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therapeutics 2 > Assessment of Pain/Non-opioid > Flashcards

Assessment of Pain/Non-opioid Flashcards

(75 cards)

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1
Q

what questions should be asked to assess subjective pain

A

PQRSTU
(palliative/precipitating, quality, region, severity, time related, impact on U)

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2
Q

what objective information should you collect to assess pain

A

behavior changes
physiological changes

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3
Q

what are the goals of therapy with pain

A

correct underlying pain
minimize pain and symptoms
improve QOL
limit drug side effects

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4
Q

non-pharm therapy options

A

correct underlying cause
exercise
acupuncture
physical manipulation
heat or ice
massage

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5
Q

WHO step 1 treatment

A

non-opioid +/- adjuvant analgesic

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6
Q

WHO step 2 treatment

A

opioid for mild to moderate pain
+ non opioid
+/- adjuvant analgesic

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7
Q

WHO step 3 treatment

A

opioid for moderate to severe main
+ non opioid
+/- adjuvant analgesic

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8
Q

when to step up in treatment

A

pain is persisting or increasing

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9
Q

when to step down in treatment

A

pain is resolving or toxicity occurs

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10
Q

what are examples of adjuvant therapy

A

gabapentinoids
SNRIs
TCAs
muscle relaxants
antiepileptics
topical agents

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11
Q

what are the non-opioid pain options

A

APAP
NSAIDs

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12
Q

acetaminophen uses

A

analgesic and antipyretic

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13
Q

acetaminophen formulations

A

tablet
capsule
chewable
liquid/gel
IV
suppository

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14
Q

acetaminophen recommended dosing for adults

A

325-1000mg PO q4-6h prn

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15
Q

acetaminophen max dose adults

A

3-4 g/day

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16
Q

acetaminophen max dose liver disease

A

2 g/day

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17
Q

acetaminophen dosing peds

A

10-15 mg/kg PO Q4H prn

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18
Q

acetaminophen max dose peds

A

75 mg/kg/day or 3-4 g/day

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19
Q

acetaminophen side effects

A

hepatotoxicity (greater than 10g dose)

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20
Q

what is acetaminophen the gold standard for

A

osteoarthritic in geriatric patients due to fewer side effects

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21
Q

education points for acetaminophen

A

max daily doses
combo products

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22
Q

what are NSAIDs used for

A

analgesic, antipyretic, anti-inflammatory

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23
Q

NSAID side effects

A

GI bleeding (black box warning)
nephrotoxicity
fluid retention
increase CV events

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24
Q

NSAID education points

A

take with food

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25
who should avoid NSAIDs
geriatric patients patients with cardiac history severe liver or kidney disease
26
aspirin formulations
chewable tablet EC tablet capsule ER capsule suppository
27
aspirin adult dosing
325-1000mg PO q4-6h PRN
28
aspirin adult max dose
4g/day
29
aspirin peds dosing
AVOID (reye's syndrome)
30
what is reye's syndrome
rare serious condition that causes swelling in the brain and liver
31
Ibuprofen formulations
capsule tablet (200mg) chewable suspension IV solution
32
ibuprofen adult dosing
200-800mg PO q6-8h PRN
33
ibuprofen adult max dose
3200mg/day
34
ibuprofen peds dosing
5-10mg/kg PO q4-6h PRN
35
ibuprofen peds max dose
40mg/day or 2400mg whichever is less
36
how old do kids have to be to take ibuprofen
>6 months
37
diclofenac formulations
capsule tablet IV solution suppository topical gel/solution eye solution patch
38
diclofenac adult dose
50mg PO q8h or 2-4g topically 4 times/day
39
clinical pearls of diclofenal
minimal side effects with gel
40
naproxen formulations
capsule tablet DR/ER tablet suspension
41
naproxen adult dosing
220-500mg PO q6-12h
42
naproxen adult max dose
1000mg/day
43
ketorolac formulations
tablet iv/im solution nasal spray eye solution
44
ketorolac adult dosing
15-30 IM/IV q6h prn or 10mg q6h prn
45
ketorolac peds dosing
0.5mg/kg/dose IM/IV q6h prn
46
max duration of ketorolac
5 days (increased risk of GI bleed when used longer)
47
celecoxib adult dosing
200mg PO BID
48
celecoxib clinical pearl
cox 2 selective -- less GI toxicity
49
gabapentinoid uses
fibromyalgia neuropathies post-op pain
50
gabapentin dosing
100-300mg PO TID (max 3600mg/day)
51
pregabalin dosing
75mg PO BID (max 600mg/day)
52
gabapentinoid side effects
sedation, dizziness, peripheral edema
53
gabapentinoid clinical pearls
renally dose adjusted titrate up dose use in combo to decrease dose requirements pregabalin is schedule V
54
SNRI uses
fibromyalgia neuropathy
55
venlafaxine dosing
37.5-75mg PO daily (max 225mg/day)
56
duloxetine dosing
30mg PO daily x 1 week then increase to 60mg PO daily (max)
57
SNRI side effects
nausea headache HTN sedation weakenss
58
SNRI clinical pearls
start low and titrate slow renally dose adjust venlafaxine and avoid duloxetine for CrCl < 30 mL/min
59
TCA uses
fibromyalgia neuropathy migraine prophylaxis
60
amitriptyline or nortriptyline dosing
10mg PO qhs (max 150mg/day)
61
TCA side effects
anti-cholinergic side effects sedation
62
TCA clinical pearls
last line for neuropathy and fibromyalgia due to side effects
63
muscle relaxant side effects
sedation/drowsiness dizziness dry mouth vision changes
64
muscle relaxant pearls
short term use (<3 weeks) carisoprodol is schedule IV
65
carbamazepine clinical pearls
increased risk of hypersensitivity reactions in patients with HLA-B*1502 autoinduction of hepatic enzymes
66
lidocaine side effects
hypotension arrythmia
67
lidocaine clinical pearls
tachyphylaxis with continued use 12 hour break between patches local affect so apply to where pain is
68
capsacian uses
muscle/joint pain neuropathic pain
69
capsaician side effects
skin irritation and pain
70
capsaician clinical pearls
do not get in eyes wash hands after applying
71
non cox-2 selective NSAIDs in geriatric patients
avoid chronic use avoid short term schedule use when used in combo
72
indomethacin and ketorolac in geriatric patients
avoid
73
skeletal muscle relaxants in geriatric patients
avoid
74
SNRIs, TCAs, Carbamazepine in geriatric patients
use with caution
75
opioids and benzos in geriatric patients
avoid

therapeutics 2 (24 decks)

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