PA Pain Management (Exam #3)

Question 1

What is the most common AE associated with opioid use?

Answer 1

Constipation

Question 2

What is undertreated pain resulting in red flag behaviors?

Answer 2

Pseudo-Addiction

Question 3

What is withdrawal sxs with abrupt discontinuation/decrease in opioid use (esp. chronic)?

Answer 3

Physical Dependence

Question 4

What are two major characteristics associated with ADDICTION?

Answer 4

• Impaired control over drug use/cravings

- Compulsive/continued use despite harm

Question 5

What are the three types of pain? Describe each

Answer 5

• Nociceptive: injury to tissue
• Neuropathic: damage to/dysfunction of nerves, spinal cord or brain
• Psychogenic: persistent pain with evidence of psych disturbance

Question 6

What are two examples of tx options for Nociceptive pain? What other two options may be considered as last resort?

Answer 6

• NSAIDs (short-term)
• Tylenol

Steroids and oral/topical Opioids are last resort

Question 7

What are two examples of tx options for Neuropathic pain? What other three options may be considered, and under what co-consideration?

Answer 7

• Gabapentin (Neurontin)
• Pregabalin (Lyrica)

Also…

• Amitriptyline if at night
• Duloxetine (Cymbalta) if depression too
• Tramadol only if NOT DM neuropathy

Question 8

What are three examples of tx options for Psychogenic pain?

Answer 8

NOT MEDS

• Biofeedback/distraction techniques
• Encourage exercise
• Psych eval/therapy

Question 9

What two pain tx options are specifically recommended for Fibromyalgia? Which meds should be avoided?

Answer 9

• EXERCISE
• Gabapentin (Neurontin)

NOT OPIOIDS

Question 10

When is use of Patient-Controlled Analgesia (PCA) considered (2)?

Answer 10

• Severe post-op pain

- Intractable CA pain

Question 11

What are the three options of Patient-Controlled Analgesia (PCA) administration?

Answer 11

• Demand dose (every “time”)
• Continuous dose (over “time”)
• Combination of both

Question 12

What is the major AE associated with Patient-Controlled Analgesia (PCA)?

Answer 12

Overdose risk (if not properly monitored/titrated)

Question 13

What is the main goal with CA pain treatment (2)?

Answer 13

Optimize opioid tx + analgesic adjuncts

Question 14

When is Fentanyl used, and in what population is it less effective?

What is the primary AE?

Answer 14

NOT for acute pain
- Less effective if cachectic

AE: heat exposure (causes increased absorption)

Question 15

What type of pain is Methadone used to tx?

What are the two primary AEs?

Answer 15

Neuropathic pain

AE: QT prolongation (TdP); many drug interactions

Question 16

What type of pain is Tramadol used to tx?

What is the primary caution, and what can this cause?

Answer 16

Neuropathic pain

Caution if on antidepressants → possible Serotonin Syndrome

Question 17

With which two medications should you caution ESRD?

What two meds can be used instead?

Answer 17

• Hydromorphone
• Oxycodone

Use Fentanyl or Methadone

Question 18

With what two conditions should opioid use be avoided?

Answer 18

• Liver dysfunction

- Increased ICP

Question 19

Generally, what pain are opioids used to treat? What two opioid characteristics are preferred?

Answer 19

ACUTE PAIN

- Low-dose and long-acting opioids are preferred

Question 20

When evaluating pain, which three pain-related HPI questions should be asked?

Answer 20

• Type of pain
• Source/location of pain
• Severity of pain

Question 21

For peds, what does pain assessment depend on?

Answer 21

Child’s cognitive ability (age)

Question 22

Which two pain medications should be avoided if <12 years?

Answer 22

• Codeine

- Tramadol

Question 23

What consideration/implementation should always be made for peds pain?

Answer 23

Appropriate adjuvant therapy options

Question 24

What three aspects of normal aging should be considered in the tx of geriatrics?

Answer 24

• Increased body fat = meds stored
• Decline in renal function
• Decline in hepatic function

Question 25

What is Beers Criteria (2)?

Answer 25

• Avoid concurrent opioids with Benzos or Gabapentin

- Avoid SNRIs

Question 26

What is STOPP Criteria (2)?

Answer 26

• Consider drug interactions

- Duplications of drugs within the same class

Question 27

With ANY new sxs in the geriatric population, what should be considered?

Answer 27

Adverse Drug Events (ADE)

- Serious consequences of inappropriate prescribing

Question 28

What should be reviewed at every visit with geriatric patients?

Answer 28

Med list