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Flashcards in 10 - pain Deck (32)
1

def. nociceptive pain

due to damaged tissue
- aching and burning

2

def. neuropathic pain

due to damaged nerves
- sharp and burning

3

def chronic pain

>6mos beyond point of expected resolution

4

what is clinically signigicant reduciton in pain

3/10

5

Phx for pain

- point tenderness
- hyperalgesia
- allodynia

6

4 principles of good pain mgmt

1. treat underlying source
2. manage preventatively
- analgesics before doing painful things
3. use a multimodal approach
4. manage pain continuosly

7

meds for nociceptive pain

- tylenol
- nsaid
- opioid
- local

8

meds for neuro

- opioids
- TCA
- anti convulsants

9

tylenol dose for acute pain

1g qid
- reduce in alcohol

10

only IV NSAID

ketrolac

11

risk with NSAIDS

- ulcer
- perfs
- bleeds
- HT
- Pulmonary edema
-

12

contraindications to NSAID use

- allergy
- asthma
- rhinitis or urticaria
- ulcer
- IBD

13

adv and disadv of COX-2

same pain effect
adv - less GI and ulcer
dis - more CV such as MI and stroke

14

preferable route for opioids

IV

15

what is mophine excretion

renal - get higher dose with impairment

16

power of hydromorphone

5-8x

17

basic dosing of morphine for acute pain

2-3mg boluses every 5 minutes prn
or .25-.5mg hydromorph

18

opioid to avoid

merperidine

19

when to use fentanyl

no metabolites and rapidly out of system
- for short procedures
-0.5ug/kg

20

3 drugs for morphine N/V

- dimenhydrinate
- odansetron
- prochloroperazine

21

use for codeine and tramadol

mild to moderate pain for discharge

22

use for oxycodone

moderate to severe pain or those unresponsive to codeine
- most commonly compounded - percocet

23

what to ask about with oxy

drug and alcohol abuse

24

how to adjust with elderly

lower dosing

25

4 steps to look out for drug seeking behaviour

1. ask for ID
2. verify objectively the presenting complaint
3. attempt to contact the regular prescriber
4. only give smallest number to treat presenting complaint

26

2 other Tx for pain

1. calcitonin - good for osteopriotic vert. fractures
2. local and topical anesthetic

27

mgmt of arthritis

- NSAIDS, opioids, steroids

28

chronic pain

try to get consult

29

herpes zoster

- topical ASA
- oral NSAIDS
- opiods
- acyclovir within 72 hours
- amytriptyline
- pregabalin for post-herpeti neuralgia

30

mgmt sickle crisis

- IV opioids
- NSAIDS

31

mgmt of ureteral colic

- opioids
- renal specific NSAID
- tamulosin

32

mgmt of vertebral compression fractures

- calcitonin