Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHRM 845 > L 77-79 Rogers- Non-malignant pain > Flashcards

L 77-79 Rogers- Non-malignant pain Flashcards

(107 cards)

Start Studying
1
Q

what is the PQRSTU acronym for? list it after you answer that.

A

subjective questions to ask pt to assess pain.
- Palliative or Precipitating Factors
- Quality of pain
- Region of pain
- Severity of pain
- Time-related nature of pain
- U- impact on yoU

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

5 physio changes for assessment of pain slide

A

dilated pupils (mydriasis)
paleness
sweating
tachycardia
tachypnea

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

4 pain intensity scales, which one is special

A

verbal
numeric
visual
wong-baker (for kids*)

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

step 1 of WHO treatment approach *

A

non-opioid with or without adjuvant analgesic

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

step 2 of WHO treatment approach *

A

Opioid for mild-moderate pain, + non-opioid, with or without adjuvant analgesic

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

Step 3 of WHO treatment approach *

A

Opioid for moderate-severe, +non-opioid, with out without adjuvant analgesic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what meds/med classes are considered adjuvant therapies to opioids
(6)

A

gaba
snris
tca
skeletal muscle relaxants
antiepileptics
topical agents

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

Recommended dosing tylenol:
Adult: (regimen) (max dose)
Kids: (regimen) (max dose)

A

Adult: 325-1000mg po q4-6h, max dose 3-4 g/day
Kids: 10-15 mg/kg po q4h, max 75 mg/kg/day or 3-4 g/day

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

if a pt has liver disease, what is the max dose of tylenol?

A

2 or less g/day

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

1 side effect listed on tylenol slide

A

hepatotoxicity (most likely doses above 10g)

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

2 clinical pearls listed with tylenol *

A

injection is super expensive
gold standard for osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

4 side effects listed with NSAIDs

A

GI bleed
nephrotoxicity
fluid retention
increase CV events

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

4 clinical pearls listed with NSAIDs

A

take with food
caution in old farts
avoid in pts with cardiac history
avoid in liver and kidney disease

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

aspirin adult dosing with max dose

A

325-1000mg po q4-6h prn
max - 4g/day

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

aspirin pediatric dosing with max dose

A

sike, dont give it to kids dumbass (bc of reye’s)

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

2 clinical pearls on aspirin slide

A

avoid in pts taking blood thinners
some formulations available OTC (no shit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ibuprofen adult dosing with max

A

200-800mg po q6-8h prn
max- 3200 mg/day

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

Ibuprofen pediatric dosing with max (under 6 months)

A

5-10 mg/kg po q4-6h prn
max - 40mg/kg/day or 2400 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

2 interesting/different formulations of diclofenac that might catch you off guard

A

ophthalmic solution
patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

adult dosing of diclofenac

A

50 mg po q8h or 2-4 g applied topically 4 times/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 clinical pearls for diclofenac

A

minimal systemic side effects with gel (duh)
some available OTC (duh)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Naproxen adult dosing with max

A

220-500 mg po q6-12hr
max - 1,000mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

two weird formulations of ketorolac

A

nasal spray
ophthalmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ketorolac adult dosing

A

15-30 mg IV q6h or 10 mg po q6h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
ketorolac pediatric dosing
0.5mg/kg dose IM/IV q6h
26
2 clinical pearls for ketorolac (first one is underlined)
- maximum duration is 5 days ** bc increased risk of GI bleed - oral dosing is continuation of IM or IV
27
Celecoxib adult dosing
200 mg po bid
28
clinical pearl celecoxib
Cox 2 selective -> less GI toxicity
29
3 uses of gabapentinoids
fibromyalgia neuropathies post-op pain
30
gabapentin recommended dosing and max
100-300 mg po tid max - 3600 mg/day
31
pregabalin recommended dosing and max
75 mg po bid max - 600mg/day
32
3 side effects listed with gabapentinoids
sedation dizziness peripheral edema
33
4 clinical pearls for gabapentinoids
- renally dose adjusted - titrate up to limit sedation - use in combo to lower requirements of other analgesics - pregab is schedule V, gaba is not scheduled
34
2 SNRIs used in pain
venlafaxine and duloxetine
35
2 uses for SNRIs in pain
fibromyalgia neuropathy
36
venlafaxine rec dosing and max
37.5-75 mg po qd max - 225 mg/day
37
duloxetine rec dosing and max
30 mg po qd x 1 week, then up to 60 mg po qd daily max- 60 mg/day
38
5 side effects with SNRIs
nausea headache htn sedation weakness
39
2 clinical pearls with SNRIs
- start low dose and titrate up - renally dose adjust venlafaxine and avoid duloxetine w/ CrCl <30 * (might come up on exam tbh)
40
2 TCAs used in pain
amitriptyline and nortriptyline
41
3 uses of TCAs in pain (all off label btw)
fibromyalgia neuropathy migraine prophylaxis *
42
amitriptyline/nortriptyline rec dose and max
10 mg po qhs max- 150 mg/day
43
2 side effects on TCA slide
anticholinergic sedation
44
1 clinical pearl under TCAs for pain
last line option for neuropathy and fibromyalgia bc of bad side effects
45
5 muscle relaxants used in pain management
cyclobenzaprine baclofen methocarbamol carisoprodol tizanidine
46
1 use listed for muscle relaxants
musculoskeletal pain/ spasms
47
cyclobenzaprine rec dosing with max
5 mg po tid max - 30 mg/day
48
baclofen rec dosing with max
5 mg po tid max - 80mg/day
49
carisoprodol rec dose and max
250-350 mg po tid max- 1050 mg/day
50
methocarbamol rec dose and max
1.5 g po 3-4 times/day max- 8g/day
51
tizanidine rec dosing and max
2-4 mg po q8-12hr max - 24 mg/day
52
4 side effects listed under muscle relaxants
sedation/drowsiness dizziness dry mouth vision changes
53
2 clinical pearls for muscle relaxants
short term use (3 or less weeks) carisoprodol is schedule IV
54
1 antiepileptic used for pain management
carbamazepine
55
1 use of carbamazepine for pain
neuropathic pain
56
carbamazepine rec dosing and max
200-400 mg po qd in 2-4 divided doses (tf) max- 1200 mg/day
57
2 clinical pearls with carbamazepine
- increased risk of hypersensitivity reaction in patient with HLA-B*1502 - Autoinduction of hepatic enzymes
58
rec dosing of lidocaine patch
apply 1 patch daily and remove 12 hours later
59
2 side effects with lidocaine patch
hypotension arrhythmia (but minimal risk with patch)
60
3 clinical pearls with topical lidocaine
tachyphylaxis with continuous use 12 hour break between patches local effect- apply to site of pain (no fucking way bro fr?)
61
2 uses for capsaicin topical
muscle/joint pain neuropathic pain (how tf)
62
1 side effect listed on capsaicin slide
skin irritation/pain
63
3 clinical pearls with capsaicin
- dont get in eyes (ok) - wash hands after applying - some otc options
64
what are the primary pain management options you should aim to use in elderly?
tylenol topicals SNRis gabapentinoids
65
what are the two weak opioid agonist
codeine and tramadol
66
Medication becomes less effective over time and it takes a higher dose of the drug to achieve the same effect A. Tolerance B. Dependence C. Addiction
a
67
When a patient stops using a drug, their body goes through withdrawal A. Tolerance B. Dependence C. Addiction
b
68
Continued use of a drug despite negative consequences A. Tolerance B. Dependence C. Addiction
c
69
Overdose or Withdrawal? insomnia/agitation
withdrawal
70
Overdose or Withdrawal? pinpoint pupils
overdose
71
Overdose or Withdrawal? dilated pupils
withdrawal
72
Overdose or Withdrawal? tachycardia
withdrawal
73
Overdose or Withdrawal? bradycardia
overdose
74
Overdose or Withdrawal? pale/clammy skin
overdose
75
3 treatments for opioid withdrawal
clonidine -> helps w/ sxs such as htn, sweating, vomiting buprenorphine -> duh methadone -> interesting
76
3 clinical pearls for opioids
- consider starting a stool softener and/or stim lax - potential for tolerance, dependence and addiction - schedule II (except tramadol and codeine)
77
4 clinical pearls for tramadol
- risk of serotonin syndrome - renally dose adjusted - box warning for use of 3A4 and 2D6 shit - schedule IV
78
3 clincial pearls for morphine
- itching more prominent ** - morphine and its metabolites are renally excreted and accumulate in renal dysfxn - box warning for avoiding alcohol while taking ER formulation bc of possible fatal overdose
79
1 clinical pearl for hydromorphone
box warning about dosing errors when prescribing: oral solution -> do not confuse mg and mL IV solution -> do not confuse high potency solution (10mg/mL) with other solutions (lower strengths)
80
2 clinical pearls for hydrocodone/acetaminophen
counsel patient on tylenol use box warning for use with 3A4 inhibitors may increase plasma concentrations
81
3 clinical pearls oxycodone/acetaminophen
- counsel pts on tylenol use - ER capsule/tabs are abuse-deterrent - box warning for use with 3A4 inhibitors may increase plasma concentrations
82
4 box warnings fentanyl
- box warning to monitor pts receiving 3A4 interacting meds - CAN use in renal impairment - less hypotension than morphine or hydromorphone - non-injectable forms are ONLY indicated for pts who are opioid tolerant - (defined as taking morphine 60 mg/day for at least 1 week)
83
how often to apply fentanyl patch
every 3 days
84
where can you apply fentanyl patch?
chest back flank upper arm
85
can you cut the fentanyl patches
no
86
2 uses of methadone in pain management
last line tx of chronic pain opioid detox
87
3 clinical pearls of methadone
box warning for QTc prolongation box warning for 3A4 interactions long half-life (8-59 hours)
88
Meperidine (demerol) 5 clinical pearls
- avoid in elderly, renal impairment, caution in hepatic - box warning for 3A4 - box warning for not using within 14 days of MAOi *** - metabolized by liver into active metabolite (accumulation can cause delirium and seizures) - not commonly used bc of adverse effects
89
what are the 4 synthetic opioids that can be used that avoids allergic cross reaction
fentanyl methadone meperidine tramadol
90
opioid equivalents: fentanyl parenteral and oral
p: 0.1 o: ---
91
opioid equivalents hydrocodone parenteral and oral
p: --- o: 30
92
opioid equivalents hydromorphone parenteral and oral
p: 1.5 o: 7.5
93
opioid equivalents morphine parenteral and oral
p: 10 o: 30
94
opioid equivalents oxycodone parenteral and oral
p: --- o: 20
95
do we need to know the naive dosing?
hopefully theres two options and we just think to hit the lower one
96
T or F: One of the CDC Recs for prescribing opioids is to prefer ER formulations over IR ones
false, they want to prescribe IR
97
what are the 4 exceptions to the 7 day prescribing limit opioid law?
cancer medication assisted tx for a substance-abuse disorder palliative care professional judgement with documentation supporting it
98
Michigan law thing with opioid prescribing after procedures: how many oxycodone 5 mg tablets for each of the following? Dental extraction: Thyroidectomy: Caesarean Section: Total Hip Arthoplasty:
0 0-5 0-20 0-30
99
In the tx of acute pain, you can only have one med order for each severity of pain**, what is the regimen for each severity? mild: moderate: severe:
mild: tramadol 25 mg po q6h moderate: oxycodone 5 mg po q4h severe: fentanyl 25 mcg IV q1h
100
first line for lower back pain
tylenol or NSAIDs
101
2nd line for lower back pain
SNRis and TCAs
102
first line for osteoarthritis pain
tylenol, NSAIDs
103
second line for osteoarthritis
intra-articular hyaluronic acid capsaicin
104
2 FDA approved meds for fibromyalgia **
pregabalin and duloxetine
105
first line for neuropathic pain
snris and gabapentinoids
106
second line for neuropathic pain
topical lidocaine and TCAs
107

PHRM 845 (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions