Wards Final Flashcards
Two types nociceptive Pain?
- Somatic
2. Visceral pain
What is somatic pain?
Aching or throbbing sensation associated w/ skin, muscle, or bony involvement of disease
What is visceral pain?
Continuous sharp, stabbing, or cramping pain associated w/ visceral organs
What is neuropathic pain?
Destruction of nerve causing paroxysmal, lancing pain that feel sharp or burning/electric
What are continuous dysesthesias?
Pain that is burning or electric character
What is the pharmacologic approach to patient with new pain from bone metastasis?
Initiate short-acting opiate
What are four short acting opiates?
- Morphine sulfate immediate release
- Hydromorphone
- Oxycodone immediate release
- Oral transmucosal fentanyl
What is the conversion of IV morphine to oral morphine?
10: 30
- 10 mg IV = 30 mg PO
What are longer lasting opioid options?
- Controlled release morphine
- Controlled release oxycodone
- Fentanyl patch
- Methadone
What is the dosing for short-acting agent for breakthrough pain?
5-15% long-acting dose
What are the non opioid options for boney mets?
- Bisphosphonates
- NSAIDs
- Corticosteroids
- Radiation therapy
- Systemic anti-neoplastic therapy
- Daily bowel regimen
Indications for PCA?
1) Postop pain
2) Severe acute pain
3) Acute exacerbation of chronic pain
4) Cancer pain
5) Patients unable to take PO
Contraindications for PCA?
1) Poor understanding of PCA
2) Poor health care support for PCA
Routes for PCA?
- IV PCA & epidural (PCEA)
- Intrathecal/transdermal (E-trans)
- Surgical incision or intra-articular (on-q pumps)
Drugs used in PCA?
- Morphine
- Fentanyl
- Hydromorphone
- Clonidine
- Baclofen
Volume in PCAs?
- 30 mL for IV pumps
- 250 mL for epidural pumps
PCA concentration?
- Morphine 5 mg/mL
PCA loading dose?
2 mg q 5min to max 20 mg
- Given in frequent intervals to load receptors
What is the demand dose?
2 mg
- Amount delivered per button push
What is the locking interval?
2 mg every 10 min
- Time interval before pump can provide the next dose
What is the basal dose? Who to use and avoid in?
Morphine 1-2 mg per hour
- Continuous infusion set per hour
Useful in: opioid tolerant patients w/ severe pain at rest or during nighttime
DO NOT USE: opioid naïve patients
How to convert PCA to oral Dosing?
*30 Mg PO = 10 Mg IV
Resting pain: 2/3 IV dose
Breakthrough: 1/3 IV dose
How to taper PO opioids?
Rapid taper: 25% less every day once condition improves
Side effects Opioids?
- Respiratory depression
- Sedation
- N/V, itching
- Urinary retention
- Constipation
* Improve w/ time except constipation
Side effects local anesthetics?
- Hypotension
- Motor weakness
- Numbness
- Urinary retention
What is MSO4?
Morphine sulfate
What to do before PCA started?
IM
What is a good 4 hour limit?
40mg
First piece of info to get?
Old charts
How much Codeine in tylenol #4?
60 mg codeine/ Tylenol #4 pill
What is meperidine?
Demorol (opioid)
Why is demerol a bad choice?
- Renal insufficiency = decreased excretion of meperidine = inc risk CNS excitability = inc risk seizures
- Half life = 8 hours, develops long after last dose - Atropine derivative = causes tachycardia
- Difficult to tell if from inc pain, dehydration, or medication - Should not be used > 48h
- Large doses over extended time required for pt w/ chronic pain or opioid tolerance
What is epidural steroid injection good for?
Acute herniated disc
What are some bowel regimens?
- Colace 100 mg BID
- Milk of magnesia
- Laxative: senekot
- Suppository (dulcolax) if no response in 2 days
