Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Geriatrics > Pain > Flashcards

Pain Flashcards

(63 cards)

Start Studying
1
Q

When can APAP be used in elderly patients?

A

OA

Low back pain

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

APAP is considered first line over what other group?

A

NSAIDs as it has a better safety profile

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

When should we particularly use caution when using NSAIDs?

A

Low CrCl
Gastropathy
CV disease
Intravascularly depleted states (CHF)

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

If NSAIDs are used, how should they be used?

A

Short term, at low doses

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

Which type of NSAIDs have improved GI safety over others?

A

Nonacetylated

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

What is an alternative to oral agents of NSAIDs?

A

Topical
No long term studies
Potentially less effective than oral agents

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

What type of NSAID should be used if that patient has gastropathy?

A

COX II inhibitor - but should be used with caution in patients with CV risks

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

If a long term NSAID therapy is chosen, what do we give with it?

A

Gastroprotective agents (H2RAs, PPIs)

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

What may be necessary for chronic, severe pain in elderly adults?

A

Opioids

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

What are the pros of APAP in pain therapy?

A 
Effective for mild-moderate pain
Cheap
Readily available
Antidote available
Limited DDIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the cons of APAP therapy?

A

Potential for confusion with combination products and OTC, liver consideration

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

What is the max dose of APAP?

A

4g daily

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

How do we reduce APAP in hepatic insufficiency?

A

50-75%

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

What are the pros for NSAID therapy?

A

Effective - especially for mild-moderate pain associated with inflammation
Cheap
Availability of topical agents which can limited ADRs

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

What are the cons for NSAID therapy?

A 
Renal insufficiency
GI bleed
CV events
Edema
Elevated BP
Avoid in CKD and CHF
Avoid chronic use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If a patient is taking ASA and wants to being an NSAID, what should be considered?

A

Adding H2RA/PPI

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

What can be added to celecoxib therapy for CV protection?

A

ASA

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

What is the preferred NSAID if the patient has a h/o GI bleed/ulcer?

A

Celecoxib

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

What is the preferred NSAID overall?

A

Salsalate

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

What is the non-preferred NSAID?

A

Diclofenac - may have the highest risk of CV effects

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

What NSAIDs are avoided in pain management in the elderly?

A

Indomethacin

Ketorolac

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

What are the pros of using opioids in pain of the elderly?

A

Effective for moderate to severe pain of various types
Multiple options for ROA
May be preferred over NSAIDs in stepwise therapy

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

What are the cons of opioids in pain of the elderly?

A 
Constipation
Respiratory depression
Sedation
Elderly more sensitive to effects
Risk of falls increased
Consideration of organ function
(morphine: hepatic for metabolism, renal elimination; meperidine: renal for toxicity)
Risk for allergies
Potential for addiction
Development of tolerance to effects of time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How should opioids be given in elderly with cognitive impairment?

A

Fixed/schedules dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Who should be in charge of dosing and conversions of methadone and fentanyl?
Those familiar with pharmacology - may take longer for elderly to reach ss
26
What are secondary amine TCAs?
Desipramine | Nortiptyline
27
What are tertiary amine TCAs?
Amitriptyline Doxepin Imipramine
28
What are the pros for TCA use for pain in the elderly?
Effective agents for depression & sleep Can be used for other indications (HA) Indicated for neuropathic pain
29
What are the cons for TCA use for pain in the elderly?
``` Anticholinergic effect Sedating Orthostasis Caution in CV disease Increased risk of falls ```
30
How do we dose TCAs?
Cautiously, unlikely to go to max doses
31
What are the preferred TCAs?
Secondary amines
32
Which TCAs should be avoided?
Tertiaty - higher risk for potent anticholinergic properties, sedating, and potential for orthostatic hypotension
33
What are the pros of SNRIs in pain for the elderly?
May be beneficial for neuropathic pain | Can also help with hot flashes
34
What are the cons of SNRIs in pain for the elderly?
``` May increase BP May affect cognition Cause dizziness Increased risk of falls DDI (duloxetine) Increases in HR (venlefaxine) Caution in renal insufficiency and dose adjust if CrCl < 30 (milnacipran) ```
35
What is the non preferred agent of SNRIs?
Milnacipran - cost, ADEs (nausea, constipation, hot flashes, hyperhidrosis, palpitations, dry mouth, HTN) Avoid in narrow angle glaucoma
36
What are the SNRIs?
Duloxetine Venlefaxine Desvenlafaxine Milnacipran
37
What are the pros of anticonvulsants?
Can be helpful for neuropathic and fibromyalgia
38
What are cons of anticonvulsants?
``` Sedation Ataxia Edema Carful dose titration Consideration of renal function with dosing - several dose adjustments (may not be ideal for fluctuating renal function) ```
39
What is the non-preferred anticonvulsant?
``` Carbamepine Monitor drug level Auto inducer Several DDIs Serum lab monitoring ```
40
What labs are monitored with carbamazepine?
``` CBC LFTs Cr BUN Electrolytes ```
41
What are the pros of corticosteroids?
``` Inflammation related pain (often gout, immune disorders - RA, etc) Cancer related bone pain Infiltration related pain Compression of nerves HA d/t intracranial pressure ```
42
What are the cons of corticosteroids?
Lots of AEs Adrenal insufficiency - requires tapering off ADEs limit use to last line typically Try to use lowest effective dose for short amounts of time
43
What are corticosteroids AEs?
``` Glucose elevation Edema Increased BP Leukocytosis Bone demineralization Fat redistribution Psychosis/delirium in elderly ```
44
What are the pros of muscle relaxants?
Slight potential for efficacy in musculoskeletal pain - risks outweigh benefits
45
What are the cons of muscle relaxants?
ADEs similar to TCAs Often ineffective Concerns for abuse (carisprodol) May relieve muscle pain but not by relaxing muscles In true muscle spasms, BZDs or baclofen are better options Increased risk of falls
46
What are the pros of BZDs?
Muscle spasms Pain related anxiety Low doses, short term or end of life
47
What are the cons of BZDs?
``` Elderly have increased sensitivity Cognitive impairment Delirium Falls Fractures MVAs ```
48
What are the pros of calcitonin/bisphosphonates?
Bone pain (metasteses) Potentially second line for neuropathic conditions Postosteoporotic fracture pain (calcitonin) Great in those with OP
49
What are the cons of calcitonin/bisphosphonates?
Calcitonin (nausea, calcium/phosphate abnormalities) | Complicated administration
50
What are issues with taking bisphosphonates?
Attention to renal function | Must be able to sit upright, cost, ONJ, nausea, calcium abnormalities
51
What are the topical analgesics?
Lidocaine Capsaicin NSAIDs
52
What are the pros of topical analgesics?
Local effects Lidocaine - neuropathic pain, ease of use, low risk of toxicity, no DDIs Capsaicin - neuropathic pain NSAIDs - some efficacy, systemic absorption minimal at recommended doses
53
What are cons of topical analgesics?
``` Skin irritation (esp w/capsaicin) Confusion with Lidoderm dosing potential problems Lidoderm CI in liver failure Capsaicin - burning ```
54
Should treatment be withheld out of fear of addiction or AEs?
No
55
How should dosing be considered in pain?
Initiated at low doses, titrated carefully, and monitored closely, but not withheld
56
What medications are elderly patients sensitive to for pain?
Opioid analgesics
57
What route of administration is preferred?
Oral - ease of dosing and predictable PK parameters
58
Why is IV therapy not preferred in elderly patients?
Rapid with a short half-life, but labor and cost intensive
59
Why are SQ and IM not preferred in elderly patients?
Wide fluctuations in absorption and do not last as long as oral medications
60
What route may be useful in patients with swallowing difficulties?
TD Rectal Transmucosal
61
What kind of regimen is recommended for chronic pain with cognitive impairment?
Scheduled
62
What type of medications should be used for breakthrough pain?
Short acting medications
63
What is the goal of pain therapy?
Acceptable QOL | Unrealistic to completely eliminate pain

Geriatrics (15 decks)

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