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Pain Control II > Choosing an analgesic > Flashcards

Choosing an analgesic Flashcards

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1
Q

acute pain

A

frequently has a known cause

has identifiable tissue damage

usually subsides as healing takes place
has a predictable endpoint
associated with anxiety – flight or fight and increase in pulse and respiratory rate

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2
Q

chronic pain

A

present in area for greater than 3 months

does not usually manifest the physiologic arousal as seen in acute pain

may exhibit reactive depression and decreased function

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3
Q

physiological condtiions associated with chronic pain

why?

A

high prevelance of psychological comorbitites among patients with chronic pain

presence of chronic pain may cause emoional distress and exacerabate premorbid psychological disorders

mood disorders
anxiety disorders 
somatic symptoms disorders 
personality disorders 
other conditions
  • unidentified can get in way of achieving management
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4
Q

three main minsconceptions regarding pain and analgesics

A
  1. patients who are in pain always have observable signs
  2. obvious pathology, test results, and the type of surgery determine the extence and the intensity of pain

3, patients should wait as long as possible before taking a pain medication. this period of abstinence will teach them to have a better tolerance for pain

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5
Q

three main minsconceptions regarding pain and analgesics

A
  1. patients who are in pain always have observable signs
  2. obvious pathology, test results, and the type of surgery determine the extence and the intensity of pain

3, patients should wait as long as possible before taking a pain medication. this period of abstinence will teach them to have a better tolerance for pain

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6
Q

post op pain mangament with aspirin

A

650 mg better than placebo or 30 mg codeine

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7
Q

post op pain mangament with aspirin

A

650 mg better than placebo or 30 mg codeine

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8
Q

adult ibuprofen rx

A

200-800 mg
q 6 hrs
no excees 3.2 g/day

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9
Q

downfalls of the COX -2 selective

A

resulted in increase in MI’s and strokes, especially with rofecoxib and valde

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10
Q

COX-2 on the market

A

celecoxib

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11
Q

head injuries give opoids

A

no

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12
Q

head injuries give opoids

A

no

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13
Q

combination analgesics

A

opiod with non opiod

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14
Q

amount of drug in combination analgesics determined by

A

amount of the non-opiod analgesic

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15
Q

pharmacologic control of pain can b direced at any of the three nocieptive processes

A
  1. initiation of impulses
    - free nerve endings
  2. propagation of those impulses
    - like local anesthetic
  3. perception of the painful stimuli
    - like narcotics
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16
Q

hydrocodone associated with

A

vicodine

complete agonist (opiod)

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17
Q

oxycodone associated with

A

percocet

complete agonsit - opiod

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18
Q

NSAIDs act where

A

at site of the initiation of nociceptive impulses

primarily in periphery by preventing synthesis and release of inflammatory mediators

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19
Q

aspirin like drugs effect

A

acetylsalicyclic acid moiety binds irreversibly to platalet cyclooxygenases

prevents platelet production of prostaglandins and thromboxanes - which are essential for platalet aggregation

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20
Q

6 main indications for aspirin like drugs

A
  1. mild to moderate pain
  2. fever
    3/ arthritis
    4/ thromboemolic disorders
  3. TIAs
  4. postmyocardial infarction
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21
Q

contraindications and side effects of aspirin like drugs

A
  1. alergic
  2. anti-coagulated patient
  3. gastric ulcers
  4. side effects such as
    - epigastric distress
    - nausea / vomit
    - increased bleeding time
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22
Q

reyes syndrom from

A

aspirin given to young children resulting in encephalopathy and liver disease

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23
Q

aspirin dose effetive after extraction

Study These Flashcards
A

650 mg vs 30 mg of codeine or placebo

24
Q

ibuprofen is
peak?
half life?

Study These Flashcards
A

motrin / advil
peal is 1-2 hr
half life 2-4

25
adult vs children dose of ibuprofen
200-800 mg q 6 hr - not exceed 3.2 grams / day 2-11 yrs. 7.5 mg/ kg qid not exceed 30 mg/kg/day
26
naproxen sodium dosage? naproxen dosage
safe for short use similar to ibuprofen slightly slower onset but longer duration may consider before night before surgery loading dose of 550 mg - then 275 mg q6-8 hr. not exceeding 1375 mg/day naproxen = 250-500 mg bid not exceed 1g/day
27
prostaglandins usually used for? implication
responsible for producing compounds that protect gastric lining - so inhibiting them with NSAIDS - can see most common side effects of - gastrointestinal problems - dyspepsia, gastric erosions, and mucosal ulcerations
28
NSAID that effects bleeding
ASA - only one because it IREVERSIBLY inhibits the COX pathways - prolongs bleeding
29
dosage of celecoxib aka
celebrex COX-2 inhibitor 100 or 200 mg BID
30
pregnency use of NSAIDs | avoid when? why?
APAP > ASA apap -- therapeutic doses is generally considered best choice for manging acute pain ASA -- can lead to anemia and delivery cmplications and postpartum hemorrhage avoid ASA and NSAIDs in THIRD TRIMESTER - inhibit prostaglandin syntheiss and can inhibit contractions in labor - constriction of ductus arteriosis in utero -- pulmonary HTN of newborn -
31
NSAIDs and alcohol - general
combo increases the risk of fecal blood loss associated with GI erosions and ulcers
32
acetaminophen aka ? | metabolite of?
tylenol metabolite of phenatecin -- equipotent to ASA but fewer side effects b/c acts more centrally -- weak inhibitor of the peripheral prostaglandins
33
no / minimal antiinflammatory NSAID
APAP - acetaminophen / tylenol / panadol
34
hepatic / liver toxicity in which NSAID | dose?
acetaminophen -- induced with APA with daily dose of 4000mg is exceeded so daily dose is 3000 mg max or 3 g / day
35
acetaminophen dose with opiods
max of 325 mg
36
indications for acetaminophen
mild to moderate pain | fever
37
contraindications for acetaminophen /
hypersensitivityy precautions - hepatic / liver disease - renal disease - chronic alcoholism
38
acetaminophen dosage
325-650 mg q4 h | not to exceed 3gm / day
39
LA's working where
blocking propagation at peripheral site so do not reach spinal cord or brain
40
opiods receptors are where
spinal cord, medulla, and periaqueductal grey matter (considered important areas in perception of pain) - decrease the perception of pain in the CNS
41
contraindications for opiods
hypersensitivirt CHRONIC OROFACIAL PAIN - NO head injuries - NO
42
first pass addect in centrally acting analgesics
50 to 90% of the absorbed drug is metabolized on the first pass through the liver -- clinically this means that only one-tenth to one-half of the dose reaches the analgesic receptors in the brain
43
codeine is
tylenol #3
44
most important for choosing regimen for pain control
cause of pain and pain severity
45
important use of LA
perioperative LONG ACTING LA can delay onset of post procedural pain
46
long acting LA
bupivacaine - marcaine exparel -- liposomal bupivacaine -- injected into SURGICAL site - not for use of 18 year or younger
47
major differences between non-opioid and opioid
non opioid - ceiling effect to anagesia (no ceiling effect on analgesic response) -no toleranc or physical dependence built - are antipyretic =- posses antinflamm + analgesic (except acetaminophen )
48
If use opioid should be
FULL agonist with minimal first pass affect
49
dosing equivalaents of oxy, hydroco, codeine and tramadol
5mg of oxycodone = 10 mg of hydrocodone = 65 mg of codeine = 75 mg tramadol
50
source of diversion
non used drugs - then used for nonmedical use by those around - not prescribed
51
max dos of acetaminophen
3 grams aily 325-650 po - q4-6 hours or 1 g po 3x day
52
percocet is? | dosing?
5/325 acetaminophen 325 mg oxycodone = 5mg 12 tablets usually q 6 hr
53
vicodin is? | dosing?
acetaminophen 300 mg hyrocodone 5 mg 15 tabs usually q 6
54
vicoprofen is? | dose?
hydrocodone bitartrate 7.5 mg ibuprofen 200 mg 15 tabs 4-6 hr prn pain
55
potential drug interactions with motrin
motrin = ibuprofen antihypertensive - may decrease effectivenes ASA, corticosteroids - increased risk of adverse GI reactions Digoxin, lithium , oral anti-coagulants- may incease the plasma levels or affects of these medications methotrexate -- decreased clearance and thus increased toxicity
56
gastric bypass probably not giving?
NSAID | or esophagial reflux

Pain Control II (15 decks)

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