collins

What is pain?

Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
-Hard to assess

How well did you know this?

Not at all

Perfectly

Why does pain matter?

-Number 1 reason pts seek care
-30% of Americans have chronic pain
-Interferes with QOL and productivity
-Annual cost in US exceeds 500 billion dollars
-Opioid epidemic: need for increased safety due to elevated opioid related deaths–prescribing opioid pain meds and pts become addicted

How well did you know this?

Not at all

Perfectly

Role of pharmacists

-Assess pain
-Recommend OTC
-Refer pts
-Recommend initial analgesic prescription to providers
-Educate pts on analgesic tx
-Evaluate safe and effective use (abuse, SE, etc.)
-Adjust med tx based on response
-Track opioid use (INSPECT in IN)
-Med recs

How well did you know this?

Not at all

Perfectly

Questions to subjectively assess a pt’s pain

“PQRSTU” mnemonic
P: Palliative or precipitating (What makes it better/worse?)
Q: Quality of pain
R: Region of pain location
S: Severity (pain assessment instruments)
T: Time related nature of pain (How long have they been in pain for? Is it worse at certain times of the day?
U: Impact of pain on yoU

What have you tried to control the pain?

How well did you know this?

Not at all

Perfectly

Objective info to assess pain

-Behavioral changes (moaning, groaning, screaming in pain)
-Physiological changes
~Dilated pupils (mydriasis)
~Paleness (pallor)
~Sweating (diaphoresis)
~Tachycardia
~Tachypnea (Fast respiratory rate)

How well did you know this?

Not at all

Perfectly

Types of pain intensity scales to assess pain

-Verbal
-Numeric
-Visual
-Wong-baker

How well did you know this?

Not at all

Perfectly

What is the verbal pain scale?

-No pain
-Mild pain
-Mod pain
-Severe pain
-Worst possible pain

How well did you know this?

Not at all

Perfectly

What is the visual analog scale?

On a line with no pain to worst pain possible, where would you put yourself?

How well did you know this?

Not at all

Perfectly

What is a numeric pain intensity scale?

-Most widely used
-Scale of 1-10, where do you rate your pain?

How well did you know this?

Not at all

Perfectly

What is the wong-baker assessment?

Emoji faces for people to rate their pain
-Some kids may be sad about something else and may mix it up with the pain rating

How well did you know this?

Not at all

Perfectly

How long does pain last for it to be acute vs chronic?

Acute: < 3 months
Chronic: > 3 months

How well did you know this?

Not at all

Perfectly

Types of chronic pain

-Nociceptive (Tissue damage)
-Neuropathic (nerve)
-Mixed (tissue and nerve)

How well did you know this?

Not at all

Perfectly

Guidelines for tx of pain

-CDC
-PADIS
-NICE
-AAFP
**NOT 1 guideline for pain

How well did you know this?

Not at all

Perfectly

Goals of tx

-Correct underlying cause of pain if possible
-Minimize pain and sx from pain/injury (may not be possible to be pain-free; discuss this with pt; want pt’s pain a 3 or less)
-Improve QOL and AODL
-Limit pharmacotherapy SE

How well did you know this?

Not at all

Perfectly

Selecting an analgesic: We must first look at patient factors and medication factors

Patient factors:
-Hepatic/renal function
-PMH
-Previous analgesic tx
-Routes of administration (some kids can’t swallow tablets and some pt cannot swallow)
-Type of pain (nociceptive vs neuropathic)
-Severity of pain

Medication factors:
-Allergies/cross reactions
-Cost
-Drug-drug interactions
-DOA/dosing frequency
-Potency
-Route of administration
-SE

How well did you know this?

Not at all

Perfectly

Non-pharm tx

-Correct underlying cause (main focus—surgery/avoidance)
-Exercise
-Acupuncture
-Massage
-Heat or Ice
-Physical manipulation (chiropractor)
**Can be a combination with analgesic

Step 1 of the tx approach

Non-opioid +/- adjuvant analgesic

Step 2 of the tx approach

Opioid for mild/moderate pain + non-opioid +/- adjuvant analgesic

Step 3 of the tx approach

Opioid for moderate/severe pain + non-opioid /- adjuvant analgesic

Non-opioid analgesic

-Acetaminophen
-Non-steroidal anti-inflammatory drugs (NSAIDs)

Adjuvant analgesic

-Gabapentinoids
-SNRI
-TCA
-Muscle relaxant
-Antiepileptics
-Topical agents

Acetaminophen (Tylenol)
-Dosage forms

-Analgesic and antipyretic
-Available formulations
~Tablet (regular strength: 325 mg; extra strength: 500 mg; arthritis: 650 mg ER)
~Capsule
~Chewable tablet (80 or 160 mg)
~Liquid/gel
~IV solution (if throwing up or bowel obstruction)
~Suppository

Acetaminophen recommended dosing

Adults: 325-1000 mg PO Q4-6H PRN (max dose <3-4 g/day)
~In liver disease, the max is 2 g/day

Peds: 10-15 mg/kg PO Q4H PRN (max dose 75 mg/kg/day or <3-4 g/day)

SE of acetaminophen

-Hepatotoxicity (acute liver failure most likely with more than 10 g dose)–most common cause of acute liver failure in the US

Clinical pearls of acetaminophen

-Gold standard for osteoarthritis due to fewer SE in geriatric pts than NSAIDs -Educate pts about max daily doses, including combo products -Injection is expensive (often restricted use-->ex is surgery)

NSAIDs -SE and clinical pearls

-Analgesic, antipyretic, and anti-inflammatory -SE ~GI bleed (BBW)--breaks down stomach lining ~Nephrotoxicity ~Fluid retention: hold onto a bit of Na+ too ~Increase CV events (BBW) -Clinical pearls ~Take with food ~Caution use in geriatric pts due to increased SE (Beer's list) ~Avoid systemic NSAIDs in pts with cardiac hx (HF or MI)--can use topical NSAIDs instead (would not absorb much systemically) ~Avoid in severe liver disease or CKD

Aspirin -Available formulations -Clinical pearls

-Chewable tablet -Tablet -EC tablet -Capsule -ER capsule -Suppository Clinical pearls: -Avoid using for pain in pts taking blood thinners or antiplatelets -Some formulations available OTC

Aspirin dosing

Adults: 325-1000 mg PO Q4-6H PRN (max 4 g/day) Pediatrics: Anyone under 18 y/o should avoid ASA due to Reye's syndrome

Reye's syndrome

-Rare but serious condition that causes swelling in brain and liver -Associated with children/teens using ASA when they have viral infections, like the flu or chickenpox with or without a fever **Not always sure if child is immunocompromised so just avoid ASA use

Ibuprofen (Advil, Motrin) -Available formulations -Clinical pearls

-Capsule -Tablet (regular strength=200 mg) -Chewable tablet -Suspension -IV solution Clinical pearls: some formulations are available OTC

Recommended dosing of ibuprofen

Adults: 200-800 mg PO Q6-8H PRN (max: 3200 mg/day) Pediatrics (> 6 months): 5-10 mg/kg PO Q4-6H PRN (max 40 mg/kg/day or 2400 mg, whichever is less)

Diclofenac (Valtaren) -Available formulations -Clinical pearls

-Capsule -Tablet -IV solution -Suppository -Topical gel (1%) -Topical solution -Ophthalmic solution -Patch Clinical Pearls: -Minimal systemic SE with topical gel -Some formulations available OTC -Use if pt has CKD

Recommended dosing for diclofenac

Adults: 50 mg PO Q8H or 2-4 g applied topically QID

Naproxen (Naprosyn, Aleve) -Available formulations -Clinical Pearls

-Capsule -Tablet -DR/ER tablet -Suspension Clinical pearls: -Some formulations available OTC

Recommended dosing for naproxen

Adults: 220-500 mg PO Q6-12H (Max: 1000 mg/day)

Ketorolac (Toradol) -Available formulations -Clinical pearls

-Tablet -IV/IM solution -Nasal spray -Ophthalmic solution Clinical pearls: -Maximum duration is 5 days (parenteral + oral) ~Increased risk of GI bleed when used longer -Oral dosing is intended as a continuation of IM or IV therapy ***Only recommend oral if pt is started on IV

Recommended dosing of Ketorolac

Adults: 15-30 mg IV/IV q6h prn or 10 mg PO q6h prn Pediatrics: 0.5 mg/kg/dose IM/IV q6h prn

Celecoxib (Celebrex) -Available formulations -Clinical pearls

-Capsule -Oral solution (less common) Clinical pearls: -COX-2 selective (less GI toxicity & less GI bleeding) -Caution in pts with heart, liver, and kidney disease

PHRM845-FINAL EXAM Flashcards

Non-malignant pain