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DMOP > CHRONIC PAIN MANAGEMENT 24 > Flashcards

CHRONIC PAIN MANAGEMENT 24 Flashcards

1
Q

ACUTE PAIN TRANSFORMATION
*ACUTE PAIN CAN BECOME CHRONIC IF IT LASTS
MORE THAN

A

6 MONTHS OR THE TIME IT WOULD
TAKE CONNECTIVE TISSUE TO HEAL

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2
Q

TEMPOROMANDIBULAR DISORDERS
* MANY ARE …
* CHRONIC TMD PAIN SYNDROMES LAST MORE THAN – MONTHS
* — SYMPTOMS AND CHRONIC MUSCULOSKELETAL PAIN HAVE
A DIRECT CORRELATION
* — INCREASES THE PATIENT’S SELF REPORTING OF PAIN
ESPECIALLY SKELETAL MUSCLE PAIN

A

MILD AND SELF-LIMITING
6
DEPRESSIVE
ANXIETY

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3
Q

MULTI-MODALITY APPROACH IS BEST FOR
MANAGEMENT OF TEMPOROMANDIBULAR
DISORDERS
(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

TEAM APPROACH FOR
CHRONIC PAIN HAS BEST
TREATMENT OUTCOME
* INVOLVE MULTI-SPECIALTIES SUCH
AS:
(5)

A
  • OROFACIAL PAIN
  • PHYSICAL THERAPY
  • PAIN PSYCHOLOGIST
  • RHEUMATOLOGIST
  • NEUROLOGIST
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6
Q

CAUSE HEAD & FACIAL PAIN:

A
  • MIGRAINE HEADACHE
    · TENSION HEADACHE
  • TRIGEMINAL AUTONOMIC CEPHALGIAS (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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7
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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8
Q

PAIN
Mild/Moderate
(4)

A

NSAIDs, muscle
relaxants

Mixed analgesics,
Class III narcotics

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9
Q

PAIN
Severe
(4)

A

Steroids, muscle relaxants

Sleep medications, antidepressants,
neuropathic pain medications

Mixed analgesics,
Class II narcotics

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10
Q

ACETAMINOPHEN
* Other name
* Other name
* NO — EFFECTS
* MINIMAL INCREASED RISK OF —
* OVERDOSE: —
* MAX DAILY DOSE: — MG PER DAY IN DIVIDED DOSES EXCEPT
* CHRONIC PAIN — MG PER DAY IN DIVIDED DOSES

A

PARACETAMOL (GENERIC IN SOME FOREIGN COUNTRIES)
APAP (ACETYL-PARA-AMINOPHENOL)
ANTI-INFLAMMATORY
BLEEDING
HEPATOTOXICITY
4000
3000

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11
Q

ACETAMINOPHEN DOSAGE FORMS
* CAPLET, TABLET
(3)
* ELIXIR
(2)
* INJECTABLE (IV)
(1)
* SUPPOSITORY
(3)

A

325MG, 500MG, 650MG EXTENDED RELEASE (LASTS 8 HRS.)

  • 160MG/5ML
  • 500MG/5ML
  • 10MG/ML
  • 120MG, 325MG, 650MG
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12
Q

COMBINATION WITH OPIOIDS
* HYDROCODONE-ACETAMINOPHEN
(3)

A
  • NORCO 5MG, 7.5MG, 10MG/325MG
  • VICODIN 5MG, 7.5MG, 10MG/300MG
  • WATCH FOR CONCURRENT MEDICATIONS
    CONTAINING ACETAMINOPHEN
    ESPECIALLY OTC PRODUCTS SUCH AS
    SLEEP AIDS
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13
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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14
Q

COMBINATION WITH CODEINE
* 300mg/— Tylenol with codeine
No.2
* 300mg/— Tylenol with codeine
No.3
* 300mg/— Tylenol with codeine
No.4

A

15mg
30mg
60mg

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15
Q

COMBINATION
WITH
TRAMADOL

A
  • ULTRACET
  • ACETAMINOPHEN/
    TRAMADOL
  • 320MG/37.5MG
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16
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
17
Q

OTC PRODUCTS
CONTAINING
ACETAMINOPHEN
(2)

A

Excedrin Extra
strength, Excedrin
Migraine
Acetaminophen/
Aspirin/ Caffeine
* 250mg/ 250mg/
65mg

Comtrex
Acetaminophen/
Dextromethorphan/
Phenylephrine
* 325mg/ 10mg/
5mg

18
Q

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS)

A

*ASPIRIN
*IBUPROFEN
*NAPROXEN
*PIROXICAM
*MELOXICAM
* INDOMETHACIN
* DICLOFENAC
* KETOROLAC
* CELECOXIB
* ETODOLAC
* NABUMETONE

19
Q

NSAIDS
Effects (3)

A
  1. ANTI-INFLAMMATORY EFFECTS
  2. ANALGESIC EFFECTS
  3. ANTIPYRETIC EFFECTS
20
Q

NSAIDS
At low dose
(2)
At higher doses
(1)

A
  • Antipyretic effects
  • Analgesic effects
  • More anti-inflammatory effects
    besides mentioned effects
21
Q

NSAIDS
* IBUPROFEN (MOTRIN®, ADVIL®)
* OTC —MG
* RX (3)
* MAX DOSE: — MG PER DAY IN DIVIDED DOSES
* TOXICITY: —
* TO REACH ANTI-INFLAMMATORY EFFECTS MUST USE —DAY IN DIVIDED DOSES

A

200
400MG, 600MG, 800MG
3200
GI ULCER
1800MG3200MG/

22
Q

COMBINATION
WITH OPIOIDS
27
Oxycodone/ Ibuprofen
mg
max
Hydrocodone/ Ibuprofen
mg
max

A
  • 5mg/ 400mg
  • Maximum of 4 tablets/day in
    divided doses
  • 2.5mg, 5mg, 7.5mg, 10mg/ 200mg
  • Maximum of 5 tablets /day in
    divided doses
23
Q

SELECT A LONG LASTING NSAID
* NAPROXEN (ALEVE® 220MG OTC)
* MAX DAILY DOSE: — MG PER DAY IN DIVIDED
DOSES
* TOXICITY:
* COMBINATION WITH — TO
MINIMIZE THE GI DAMAGE (BRAND NAME VIMOVO®)

A

1500
GI ULCER
PPI ESOMEPRAZOLE

24
Q
  • CELECOXIB (CELEBREX®)
  • SELECTIVE …
  • — OR — MG TWICE DAILY
  • AVOID IF PATIENT HAS — ALLERGY
A

COX 2 INHIBITOR
100MG 200
SULFA

25
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
(3)

A

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

 NSAID WITH MUSCLE RELAXANTS
 1% FLEXERIL WITH10% KETOPROFEN/10% IBUPROFEN
 1% DICLOFENAC SODIUM GEL(VOLTAREN) RX OR OTC

26
Q

ACETAMINOPHEN,
NSAIDS
These analgesics have ceiling effect
(4)
No — happen with
these analgesics
Take NSAIDs with — to lower GI ADRs

A
  • Has a limit in relieving the pain
  • Above the limit
  • No more analgesic effect
  • More toxicity

tolerance or dependence

food

27
Q
A

DMOP (15 decks)

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