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Opiods > Wards Final > Flashcards

Wards Final Flashcards

1
Q

Two types nociceptive Pain?

A
  1. Somatic

2. Visceral pain

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2
Q

What is somatic pain?

A

Aching or throbbing sensation associated w/ skin, muscle, or bony involvement of disease

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3
Q

What is visceral pain?

A

Continuous sharp, stabbing, or cramping pain associated w/ visceral organs

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4
Q

What is neuropathic pain?

A

Destruction of nerve causing paroxysmal, lancing pain that feel sharp or burning/electric

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5
Q

What are continuous dysesthesias?

A

Pain that is burning or electric character

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6
Q

What is the pharmacologic approach to patient with new pain from bone metastasis?

A

Initiate short-acting opiate

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7
Q

What are four short acting opiates?

A
  1. Morphine sulfate immediate release
  2. Hydromorphone
  3. Oxycodone immediate release
  4. Oral transmucosal fentanyl
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8
Q

What is the conversion of IV morphine to oral morphine?

A

10: 30

- 10 mg IV = 30 mg PO

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9
Q

What are longer lasting opioid options?

A
  1. Controlled release morphine
  2. Controlled release oxycodone
  3. Fentanyl patch
  4. Methadone
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10
Q

What is the dosing for short-acting agent for breakthrough pain?

A

5-15% long-acting dose

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11
Q

What are the non opioid options for boney mets?

A
  1. Bisphosphonates
  2. NSAIDs
  3. Corticosteroids
  4. Radiation therapy
  5. Systemic anti-neoplastic therapy
  6. Daily bowel regimen
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12
Q

Indications for PCA?

A

1) Postop pain
2) Severe acute pain
3) Acute exacerbation of chronic pain
4) Cancer pain
5) Patients unable to take PO

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13
Q

Contraindications for PCA?

A

1) Poor understanding of PCA

2) Poor health care support for PCA

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14
Q

Routes for PCA?

A
  1. IV PCA & epidural (PCEA)
  2. Intrathecal/transdermal (E-trans)
  3. Surgical incision or intra-articular (on-q pumps)
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15
Q

Drugs used in PCA?

A
  1. Morphine
  2. Fentanyl
  3. Hydromorphone
  4. Clonidine
  5. Baclofen
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16
Q

Volume in PCAs?

A
  • 30 mL for IV pumps

- 250 mL for epidural pumps

17
Q

PCA concentration?

A
  • Morphine 5 mg/mL
18
Q

PCA loading dose?

A

2 mg q 5min to max 20 mg

- Given in frequent intervals to load receptors

19
Q

What is the demand dose?

A

2 mg

- Amount delivered per button push

20
Q

What is the locking interval?

A

2 mg every 10 min

- Time interval before pump can provide the next dose

21
Q

What is the basal dose? Who to use and avoid in?

A

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

22
Q

How to convert PCA to oral Dosing?

A

*30 Mg PO = 10 Mg IV
Resting pain: 2/3 IV dose
Breakthrough: 1/3 IV dose

23
Q

How to taper PO opioids?

A

Rapid taper: 25% less every day once condition improves

24
Q

Side effects Opioids?

A
  1. Respiratory depression
  2. Sedation
  3. N/V, itching
  4. Urinary retention
  5. Constipation
    * Improve w/ time except constipation
25
Q

Side effects local anesthetics?

A
  1. Hypotension
  2. Motor weakness
  3. Numbness
  4. Urinary retention
26
Q

What is MSO4?

A

Morphine sulfate

27
Q

What to do before PCA started?

A

IM

28
Q

What is a good 4 hour limit?

A

40mg

29
Q

First piece of info to get?

A

Old charts

30
Q

How much Codeine in tylenol #4?

A

60 mg codeine/ Tylenol #4 pill

31
Q

What is meperidine?

A

Demorol (opioid)

32
Q

Why is demerol a bad choice?

A
  1. Renal insufficiency = decreased excretion of meperidine = inc risk CNS excitability = inc risk seizures
    - Half life = 8 hours, develops long after last dose
  2. Atropine derivative = causes tachycardia
    - Difficult to tell if from inc pain, dehydration, or medication
  3. Should not be used > 48h
    - Large doses over extended time required for pt w/ chronic pain or opioid tolerance
33
Q

What is epidural steroid injection good for?

A

Acute herniated disc

34
Q

What are some bowel regimens?

A
  1. Colace 100 mg BID
  2. Milk of magnesia
  3. Laxative: senekot
  4. Suppository (dulcolax) if no response in 2 days

Opiods (1 decks)

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