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DMOP > CHRONIC PAIN MANAGEMENT > Flashcards

CHRONIC PAIN MANAGEMENT Flashcards

1
Q

CUTE PAIN TRANSFORMATION
* ACUTE PAIN CAN BECOME CHRONIC IF IT LASTS
MORE THAN — OR THE TIME IT
WOULD TAKE CONNECTIVE TISSUE TO HEAL

A

3 TO 6 MONTHS

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2
Q

TEMPOROMANDIBULAR DISORDERS
(3)

A
  • MANY ARE MILD AND SELF-LIMITING
  • CHRONIC TMD PAIN SYNDROMES LAST AT MORE THAN 6 MONTHS
  • DEPRESSIVE SYMPTOMS AND CHRONIC MUSCULOSKELETAL PAIN
    HAVE A DIRECT CORRELATION
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3
Q

TMD MANAGEMENT
(6)

A
  • MEDICATIONS
  • SPLINT THERAPY
  • PHYSICAL THERAPY
  • ACCUPUNCTURE
  • PSYCHOTHERAPY
  • SURGERY
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4
Q

CHRONIC OVERLAPPING PAIN CONDITIONS (COPCS)
COMMON CO-EXISTING PAIN CONDITIONS:
(4)

A
  1. TMD
  2. FIBROMYALGIA
  3. HEADACHES (MIGRAINES, TENSION-TYPE, AND TAC’S)
  4. IRRITABLE BOWEL SYNDROME (IBS)
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5
Q

CAUSE HEAD & FACIAL PAIN:

A
  • MIGRAINE HEADACHE
    · TENSION HEADACHE
  • TAC’S
    · TEMPORAL ARTERITIS
    · EAR INFECTION
    · SINUS INFECTION OR TUMORS
    · TOOTH INFECTION
    · JAW JOINT SPRAIN
    · NEURALGIA
    · JAW JOINT DISK DISPLACEMENT *
    *MAY NOT BE PAINFUL
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6
Q

CAN CAUSE MALOCCLUSION:

A
  • ORAL CANCER
    · JAW JOINT TUMORS (I.E.
    OSTEOCHONDROMA)
    · DENTAL MALOCCLUSION ESPECIALLY
    SECONDARY TO OSTEOARTHRITIS OR
    RHEUMATOID ARTHRITIS
  • FACIAL MUSCLE SPASM
    JAW FRACTURE
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7
Q

ACETAMINOPHEN

A
  • PARACETAMOL (GENERIC IN SOME FOREIGN COUNTRIES)
  • APAP (ACETYL-PARA-AMINOPHENOL)
  • NO ANTI-INFLAMMATORY EFFECTS
  • MINIMAL INCREASED RISK OF BLEEDING
  • OVERDOSE: HEPATOTOXICITY
  • MAX DAILY DOSE: 4000 MG PER DAY IN DIVIDED DOSES EXCEPT
  • 3000 MG PER DAY IN DIVIDED DOSES FOR CHRONIC PAIN
    13
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8
Q

CETAMINOPHEN DOSAGE FORMS
* CAPLET, TABLET
(1)
* ELIXIR
(2)
* INJECTABLE (IV)
(1)
* SUPPOSITORY
(1)

A
  • 325MG, 500MG, 650MG EXTENDED RELEASE
  • 160MG/5ML
  • 500MG/5ML
  • 10MG/ML
  • 120MG, 325MG, 650MG
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9
Q

COMBINATION WITH OPIOIDS
* HYDROCODONE-ACETAMINOPHEN
(2)

A
  • NORCO 5MG, 7.5MG, 10MG/325MG
  • VICODIN 5MG, 7.5MG, 10MG/300MG
  • WATCH FOR CONCURRENT MEDICATIONS CONTAINING ACETAMINOPHEN ESPECIALLY OTC
    PRODUCTS.
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10
Q

COMBINATION WITH OPIOIDS
* OXYCODONE WITH ACETAMINOPHEN
(2)

A
  • ENDOCET, ROXICET
  • 5MG, 7.5MG, 10MG/ 325MG
  • PERCOCET
  • 5MG, 7.5MG, 10MG/ 325MG
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11
Q

COMBINATION WITH CODEINE
* TYLENOL WITH CODEINE NO.2
(1)
* TYLENOL WITH CODEINE NO.3
(1)
* TYLENOL WITH CODEINE NO.4
(1)

A
  • 300MG/15MG
  • 300MG/30MG
  • 300MG/60MG
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12
Q

COMBINATION WITH TRAMADOL
* ULTRACET
(2)

A
  • ACETAMINOPHEN/ TRAMADOL
  • 320MG/37.5MG
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13
Q

ADVANTAGES OF LONG-ACTING OPIOIDS
(5)

A
  • MORE CONSISTENT ANALGESIA
  • FEWER ADVERSE EFFECTS
  • MORE TOLERANCE TO ADVERSE EFFECTS
  • BETTER SLEEP ➔ BETTER DAYTIME FUNCTION
  • LESS EUPHORIA, ADDICTION, DIVERSION
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14
Q

OTC PRODUCTS CONTAINING ACETAMINOPHEN
* EXCEDRIN EXTRA STRENGTH, EXCEDRIN MIGRAINE
(2)

A
  • ACETAMINOPHEN/ ASPIRIN/ CAFFEINE
  • 250MG/ 250MG/ 65MG
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15
Q

OTC PRODUCTS CONTAINING ACETAMINOPHEN
* COMTREX
(2)

A
  • ACETAMINOPHEN/ DEXTROMETHORPHAN/ PHENYLEPHRINE
  • 325MG/ 10MG/ 5MG
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16
Q

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS)

A
  • ASPIRIN
  • IBUPROFEN
  • NAPROXEN
  • PIROXICAM
  • MELOXICAM
  • INDOMETHACIN
  • DICLOFENAC
  • KETOROLAC
  • CELECOXIB
  • ETODOLAC
  • NABUMETONE
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17
Q

NSAIDS
(3)

A
  1. ANTI-INFLAMMATORY EFFECTS
  2. ANALGESIC EFFECTS
  3. ANTIPYRETIC EFFECTS
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18
Q

NSAIDS
* AT LOW DOSE
(2)
* AT HIGHER DOSES
(1)

A
  • ANTIPYRETIC EFFECTS
  • ANALGESIC EFFECTS
  • MORE ANTI-INFLAMMATORY EFFECTS BESIDES MENTIONED EFFECTs
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19
Q

NSAIDS
* IBUPROFEN (MOTRIN®, ADVIL®)
(5)

A
  • OTC 200MG
  • RX 400MG, 600MG, 800MG
  • MAX DOSE: 3200 MG PER DAY IN DIVIDED DOSES
  • TOXICITY: GI ULCER
  • TO REACH ANTI-INFLAMMATORY EFFECTS MUST USE 1800MG-3200MG/DAY IN DIVIDED DOSES
20
Q

COMBINATION WITH OPIOIDS
* OXYCODONE/ IBUPROFEN
(2)

A
  • 5MG/ 400MG
  • MAXIMUM OF 4 TABLETS/DAY IN DIVIDED DOSES
21
Q

COMBINATION WITH OPIOIDS
* HYDROCODONE/ IBUPROFEN
(2)

A
  • 2.5MG, 5MG, 7.5MG, 10MG/ 200MG
  • MAXIMUM OF 5 TABLETS /DAY IN DIVIDED DOSES
22
Q

NSAIDS
* NAPROXEN (ALEVE® 220MG OTC)
(3)

A
  • MAX DAILY DOSE: 1500 MG PER DAY IN DIVIDED DOSES
  • TOXICITY: GI ULCER
  • COMBINATION WITH PPI ESOMEPRAZOLE TO MINIMIZE THE GI DAMAGE (BRAND NAME VIMOVO®)
23
Q

TOPICAL ANALGESICS: LESS LIKELY THAN SYSTEMIC
ANALGESICS TO PRODUCE SIDE EFFECTS & CAN TREAT A
VARIETY OF PAINFUL DISORDERS
 USED FOR MUSCLE OR TMJ PAIN
 (I.E. ARTHRITIS)
 NSAIDS: COMPOUNDED
(4)
 USED FOR MUSCULOSKELETAL PAINS
 NSAID WITH MUSCLE RELAXANTS
(3)

A

 10% OR 20% INDOMETHACIN
 10% OR 20% IBUPROFEN
 10%, 15% OR 20% KETOPROFEN
 3%, 5%, OR 10% DICLOFENAC

 1% FLEXERIL WITH10% KETOPROFEN/10% IBUPROFEN
 1% DICLOFENAC SODIUM GEL(VOLTAREN) RX OR OTCThis Photo by Unknown Author is licensed under CC BY-SA

24
Q

NSAIDS
* CELECOXIB (CELEBREX®)
(3)

A
  • SELECTIVE COX 2 INHIBITOR
  • 100MG OR 200 MG TWICE DAILY
  • AVOID IF PATIENT HAS SULFA ALLERGY
25
Q

ACETAMINOPHEN, NSAIDS
* THESE ANALGESICS HAVE — EFFECT
* HAS A LIMIT IN RELIEVING THE PAIN
(2)
* MORE TOXICITY
* NO — HAPPEN WITH THESE ANALGESICS
* TAKE NSAIDS WITH FOOD TO LOWER – ADRs

A

CEILING

  • ABOVE THE LIMIT
  • NO MORE ANALGESIC EFFECT

TOLERANCE OR DEPENDENCE

GI ADRS

26
Q

ORAL OPIOIDS
MU RECEPTOR AGONISTS
(6)

A
  • HYDROMORPHONE 7.5MG
  • OXYCODONE 20MG
  • MORPHINE 30MG
  • HYDROCODONE 30 MG
  • CODEINE 200MG
  • MEPERIDINE 300MG
27
Q

CURES
(2)

A
  • CURES (CONTROLLED SUBSTANCE UTILIZATION REVIEW AND EVALUATION
    SYSTEM) IS A DATABASE OF CONTROLLED PRESCRIPTIONS DISPENSED IN
    CALIFORNIA
  • CURES IS COMMITTED TO THE REDUCTION OF PRESCRIPTION DRUG ABUSE
    AND DIVERSION WITHOUT AFFECTING LEGITIMATE MEDICAL PRACTICE OR
    PATIENT CARE
28
Q

OPIOIDS
* NO — EFFECT
* —
* USE DISORDER AND DEPENDENCE
* — SUBSTANCES

A

CEILING
* NO LIMITATION IN RELIEVING THE PAIN WHEN ESCALADE THE DOSE

TOLERANCE
* NEED FOR DOSE INCREASE

CONTROLLED

29
Q

OPIOIDS ADRS
(7)

A
  • RESPIRATORY DEPRESSION
  • NAUSEA/ VOMITING
  • SEDATION
  • DIZZINESS
  • CONFUSION
  • PRURITUS
  • CONSTIPATION
30
Q

TRAMADOL
(4)

A
  • BINDS TO CNS OPIOID RECEPTORS AND INTERRUPTS WITH NOCICEPTIVE TRANSMISSION
  • INHIBITS THE REUPTAKE OF SEROTONIN AND NOREPINEPHRINE
  • DOSE TITRATION IS NEEDED
  • ABRUPT D/C IS NOT RECOMMENDED
31
Q

NEUROPATHIC PAIN
PERIPHERAL DAMAGE
(3)

A
  • DIABETIC NEUROPATHY
  • POST-HERPETIC NEUROPATHY
  • IMMUNOSUPPRESSANT THERAPY FOR
    CANCER TREATMENT
32
Q

NEUROPATHIC PAIN
CENTRAL DAMAGE
(5)

A
  • POST- STROKE
  • SPINAL OR OTHER CNS DAMAGE
  • TRAUMA
  • MALIGNANCY
  • MULTIPLE SCLEROSIS- CAN LEAD TO
    TRIGEMINAL NEURALGIA
33
Q

ANTIDEPRESSANTS
* INITIATION OF ANALGESIC EFFECTS IS —
DURATION THAN TIME NEEDED FOR ANTIDEPRESSANT
EFFECTS:
* — DOSES EFFECTIVE FOR ANALGESIC EFFECTS
THAN DOSES FOR ANTIDEPRESSANT EFFECTS

A

SHORTER
3-10 DAYS VS 2-4 WEEKS
LOWER

34
Q

TRICYCLIC ANTIDEPRESSANTS (TCA’S)
* MOA
(5)

A
  • INHIBITION OF NOCICEPTIVE PATHWAY
  • INHIBITION OF NOREPINEPHRINE AND SEROTONIN REUPTAKE
  • INCREASE THE SYNAPTIC CONCENTRATIONS OF 5HT3 & NE
  • POTENTIATE THE ANALGESIC EFFECTS OF OPIOIDS
  • SODIUM CHANNEL BLOCKING EFFECTS (LIKE LOCAL
    ANESTHETICS)
35
Q

TCAS ADVERSE DRUG REACTIONS
* ANTICHOLINERGIC EFFECTS
(4)

A
  • URINARY RETENTION
  • CONSTIPATION
  • DRY MOUTH (XEROSTOMIA)
  • ORTHOSTATIC HYPOTENSION
36
Q

OTHER COMMON ADVERSE DRUG REACTIONS
(ADRS)
(4)

A
  • ORTHOSTATIC HYPOTENSION
  • COGNITIVE DYSFUNCTION
  • SEDATION
  • WEIGHT GAIN
37
Q

TRICYCLIC ANTIDEPRESSANTS (TCAS)
(5)

A
  • DESIPRAMINE
  • NORTRIPTYLINE
  • AMITRIPTYLINE
  • DOXEPIN
  • IMIPRAMINE 45
38
Q

SELECTIVE SEROTONIN NOREPINEPHRINE
REUPTAKE INHIBITORS (SNRIS)
(5)

A
  • INHIBIT SEROTONIN AND NOREPINEPHRINE REUPTAKE
  • LOWER DOSES NEEDED FOR NP THAN DOSES IN DEPRESSION TREATMENT
  • DULOXETINE (CYMBALTA)
  • VENLAFAXINE (EFFEXOR)
  • DESVENLAFAXINE (PRESTIQ)
39
Q

SNRIS ADRS
(3)

A
  • XEROSTOMIA
  • NEW ONSET OR WORSENING OF BRUXISM,
    (MORE COMMON WITH SSRIS: PAROXETINE:
    ANTIDEPRESSANTS)
  • INCREASE IN BLOOD PRESSURE
40
Q

ANTICONVULSANTS
(4)

A
  • GABAPENTIN (NEURONTIN)
  • PREGABALIN (LYRICA)
  • CARBAMAZAPINE
  • OXCARBAZEPINE
41
Q

ANTICONVULSANTS ADRS
(7)

A
  • PERIPHERAL EDEMA
  • ATAXIA
  • DIZZINESS
  • SOMNOLENCE
  • FATIGUE
  • INCREASE APPETITE, WEIGHT GAIN
  • BLURRED VISION
42
Q

NTICONVULSANTS (ADVERSE EFFECTS)
(5)

A
  • RASH
  • N/V
  • XEROSTOMIA
  • SIADH
  • HYPONATREMIA
43
Q

MUSCLE RELAXANTS
(3)

A
  • MUSCLE RELAXANTS FREQUENTLY ARE USED AS ADJUNCTIVE
    MEDICATION IN THE TREATMENT OF ACUTE LOW BACK PAIN. THEIR
    USE IN CHRONIC PAIN IS MORE LIMITED
  • ALL MUSCLE RELAXANTS CAN CAUSE DIZZINESS AND SEDATION
  • DIFFERENT AGENTS HAVE DIFFERENT MECHANISM OF ACTION
44
Q

MUSCLE RELAXANTS
(9)

A
  • CYCLOBENZAPRINE
  • CARISOPRODOL
  • METAXALONE
  • METHOCARBAMOL
  • TIZANIDINE
  • CLONIDINE
  • BENZODIAZEPINES
  • DIAZEPAM
  • LORAZEPAM
45
Q

ACUPUNCTURE

A

Recommend 1-2
times/week for 6-8
weeks to decrease
jaw pain or
headaches

DMOP (15 decks)

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