Day 5- Pain Management Flashcards
What is allodynia?
What is hyperalgesia?
What is analgesia?
Pain in response to a stimulus that does not normally cause pain.
Increased response to something that is painful but not that bad.
Inability to feel pain while still conscious.
What are the 2 types of nocioceptive pain?
What are the 2 types of non-nocioceptive pain?
How do you define acute pain?
Somatic–> Musculoskeletal pain, skin, muscle, etc. Treated with APAP, opioids, NSAIDS. Visceral–> internal organs, treated with Opioids.
Neuropathic–> nerve degeneration(shooting, burning, tingling). Sympathetic–> nervous system over activity after fractures and injuries. Extreme hypersensitivity around skin.
1-2 weeks in duration and you can identify what caused that pain.
How do you define chronic pain?
What are some non pharmacologic treatments for pain?
What things to know about acetaminophen?
Last beyond usual time frame for acute injury(1.5-3 months or more). Severeity does not coorelate with noxious stimuli, can occur without timely relationship. Patients may not appear to be suffering, signs and symptoms normally not present, comorbid conditions are often present.
Physical manipulation, hot cold compress, massage, biofeedback, cognitive behavioral therapy, relaxation techniques, acupuncture, exercise.
1st line, watch for hepatotoxicity, watch for combination products, Max dose is 3000/24 hours in OTC setting, 4000/24 hours with health care professional supervision.
What is useful in cancer related bone pain?
What are the NSAID side effects?
What are the A/E’s of the opioids?
NSAID’s, most commonly used for this.
Gastric irritation(use Celecoxib to minimize), Nephrotoxicy, BBW for MI/stroke, hypertension, impair platelet aggregation.
Mood changes, miosis, sedation, respiratory depression, dependance, seizures, constipation, nausea, vomiting, itching. Patients can develop tolerance to side effects over time but never observe tolerance to constipation/miosis.
Are opioid side effects dose related?
What are the counseling points for the fentanyl patch?
What are some other counseling points for the fentanyl patch?
YES.
Apply to nonirritated skin, do not shave skin, clean site with clear water and allow to dry completely prior to applicaiton, do not use damaged cut or leaking patches, firmly press in place and hold for 30 seconds, change patch every 72 hours, do not use soap, alcohol, or other solvents to remove transdermal gel if it accidentally touches skin and use copious amounts of water.
No external heating with patch, the edges of the system may be taped in place, disposal(remove patch from pouch and liner, fold adhesive ends together and flush patch down toilet).
What do we need to know about methadone?
What is patient controlled analgesia?
When do you do spinal administration through spinal catheter?
It’s cheap, long duration of action, many mechanisms of action for pain relief, utilized for pain and addiction management, safe in renal impairment! Complicated dose conversion, FDA warning for respiratory depression and cardiac arrhythmia, dose adjust with hepatic impairment, social stigma associated with it.
Continuous function(+/- baseline), bolus function/demand dose(lock out period(5-10 minutes)) after each demand dose. Better pain control/less side effects when compared to conventional PRN dosing. Patient has to be willing/able to press, support staff, supportive family, patient must have moderate-severe pain(acute pain expected to last >12 hours like post op, also used in home care with metastatic cancer pain).
Epidural, intraethical. Acute, chronic non cancer pain, cancer pain. Higher potency–> much lower dose required, must be preservative free.
What is a true allergy to an opioid?
How do you manage histamine release in opioids?
How do you manage true allergies in opioids?
Severe hypotension, Edema, Swelling of the Airway, tachycardia, rash, anaphylaxis.
anti histamines, 5-HT3 antagonists, cold compress, slow administration, avoid opioids associated with it.
avoid opioid agents, utilize and opioid in a different class, decreased cross sensitivity and monitor closely.
Which ones have high histamine release?
How do you manage N/V in opioids?
How do you manage CNS stimulation?
Codeine, Morphine, Merperidine. Fentanyl has low.
Metoclopramide PRN, Ondansetron PRN.
Titrate down, switch agent, adequately hydrate.
How do you manage constipation in opioids?
What is Alvimopan?
What to know about Methylnaltrexone?
Physical activity and adequate hydration, bowel regimen(you can’t push mush), Need stool softener and a stimulant(docusate, senna) may require bisacodyl. Avoid bulk forming agents due to aspiration risk.
U-receptor antagonists, post op to decrease time to discharge. Must be dosed before surgery.
used for OIC, does not cross BBB, black opioid bowel lining. CI’d in known or suspected GI obstruction.
How do you treat sedation in opioids?
How do you manage respiratory depression?
What is the WHO pain relief ladder tiers?
monitor sedation/respiratory rate, avoid concurrent sedative medicines, reduce dose/withhold medicine/change opioid, opioid antagonists may be utilized for over sedation, methylphenidates used in pallative setting to improve quality of life.
Reverse with naltrexone, avoid combination with other CNS depressants.
1- APAP, Tramadol, ASA, NSAID’s. 2- Hydrocodone/APAP, Oxycodone/APAP, Codeine. 3- everything else.
Do long acting opioids require REMS programs?
Which opioids do we avoid in renal and hepatic dysfunction?
What is the 5-step process for analgesic dosing?
TRUE. Not ALL require them though.
Codeine, Meperidine. We don’t use Methadone either in hepatic dysfunction.
assess, determine total daily usage of current opioid, decide which analgesic will be used moving forward, individualize, follow and reassess.
What is the parenteral and oral dosing for morphine?
What is the parenteral and oral dosing for hydromorphone?
What is the parenteral and oral dosing for oxymorphone?
10, 30.
1.5,7.5.
1, 10.
What is the parenteral dosing for fentanyl?
What is the oral dosing for codeine?
What is the oral dosing for oxycodone? Hydrocodone?
0.1.
200
- 30.
How often do you dose adjust?
How do you adjust dose that is mild-moderate?
How do you adjust dose that is severe-uncontrolled?
Every 2-3 days. For breakthrough it’s every day.
25-50% increase.
50-100% increase.
How do you do intolerable adverse effect?
How do you dose decrease with a different opioid?
How do you calculate breakthrough dose?
Hold/decrease dose or give Naloxone.
25%.
5-15% of new dose.
