Exam 2 - Pain

Question 1

Acute Pain lasts how long? What are common causes?

Answer 1

Lasts hours to weeks. Surgery, trauma, medical procedures

Question 2

General tx for Acute Pain?

Answer 2

Treat underlying causes, analgesics

Question 3

Chronic Pain lasts how long? What are common causes?

Answer 3

Lasts months to years. Cancer or non-cancer causes.

Question 4

Chronic Pain general treatment criteria?

Answer 4

Multimodal treatment (non-pharm, non-opioid-pharmacologic, opioids)

Question 5

Mild to Moderate pain best treated by which pharm agents?

Answer 5

Non-opoid analgesics: APAP, ASA, NSAIDs

MOA: PG inhibition

Question 6

Moderate to Severe pain treated with which pharm options?

Answer 6

Opioids +- non-opioids +- adjuvant analgesics

Question 7

MOA of NSAIDSs?

Answer 7

Inhibit prostaglandin synthesis via COX enzymes in peripheral tissue. Reversibly inhibit platelet function.

Question 8

Somatic Pain location and quality?

Answer 8

Localized. Acute/pressure/sharp.

Question 9

Somatic Pain fibers and examples?

Answer 9

C-fibers.

Superficial lacerations, burns.

Question 10

Somatic Pain tx?

Answer 10

APAP, NSAIDs, Opioids. Superficial heat/cold.

Question 11

Visceral Pain location and quality?

Answer 11

Generalized. Sharp/stabbing.

Question 12

Visceral Pain fibers and example?

Answer 12

A-Fibers. Appendicitis.

Question 13

Visceral Pain tx?

Answer 13

Steroids, NSAIDs, opioids, instraspinal LA.

Question 14

Neuropathic Pain location and quality?

Answer 14

Radiating or specific.

Burning, shock-like, electric-like

Question 15

Neuropathic Pain mechanism and examples?

Answer 15

Dermatomal or Central mechanism.

Diabetic neuropathy, post-herpetic neuralgia.

Question 16

Neuropathic Pain tx?

Answer 16

Anticonvulsants, antidepressants, neuroblockade

Question 17

MOA of Opioid Analgesics?

Answer 17

Activate descending inhibitory pathway which modulates transmission in spinal cord; alters limbic system activity

Question 18

PO vs Parenteral ratio (in general)

Answer 18

3 : 1

Question 19

PO vs Rectal ratio (in general)

Answer 19

1 : 1

Question 20

Max APAP dose/day?

Answer 20

4g

Question 21

Ketorlac is which class of pain drug and what route?

Answer 21

IV NSAID

Question 22

Can you give Ketorlac for more than 5 days? Why?

Answer 22

NO, dt bleeding and renal impairment

Question 23

Celebrex should not be given to a patient with which allergy?

Answer 23

Sulfa allergy

Question 24

If giving NSAID at high dose for chronic pain what should also give?

Answer 24

PPI

Question 25

Guideline for starting and titrating Opioids?

Answer 25

Start with lowest possible dose. Titrate up or down as percent of total daily dose.

Question 26

Goal for Opioids?

Answer 26

Minimal analgesia with minimal ADRs

Question 27

What is bowel regimine for opioid induced constipation?

Answer 27

Softener + Stimulant

Question 28

Tx for Opioid-induced pruritis not due to allergy?

Answer 28

Mixed agonist/antagonist

Question 29

Tx for Opioid-induced delerium/hallucinations?

Answer 29

Lower dose, change opioids, Haldol

Question 30

Tx for Opioid-induced myoclonic jerking?

Answer 30

Lower dose, change opioid, muscle relaxant

Question 31

Tx for Opioid-induced respiratory depression?

Answer 31

Hold opioids, supportive care, Narcan

Question 32

Indications for Corticosteroids? (Hint: 3, not all pain-related)

Answer 32

- Acute spinal cord/nerve compression - Alleviate N/V - Bone pain

Question 33

Corticosteroid ADRs?

Answer 33

GI upset, hyperglycemia, weight gain, increased appetite, immunosppression, behavior changes

Question 34

Local Anesthetics indication?

Answer 34

Neural blockade to reduce surgery-indiced immune response

Question 35

What is Multimodal Analgesia?

Answer 35

2 or more analgesics with different MOAs

Question 36

3 examples of Multimodal Analgesia?

Answer 36

1. Opioid + APAP 2. Opioid + NSAID 3. Opioid + alpha-2-agonist

Question 37

Antidepressants and pain? Which to give? MOA?

Answer 37

For chronic pain. TCA and SNRIs work (SSRIs don't). | MOA=increase descending pathway modulation

Question 38

Anticonvulsants and pain tx?

Answer 38

Decrease neuroanal hyperexcitability

Question 39

In Chronic Pain what should be tried before opioids?

Answer 39

Non-pharm and non-opioid treatment

Question 40

Before starting opioids for chronic pain what need to establish?

Answer 40

Realistic goals for pain and function, and how to d/c if benefits not outweight risk

Question 41

When to continue opioids for chronic pain?

Answer 41

If clinically meaningful improvement in pain and function outweights safety risk

Question 42

When starting opioids can give long-acting/extended-release?

Answer 42

No! Start with immediate-release!

Question 43

Urine and chronic pain?

Answer 43

Check before starting and annually

Question 44

Can give BZD and opioids together?

Answer 44

Try not to if possible