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PHAR 557 > Pain 3 > Flashcards

Pain 3 Flashcards

1
Q

T or F: Pain is an objective phenomenon that requires careful measurement and tx.

A

F

Pain is completely subjective and is whatever the pt says it is

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2
Q

List all therapeutic alternatives for chronic non-cancer pain:

A

Opioids, NSAIDs, acetaminophen, TCAs, SNRIs, anticonvulsants

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3
Q

Patient is on hydromorphone 10mg po daily. What’s their total daily morphine equivalents?

A

50mg MEQ

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4
Q

Patient with chronic back pain is taking Tylenol #3s (300mg acetaminophen/30mg codeine/15mg caffeine) 3 tabs po q4h for chronic back pain.

What is the patient’s total daily MEQ?

A

81mg MEQ

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5
Q

Current inpatient medication administration record for Patient A:
-Hydromorphone 1 mg subcut q4h scheduled-

What is Patient A’s total daily MEQ?

A

60mg MEQ

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6
Q

Current inpatient medication administration record for patient B: • Morphine 5mg IV intermittent q4h scheduled
• Oxycodone 5mg po q4h prn
• Used 3 x 5mg doses in last 24 hours

What is Patient B’s total MEQ in the last 24 hours?

A

82.5 mg MEQ

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7
Q

Patient C has is taking M-Eslon (morphine) SR 100 mg po q12h
• Patient C has declining renal function and her family physician is worried about CNS adverse effects of morphine and would like to change to hydromorphone
• What is the equivalent dose of hydromorphone that you would recommend for Patient C? (give dosing interval and prn dosing too)

A

20mg hydromorphone/d

10mg bid (q12h) (just like prev dosing regimen)

and 2mg q4-6h (10% of total daily dose)

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8
Q

Before turning to opioids, what must we do for pain tx?

A

Optimize non-opioid interventions first! > non-pharm and non-opioid tx FIRST!

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9
Q

T or F: Opioids are trialed and are not often intended to be used indefinitely

A

T

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10
Q

How long should an opioid trial be?

A

3-6 mths

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11
Q

Which opioids are first line for mild-mod pain?

A

codeine

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12
Q

Which opioids are first line for severe pain?

A

morphine, oxycodone, hydromorphone

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13
Q

Which opioids are second line for mild-mod pain?

A

morphine, oxycodone, hydromorphone

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14
Q

Which opioids are second line for severe pain?

A

fentanyl

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15
Q

Which opioids are third line for mild-mod pain?

A

No alternatives - stick w/ second-line and optimize non-pharm and non-opioid options

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16
Q

Which opioids are third line for severe pain?

A

methadone

17
Q

How should the optimal opioid dose for a pt be determined?

A

By starting w/ a low dose and slowly titrating up in small qty’s

18
Q

Maximum opioid dose for new pts?

A

50 MEQ/day

19
Q

For all pts on opioids, what is the max opioid dose?

A

90 MEQ/day

20
Q

What should we do if a pt is on > 90 MEQ/day?

A

Switch or taper down

21
Q

Which population should be careful when using codeine?

A

Breast-feeding women > some may be fast-metabolizers and convert codeine rapidly to morphine, which may place the infant at risk of morphine tox

22
Q

Which opioid increases risk of seizure?

A

tramadol

23
Q

Which opioid should we avoid during renal dysfn?

A

morphine

24
Q

Which opioids have a higher abuse potential?

A

oxycodone and hydromorphone

25
Q

What should we ensure before switching an ind to fentanyl?

A

that they’ve been on a total daily SCHEDULED dose of at least 60 MEQ/day for ≥ 2 weeks

26
Q

What opioid can we NEVER switch to an opioid from?

A

codeine

27
Q

What should we counsel a pt on when dispensing fentanyl patches?

A
  1. be alert for signs of overdose (slurred speech, ataxia, nodding off during conversation or activity, emotionally labile)
  2. don’t use >1 patch at a time, nor change more often than directed
  3. avoid any sources of heat
  4. dispose patches carefully
28
Q

How often should we titrate methadone?

A

titrate no more frequently than q5d

29
Q

Why is methadone titrated in such long intervals?

A

due to its long t1/2

30
Q

Max daily acetaminophen dose when using it chronically?

A

3.2g

31
Q

Optimal opioid dose is reached when these three factors are balanced:

A
  1. effectiveness (at least 30% pain reduction)
  2. plateauing (increased doses aren’t beneficial)
  3. AEs are manageable
32
Q

T or F: If an opioid’s dose is completely effective at dealing w/ pain, that is considered to be the optimal dose despite AEs that reduce quality of life.

A

F

33
Q

A person’s pain goes from 8 to 3. What is the percent change of their pain?

A

8-3 = 5

5/8 * 100 = 62.5% reduction in pain

34
Q

Common AEs of opioids

A

N/V, constipation, drowsiness, dizziness, dry skin/pruritus

35
Q

Medical complications of opioid use:

A

neuroendocrine abnormalities (HPO and HPA axis probs), erectile dysfn, sleep apnea, hyperalgesia

36
Q

What kinds of pts should we consider starting at lower doses of opioids?

A

older, reduced wt, sleep apnea, impaired renal/hepatic fn, interacting drugs/concurrent CNS depressants, pulmonary dz/conditions that cause decreased pulmonary drive, seizure pts, risk of developing GI obstruction

PHAR 557 (36 decks)

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