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Pharm II > Test 4- Dr. Wag > Flashcards

Test 4- Dr. Wag Flashcards

1
Q

pain is a _________ response

A

learned

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2
Q

typically short lived, resolves when the inciting event removed or healing has taken place, usually sharp and sudden in nature

most pain falls under this category

A

Acute Pain

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3
Q

lasts longer than the inciting event or the healing phase (3 months), associated with ongoing pathology, nagging persistent dull pain may have break through episodes

A

Chronic Pain

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4
Q

episodes of exacerbated pain in a chronic pain patient, last for a short period of time before pain returns to baseline chronicity

A

Breakthrough Pain

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5
Q

controls voluntary movements

A

Somatic Nervous System

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6
Q

controls involuntary movements

A

Autonomic Nervous System

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7
Q

On a 1-10 scale, how is pain defined?

A

0-4 = mild

5-6 = moderate

7-10 = severe

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8
Q

most acute pain is specific and likely _________

A

nociceptive

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9
Q

most chronic pain is _______

A

mixed

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10
Q

the only UNMYELINATED fiber, the second in the blockade order, and results in pain relief and loss of temperature sensation when blocked

A

C Fibers

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11
Q

this fiber is MYELINATED, the first to go off in the blockade, and results in increased skin temperature when blocked

A

B Fibers

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12
Q

this fiber, along with the C fiber, is the second in the blockade but serves a function for fast pain and temperature

results in pain relief and loss of temperature sensation

A

A delta Fibers

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13
Q

small fiber

thin, myelinated, slow, causes the gate to open, transmits sharp, prickly pain

A

A delta fibers

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14
Q

small fiber

thin, UNmyelinated, slow, causes the gate to open, transmits dull, aching pain

A

C fiber

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15
Q

large fiber

thick, myelinated, fast, causes the gate to close, transmits non-painful stimuli

A

A beta fibers

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16
Q

what is the end result of peripheral pain?

A

scarring

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17
Q

what is the end result of neuroinflammation?

A

constant pain

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18
Q

It is preferable to NOT prescribe medication until the urine toxicology screen is obtained.

A

TRUE

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19
Q

Depression can cause pain and pain can cause depression

A

TRUE

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20
Q

pain initiated or caused by a primary lesion or dysfunction in the nervous system (CNS or PNS)

ex: Postherpatic neuralgia, Trigeminal neuralgia, painful diabetic neuropathy, post-surgical neuropathic pain

A

Neuropathic Pain

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21
Q

How is neuropathic pain often described?

A

burning

tingling

hypersensitivity to touch or cold

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22
Q

pain caused by injury to body tissues (musculoskeletal, cutaneous, or visceral)

ex: pain due to inflammation, limb pain after a fracture, joint pain due to OA, post-operataive visceral pain

A

Nociceptive Pain

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23
Q

How is nocicpetive pain often described?

A

aching

sharp

throbbing

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24
Q

pain with neuropathic and nociceptive components

A

Mixed pain

**most chronic pain is mixed pain

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25
Q

what are some examples of mixed pain?

A

LBP with radiculopathy

Cervical Radiculopathy

Cancer Pain

Carpal Tunnel Syndrome

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26
Q
  • 80% of adults will get this in life
  • female to male is equal
  • MC is acute, short term with spontaneous resolution
  • majority is musculoskeletal in nature
  • chronic is more than 12 weeks
  • treat with keeping active and NSAIDS
A

Low Back Pain

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27
Q

What is the preferred test for working up a patient with LBP?

A

MRI

can see all structures including nerves and soft tissues

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28
Q

Heat is better for musculoskeletal pain

A

TRUE

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29
Q
  • chronic, affects most often the limbs, usually after injury or trauma
  • damage/malfunction to the PNS/CNS and its affects on the sympathetic nervous system
  • mild to severe pain with temperature changes, skin color changes, swelling, regional pain
  • symptoms vary in severity and duration, most cases are mild and recover gradually over time
  • individuals may not recover and have long term disability
  • MC is in women, around age 40
A

CRPS

Complex Regional Pain Syndrome

30
Q

Type I CRPS

A

reflex, no injury, RSD, no known cause

31
Q

Type II CRPS

A

causative, event starts inflammatory process

32
Q

Not all anti-depressants are the same, as they vary in their NE effect and serotonin effect

A

TRUE

33
Q

this drug has demonstrated effectiveness in the treatment of chronic pain

A

Nortriptyline (Pamelor)

34
Q

this drug is indicated for diabetic peripheral neuropathic pain

A

Duloxetine (Cymbalta)

35
Q

this drug may decrease neuropathic pain and help with sleep and other mood disorders

A

Venlafaxine (Effexor, Effexor XR)

36
Q

Anticonvulsants can cause dizziness, somnolence, HA, confusion, N/V, weight changes, and abnormal thoughts that may lead to suicide

A

TRUE

37
Q

DOC for mild to moderate pain

A

Ibuprofen

38
Q

What NSAIDs are most commonly linked to hepatotoxicity?

A

Sulindac and Diclofenac

39
Q

these injections are best done with ultrasound

A

trigger point injections

40
Q

Neurotome blocks can be done anywhere

A

TRUE

41
Q

needles should never be placed above C6

A

TRUE

42
Q

Pudendal nerve blocks can be done both _________ and ________

A

internally

externally

43
Q

What do you do if you have a CSF leak?

A

perform a blood patch

44
Q

direct exposure of the nerve

placement of the electrode next to the nerve trunk

done when the patient is awake

biggest problem is erosion that results in revision

A

PNS

Peripheral Nerve Stimulation

45
Q

any naturally occurring, semi-synthetic, synthetic compound that binds specifically to opioid receptors and shares properties of one or more of the endogenous opioids

(hydromorphone, hydrocodone, tramadol, fentanyl, etc.)

A

Opioid

46
Q

any opioid alkaloid FOUND NATURALLY in the poppy plant

codeine, morphine, thebaine

A

Opiate

47
Q

a drug or other substance affecting mood or behavior and sold for non-medical use

A

Narcotic

48
Q

How should you order Fentanyl?

A

as a matrix, not a reservoir

49
Q

Do differences exists between brand and generic?

A

active ingredient the same, up to 20% difference in generic

stick with same manufacturer if possible

50
Q

Neuropathic pain is opioid resistant

A

TRUE

51
Q

Respiratory Depression is enhanced when Benzo’s are added to an opioid

A

TRUE

52
Q

Opioids are weak bases

A

TRUE

53
Q

Patients on 5 or more medications have a 50% risk of drug to drug interaction

A

TRUE

54
Q

What are the 4 A’s of pain management?

A

Analgesia

Adverse Affects

Adverse Events

Aberrant Behaviors

55
Q

times of breakthrough pain are irregular

takes 10 mins from baseline to peek

69% predictable

2 episodes a day

give patient a long acting baseline medication

short acting must be given before an episode, otherwise drug won’t be treating anything

A

Chronic Pain

56
Q

New patient is taking pain meds. When should you screen them with UT?

A

first 8 to 10 days

57
Q

(5-HT) CDVD I AMN (NE)

A

Spectrum of Antidepressants

58
Q

What Benzo has the Shortest Half Life? Fastest onset?

A

Shortest half life = Oxazepam

Fastest onset = Diazepam

59
Q

Neonatal Benzo withdrawal includes hypertonia, hyperreflexia, hyperactivity, and vomiting. How long does this last?

A

3-6 months

60
Q

What are the MC SE’s of Benzos?

A

insomnia

gastric problems

tremors

agitaton

fearfulness

muscle spasms

61
Q

10% of Benzo patients experience what?

A

Protracted Withdrawal

62
Q

Spasticity is a muscle tone disorder that results in the imbalance of excitatory and inhibitory inputs at the level of the __________

A

spinal cord

63
Q

What is the only muscle relaxant that DOES have significant effect at the muscle fiber rather than acting at the spinal cord, brainstem or cerebrum?

A

Dantrolene

64
Q

Cyclobenzaprine has anti-Ach properties, such as dry mouth, constipation, nausea, urinary retention, tachycardia, blurred vision, and confusion

A

TRUE

65
Q

with this muscle relaxant, you must monitor the liver function when initiating

A

Metaxalone (Skelaxin)

66
Q

ETOH has cross reactivity with asthma inhalers on a toxicology screen

A

TRUE

67
Q

what is the most widely used drug (20% of hospital admissions are due to related diseases of this drug)

A

Ethanol

68
Q

ETOH may be present in people with…

A

a UTI

E. coli

diabetics with bacterial fermentation of urine

69
Q

single dose of 7grams will cause liver failure

deathly to cats and snakes

metabolized in the liver and is toxic to the skin also (SJS and TENS)

A

Acetaminophen

70
Q

If codeine/hydrocodone ration is

A

TRUE

71
Q

If codeine/morphine ration is

A

TRUE

Pharm II (7 decks)

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