{ "@context": "https://schema.org", "@type": "Organization", "name": "Brainscape", "url": "https://www.brainscape.com/", "logo": "https://www.brainscape.com/pks/images/cms/public-views/shared/Brainscape-logo-c4e172b280b4616f7fda.svg", "sameAs": [ "https://www.facebook.com/Brainscape", "https://x.com/brainscape", "https://www.linkedin.com/company/brainscape", "https://www.instagram.com/brainscape/", "https://www.tiktok.com/@brainscapeu", "https://www.pinterest.com/brainscape/", "https://www.youtube.com/@BrainscapeNY" ], "contactPoint": { "@type": "ContactPoint", "telephone": "(929) 334-4005", "contactType": "customer service", "availableLanguage": ["English"] }, "founder": { "@type": "Person", "name": "Andrew Cohen" }, "description": "Brainscape’s spaced repetition system is proven to DOUBLE learning results! Find, make, and study flashcards online or in our mobile app. Serious learners only.", "address": { "@type": "PostalAddress", "streetAddress": "159 W 25th St, Ste 517", "addressLocality": "New York", "addressRegion": "NY", "postalCode": "10001", "addressCountry": "USA" } }

FINAL-Chronic Pain Flashcards

(44 cards)

1
Q

Chronic Pain definition…

A

Persistent pain recurring for greater than 3 months or 1 month after resolution of an acute tissue injury or non-healing lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute vs Chronic Pain tx goals…

A

Acute-CESSATION of pain

Chronic-Decrease pain and increase QOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cycle of Pain

A

Pain-Avoidance Behavior-Decreased Mobility-Altered functional status-Diminished self-efficacy-Social Limitations-Pain Augmented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Meds to use for Neuropathic Pain

A
Gabapentin (Neurontin)
G. enacarbil (Horizant)
Pregabalin (Lyrica)
Gralise
Carbamazepine (Tegretol)
Topiramate
Lamotrigine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Use for Horizant

A

Gabapentin Enacarbil

  • PHN
  • RLS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Use for Pregabalin

A

Lyrica

  • Good for SEDATION
  • Peripheral Edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Use for Gralise

A

PHN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DOC for Carbamazepine

A

Trigeminal Neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Carbamazepine Brand

A

Tegretol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Membrane Stabilizing Anticonvulsants

A

Topiramate

Lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antidepressants preferred for pain

A
TCAs
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Desipramine (Norpramin)
Imipramine (Tofranil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Amitriptyline

A

Elavil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nortriptiyline

A

Pamelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Desipramine

A

Norpramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Imipramine

A

Tofranil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Side Effects of TCAs

A
Dry mouth
Somnolence
Sedation
Constipation
Cardiac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SNRIs important to chronic pain tx…

A

Duloxetine (Cymbalta)
Venlafaxine(Effexor)
Milnacipran (Savella)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Duloxetine indication for

A

CYMBALTA

FDA INDICATED FOR

  • Fibromyalgia
  • Low Back Pain
  • Diabetic Neuropathy
19
Q

Milnacipran Indication

A

SAVELLA

FDA approved for FIBROMYALGIA

20
Q

SSRIs are not proven effective for pain tx, but are used in pts with

21
Q

Benzos

A

Shown in one study to provide some efficacy for neuralgic pain

22
Q

NMDA Receptor Agonists

A

Dextromethorphan
Memantine
Methadone
Amantidine

23
Q

NMDA receptor agonists should be used….

A

Neuropathic pain

PHN, Diabetic neuropathy, Phantom limb pain, Peripheral nerve injury, CRPS etc

24
Q

NSAIDs should be used for….

A

Patients with back pain

25
Skeletal Muscle Relaxants are recommended for...
Short term use for acute low back pain, but you will see them used for muliple chronic pain conditions
26
Skeletal muscle relaxants used for Spasticity (MS, Cerebral palsy, Post stroke syndrome, TBI, Spinal cord injury)
Tizanidine | Baclofen
27
Skeletal Muscle Relaxants
``` Carisoprodol Cyclobenzaprine Methocarbamol Metaxolone Baclofen Orphenadrine Tizanidine(Alpha 2 agonist) Dantrolene ```
28
CI for chronic opioid therapy
Decompensated psychiatric illness, psychotic dx, or mania History of drug or alcohol abuse
29
Weak to Mod Opioids
Codeine and Tramadol
30
Morphine
``` MS Contin, Kadian Gold Standard ER not for naive RENAL ADJUST CNS depression, Resp depression, Hypotension ``` Abuse deterrent ER formulas: Embeda(+naloxone) Arymo ER MorphaBond ER
31
Hydrocodone
``` Pro-drug converted to hydropmorphone Hepatic caution Usually in combo with acetaminophen ER TOO E XPENSIVE CNS Depression, hepatotoxicity(acet.) ```
32
ER Hydrocodone
Zohydro ER | Hysingla ER
33
Oxycodone
NO IV** renal/hepatic CNS depression, resp despression, hypotension
34
Oxymorphone
Opana | PO ONLY IR & ER
35
Buprenorphine
Transdermal-BUTRANS Indicated for the management of pain sever enough to require daily, around-the clock, long term opioid treatment and for which alternative treatment options are inadequate Q WEEKLY Combo with Naloxone for treatment of opioid dependence
36
Transdermal Fentanyl Info and CI
NOT FOR NAIVE Hep/Renal CI: respiratory disease DDI with Erythromycin and Clarithromycin
37
Opioid Tolerant Patients
Taking daily for a week or longer 60mg of oral morphine, 30mg oxycodone, or at least 8mg of oral hydromorphone or and equianalgesic dose of another opioid
38
Methadone
Considered ideal candidate for chronic pain -highly inexpensive -High efficay -Extended duration of action Lot of BBW *QT PROLONGATION*-->ECG at baseline AND 30 DAYS AFTER STARTING** PK non-linear to morphine SE & NE
39
Fentanyl Transmucosal
``` Actiq (lozenge) Fentora (buccal tab) Onsolis (buccal film) Abstral (SL tablet) Subsys (SL spray) Lazanda (nasal spray) ``` FOR CHRONIC INTRACTABLE PAIN
40
Breakthrough dose should be
5-15% of toatl daily dose | dose q2-6 hours
41
Ketamine
NMDA usually used for sedation USed for Maladaptive pain syndromes (CRPS) adjunct in acute pain, chronic unclear
42
Diabetic Neuropathy FDA approved tx
Duloxetine (CYMBALTA) Pregabalin (LYRICA) There are others but these are FDA indicated
43
Post Herpetic Neuralgia
Lidocaine patch FDA indicated: G. Enacarbil (HORIZANT) Gralise Oioids, there are a lot of other options
44
Trigeminal Neuralgia Tx
CARBAMAZEPINE (tegretol)