Chronic Pain Flashcards
(7 cards)
TW is a 59 year old male with severe spinal stenosis. He has recently been taking hydrocodone/APAP 7.5/325 mg 1 tablet PO every 4 hours. Dr. Payne is asking you to convert him to a long acting agent. PMH is significant for hypertension, type 2 diabetes, chronic kidney disease. Current Medications: Ramipril 10 mg daily Insulin glargine (Lantus) 20 units at bedtime Insulin aspart (Novolog) 5 units at meals Ht: 5’7 Wt: 61 kg Scr: 1.9 mg/dL Which is the best option for this patient?
A: Morphine SR (MS Contin) 15 mg PO every 12 hours ᅞ
B: Fentanyl 25 mcg/hr Transdermal Patch applied topically every 72 hours ᅚ
C: Oxycodone ER (Oxycontin) 10 mg PO every 12 hours
D: Oxymorphone ER (Opana) 10 mg PO every 12 hours
C: Oxycodone ER (Oxycontin) 10 mg PO every 12 hours
JM is a 68 year old female with chronic lower back pain due to a work injury. Her pain is well controlled on oxycodone ER 10 mg PO every 12 hours and oxycodone/APAP 5-325 mg 1 po every 4 hours prn for breakthrough pain. During her follow up appointment today she has complaints of constipation. JM reports that she has not had a bowel movement in the past 3 days (regularly has one bowel movement a day). What is the best option for the constipation JM is experiencing? ᅞ
A: Psyllium 3.4 grams powder mixed with 8 oz of water PO once daily ᅚ
B: Senna 8.6 mg/docusate 50 mg (Senna-S) 1 tablet PO twice daily ᅞ
C: Docusate sodium 50 mg 1 capsule PO daily at bedtime ᅞ
D: Polyethylene glycol 3350 (MiraLax) 17 grams in 8 oz liquid PO four times daily
B: Senna 8.6 mg/docusate 50 mg (Senna-S) 1 tablet PO twice daily ᅞ
MC is 74 year old female with poorly controlled diabetes. Her past medical history is also significant for obesity, hypertension, GERD, and constipation. Current Labs: WNL. MC has recently been experiencing a painful burning sensation in both of her feet and lower legs. The pain has increased in intensity over the last several months and is now interfering with her daily routines. MC’s primary care physician is willing to prescribe something for the pain she is feeling. Which of the following is the best initial option for MC?
Amitriptyline 50 mg 1 PO at bedtime
Pregabalin 50 mg PO three times daily
Duloxetine 60 mg PO twice daily
Gabapentin 300 mg PO at bedtime
Gabapentin 300 mg PO at bedtime
Dr. Smith calls you for your opinion. He has a patient, GR, who is 62 year old female with uncontrolled pain secondary to severe osteoarthritis. All nonpharmacological and nonopioid trials have been ineffective and Dr. Smith has decided to add an opioid to help manage her pain. PMH: hypertension, atrial fibrillation, anxiety, depression, hyperlipidemia, osteoarthritis. Current Medications: Lisinopril 10 mg daily Diltiazem CD 300 mg daily Warfarin 5 mg daily Fluoxetine 40 mg daily Atorvastatin 80 mg daily Acetaminophen 500 mg every 8 hours Labs: WNL. Which of the following opioids listed is the best option for this patient? ᅚ
A: Oxymorphone
B: Methadone ᅞ
C: Oxycodone ᅞ
D: Hydromorphone ER
A: Oxymorphone
MR is 75 year old female suffering with chronic pain who has been managed with oxycodone ER 40 mg every 12 hours. Her use of her breakthrough pain regimen also has increased over the last two months. She is currently taking hydrocodone 10/325 mg 1 po every 4 hours prn and reports averaging 5 tablets per day. Lately it is becoming more and more difficult for her to swallow pills. The doctor asks for your recommendation regarding dosing of the Fentanyl Transdermal Patch. What is the most appropriate choice for MR?
A: Fentanyl 50 mcg/hr Transdermal Patch, Apply 1 patch every 72 hours
B: Fentanyl 75 mcg/hr Transdermal Patch, Apply 1 patch every 72 hours
C: Fentanyl 25 mcg/hr Transdermal Patch, Apply 1 patch every 72 hours
D: Fentanyl Transdermal Patch is not appropriate for MR
B: Fentanyl 75 mcg/hr Transdermal Patch, Apply 1 patch every 72 hours
MR is 75 year old female suffering with chronic pain who has been managed with oxycodone ER 40mg every 12 hours. Her use of a breakthrough pain regimen also has increased over the last two months. She is currently taking hydrocodone 10/325 mg 1 PO every 4 hours prn and reports averaging 5 tablets per day. Lately it is becoming more and more difficult for her to swallow pills. Which of the following is the most appropriate medication for breakthrough pain for this patient? ᅞ
A: Continue on the hydrocodone 10/325 mg PO every 4 hours prn ᅞ
B: Morphine sulfate IR 15 mg PO every 4 hours prn ᅚ
C: Morphine sulfate 10 mg/5 ml solution, 7.5 ml (15 mg) PO every 4 hours prn ᅚ
D: Oxycodone hydrochloride 5 mg/5 ml solution 10 ml (10 mg) PO every 4 hours prn
C: Morphine sulfate 10 mg/5 ml solution, 7.5 ml (15 mg) PO every 4 hours prn ᅚ
According to the 2014 Methadone Safety Guidelines which of the following monitoring parameters for methadone are recommended? ᅞ
A: Patients with a low risk for drug abuse should not undergo urine drug testing ᅞ
B: After a dose increase, clinicians should only follow-up with the patient at their next visit to assess for adverse events
C: If methadone is used in pregnancy to treat chronic pain instead of addiction, the neonate doesnಬt need to be monitored for neonatal abstinence syndrome ᅚ
D: A follow-up ECG should be done when a patients dose reaches 40 mg/day
D: A follow-up ECG should be done when a patients dose reaches 40 mg/day
