lecture 76 Flashcards
rogers - pain 1
what is role of pharmacists as associated with pain?
assessment
recommended OTC meds
refer to PBRs
recommend initial RX analgesics to providers
educate pt on therapy
evaluate safe and effective use (abuse/SE/etc)
adjust med therapy based on response
what is the PQRSTU mnemonic?
used to subjectively assess a pt’s pain
palliative or precipitating factors
quality of pain
region of pain location
severity (pain assessment instruments)
time-related nature of pain
impact of pain on U
how is pain objectively assessed?
behavioral changes
physiological changes –> dilated pupils (mydriasis), paleness (pallor), sweating (diaphoresis), tachycardia, tachypnea
what are the different pain intensity scales?
verbal
numeric
visual
wong-baker (faces for kids)
what are the goals of therapy for treating pain?
correct (underlying)
minimize pain and symptoms
improve QOL and ADLs
limit SE
what are some important pt factors to consider when selecting an analgesic?
hepatic/renal func
PMH
previous analgesic therapy
routes for med admin
type of pain (neuropathic v nociceptive)
severity of pain
what are some important medication factors when selecting an analgesic?
allergies
cost
drug-drug interactions
duration of action/dosing frequency
potency
route of admin
SE
what are the non-pharmacologic therapies of pain?
correct underlying cause (surgery/avoidance)
exercise
acupuncture
physical manipulation
heat or ice
massage
what is the WHO analgesic ladder approach?
step 1 –> non-opioid +/- adj analgesic
step 2 –> same but add opioid for mild-moderate pain
step 3 –> same but add opioid for moderate-severe pain
what non-opioids can be used in step 1?
acetaminophen and NSAIDs
what are adjunctive therapies of step 1?
gabapentinoids
SNRIs
TCAs
skeletal muscle relaxants
anti epileptics
topical agents
what is the dosing of tylenol?
adults: 325 mg – 1000 mg PO Q4-6H PRN (max of 3-4 g/day)
pediatrics: 10-15 mg/kg PO Q4H PRN (max of 75 mg/kg/day)
what is the common SE of tylenol?
hepatotoxicity –> acute liver failure most likely with dose over 10 g; if pt has liver disease, decrease max for adults to under 2 g/day
what are the clinical pearls of tylenol?
gold standard for OA due to fewer SE in geriatric pts compared to NSAIDs
educate pts on max daily dose (including combo products)
injection is expensive thus often restricted use
what type of formulation is tylenol available in?
tablet (regular/XR), capsule, chewable tablet
liquid/gel
IV solution
suppository
what are the SE of NSAIDs?
GI bleeding (BBW), increase CV events (BBW)
nephrotoxicity
fluid retention
what are the CP of NSAIDs?
take WF
caution use in geriatric pts due to SE (Beer’s List)
avoid systemic NSAIDs in pts with cardiac hx (use topical insteaD)
avoid in severe liver disease or CKD
what are the available formulations of aspirin?
chewable tab, tab, EC tab, capsule, ER capsule
suppository
what is the recommended dosing of aspirin?
adults: 325 - 1000 mg PO q4-6H PRN (max of 4 g/day)
pediatrics: avoid due to reye’s
what are the aspirin specific CPs?
avoid using for pain in pts taking blood thinners or antiplatelets
some formulations available OTC
what is reye’s syndrome?
rare but serious condition that causes swelling in the brain and liver
associated with children/teens using aspirin when thye have viral infections such as flu or chickenpox (w/ or w/o fever)
what are the available formulations of ibuprofen?
capsule, tab, chewable tab
suspension
IV solution
what is the recommended dosing of ibuprofen?
adults: 200 - 800 mg PO Q6-8H PRN (max of 3200 mg/day)
pediatrics: 5 - 10 mg/kg PO Q4-6H PRN (max of 40 mg/kg/day or 2400 mg, whichever is less)
what are the available formulations of diclofenac?
capsule, tab
IV solution
suppository
topical gel, topical solution
opthalamic solution
patch
