FINAL-Acute Pain

Question 1

Treatment for Acute Pain

Answer 1

Treat the underlying cause

Question 2

Mild Acute Pain Info

Answer 2

Pain score 1-3

APAP and/or NSAIDs
Titrate to max dose

Question 3

Moderate Acute Pain Info

Answer 3

Pain score 4-6

Opioid/APAP or NSAIDs

May use schedules NSAID + PRN Opioid

Question 4

Severe acute pain Info

Answer 4

Pain Score 7-10

Opioids

Pt specific factors for Route of admin

Avoid excessive sedation

Question 5

Goal of Therapy

Answer 5

Take meds for shortest amount of time
Lowest effective dose
that gives effective pain relief and minimal SE

Question 6

Non pharm Treatment

Answer 6

RICE
Rest
Ice
Compression
Elevation

Question 7

IV Acetaminophen

Answer 7

OFIRMEV 2yr+

• Mild/mod
• Mod/sever + Opioid

Question 8

Ofirmev Dosing and IV infusion time

Answer 8

Adult: 650mg q4 or 1000mg q6

Peds: 12.5mg/kg q4 or 15mg/kg q 6

INFUSED OVER 15 MINS

Question 9

BBW of Acetaminophen

Answer 9

Med errors and Hepatotoxicity

Question 10

Pain Level 4-6…

Answer 10

Lots of options

Plain NSAID, muscle relaxant, maybe topical, hydrocodone + tylenol

Question 11

IV Ibuprofen

Answer 11

CALDOLOR +6M

• Mild/Mod
• Mod/Severe w/Opioid

Question 12

IV CALDOLOR Dosing Adults

Answer 12

Ibuprofen

PAIN: 400-800mg IV over 30 min q 6h PRN

FEVER: 400mg IV 30 min, 400mg q 4-6 hours or 100-200mg q4h PRN

Question 13

IV CALDOLOR Peds Dosing

Answer 13

12-17: 400mg over 10 mins q4-6hr PRN

6months-12: 10mg/kg IV over 10 min up to max dose of 400mg q4-6 hrs

Question 14

Morphine

Answer 14

IR Formulas
MS Contin, Kadian, AVINza

Histamine release may cause pruritus and exacerbate bronchospasm

Question 15

Morphines metabolites

Answer 15

M6G: Analgesic
M3G: SE

Question 16

Morphine dose reduction?

Answer 16

Dose reduction if there is renal insufficiency because its renally excreted

Question 17

Abuse deterrent ER formulas of Morphine

Answer 17

Embeda (morphine/naloxone)
Arymo ER
MorphaBond ER

Question 18

Hydrocodone

Answer 18

Mod/Severe tx
PO Combo w/acetaminophen: Norco, Anexsia, Vicodin, Lortab, Lorcet

ER (alone): Hysingla ER
Zohydro ER

ER used in chronic pain

Question 19

Hydrocodone eliminated how

Answer 19

Hepatically, risk of hep tox

Question 20

Oxycodone

Answer 20

mod/severe

IR PO: Oxy IR, Roxicodone

Question 21

Oxycodone with Acetaminophen

Answer 21

Percocet, Endocet, Roxicet

Roxicet comes in a solution too

Question 22

Oxycodone Abuse Deterrent formula

Answer 22

CR PO-Oxycontin
CR PO-XTAMPZA
IR PO-OXAYDO

Question 23

Drug metabolized in the liver by CYP2D6 to morphine…

Answer 23

Codeine

Question 24

Hydromorphone

Answer 24

Dilaudid, Exalgo ER (1x day dosing)

7-11x more potent than morphine

NO DDI

Question 25

Oxymorphone

Answer 25

Opana, Opana ER 3x more potent than PO morphine NO DDI Renally excreted-watch IR dosing has long half life so dose q6h

Question 26

Fentanyl

Answer 26

Sublimaze IV-short onset and half life 100x more potent than morphine Transdermal patch for chronic pain-used for pts who are opioid-tolerant

Question 27

Fentanyl facts

Answer 27

- High lipid solubility resulting i n rapid transfer across BBB - conc peak of IV is 4-6 mins - Good for rapid pain control but may accumulate in adipose tissue with multiple doses SO-->NOT GOOD FOR OBESE PATIENTS

Question 28

Meperidine

Answer 28

Demerol IM or IV NO PO Less potent than morphine Shorter duration * CNS TOXICITY* - Avoid renal dysfunction a nd elderly

Question 29

Petnazocine

Answer 29

W/APAP-TALACEN W/Naloxone-TALWIN NX IV TALWIN May precipitate withdrawal in opioid dependent patients

Question 30

Nalbuphine

Answer 30

Nubain | May precipitate withdrawal in opioid dependent patients

Question 31

Butorphanol

Answer 31

Mu Antagonist Kappa Partial Agonist Mainly used for migraines must attach pump atomizer and fully prime

Question 32

What do you need for a PCA?

Answer 32

- Initial Bolus Dose - Dose/Demand dose for when button is pushed - Lockout Interval minimum between doses - Continuous basal rate (mg/hr) reserved for mechanically ventilated or opioiod tolerant patients - Max tolerated dose in 1 hr -Pt must have Naloxone PRN

Question 33

Two most common modes of PCA administration

Answer 33

Demand dosing-fixed size dose is self administered intermittently Continuous infusion plus demand dose (constatn rate with supplement by patient demand)-->NEVER USED FOR OPIOID NAIVE PATIENTS

Question 34

PCA Things to note...

Answer 34

Caution in respiratory depression pts-Obese, Elderly 75, snoring. sleep apnea, COPD, renal insufficiency, hepatic dx Monitor: BP, RR, O2 sat, RASS, pain 7 days post op