Pain Flashcards

(124 cards)

1
Q

Types of pain:

A
  • nociceptive

- neuropathic

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

Nociceptive pain:

A
  • somatic

- visceral

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

What does somatic pain feel like?

A
  • well-defined

- aching

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

What does visceral pain feel like?

A
  • diffuse
  • deep
  • squeezing
  • usually whole hand approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neuropathic pain is indicative of…

A

damage/disease affecting the nervous system

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

What does neuropathic pain feel like?

A
  • burning
  • tingling
  • electrical
  • stabbing
  • pins and needles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

For acute pain, you can…

A

anticipate pain resolution

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

For chronic pain, you can’t…

A

anticipate pain resolution

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

Chronic pain can impact…

A
  • use of medications
  • monitoring
  • counseling
  • long term side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications for OTC analgesics:

A
  • aches and pains
  • fever reducer
  • sore throat
  • headaches
  • toothaches
  • muscular aches
  • minor pain of arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adult OTC maximum dose for acetaminophen:

A

3 g

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

Adult monitored maximum dose for acetaminophen:

A

4 g

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

Acetaminophen is the leading cause of…

A

acute liver failure in the US

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

Risk factors for liver failure include…

A
  • combination acetaminophen in products
  • alcohol ingestion
  • repeat dosing in excess of acetaminophen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

OTC medications account for _____ ED visits among children under 12

A

1/3

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

T/F: FDA issues a safety alert for acetaminophen

A

T

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

What was the safety alert for acetaminophen about?

A

potentially fatal skin reaction such as:

  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis
  • acute generalized exanthematous pustulosis (AGEP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

For acetaminophen, there are potential fatal skin reactions w/…

A

any dose at any time

  • rash
  • blistering
  • detachment of upper skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Counseling points for acetaminophen for adults:

A
  • avoid concurrent use of alcohol
  • liver damage w/ overuse and/or alcohol abuse
  • caution w/ combination products
  • don’t need food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Onset of action for acetaminophen:

A

< 1 hr

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

Duration of action of acetaminophen:

A

4-6 hr or 8 hr

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

Counseling points for acetaminophen for pediatrics:

A
  • avoid combination products

- can start right away

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

Salicylates are also known as…

A

aspirin

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

Max daily dose of salicylates:

A

4 g (10 tab/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
T/F: you should give children salicylates
F
26
Salicylates can cause...
Reyes syndrome
27
Reyes syndrome is associated w/...
previous viral illness, influenza, cold, or chicken pox
28
T/F: Reyes syndrome is contagious
F
29
Reyes syndrome:
- fat accumulation in the liver and encephalitis | - death within few hours to days
30
Signs of Reyes syndrome:
- vomiting - signs of brain dysfunction - personality changes - disorientation - coma
31
Side effects of salicylates:
- GI upset - bleeding (dose related) - ringing in ears
32
Salicylates have drug interactions w/...
- warfarin - antiplatelet (Plavix) - NSAIDs/steroids
33
Contraindications for salicylates:
- salicylates sensitivity/allergies - GI ulcers - alcohol ( >3 drinks/day) - pregnancy - elderly ( > 325 mg/day) - pediatrics
34
Higher the dose of salicylates, the higher risk of...
side effects
35
Salicylates can help prevent strokes by...
inhibiting prostaglandin synthesis and platelet aggregation
36
Dosage for salicylates and stroke prevention:
81 mg - 325 mg PO QD
37
Drug interactions for salicylates and stroke prevention:
NSAID and Asipirin | - take NSAID 30-120 min after / 8 hrs before aspirin
38
NSAIDs include...
- ibuprofen - ketorolac - meloxicam - indomethacin - etodolac - nambutone
39
Adult dose for ibuprofen:
200-400 mg Q4-6 H prn
40
Max adult dose for ibuprofen:
1.2 g/day or < 2.4 g per physician
41
Child dose for ibuprofen:
- weight (preferred) and age based dosing | - can be repeated 6-8 hr prn w/ max of 4 doses per day
42
When do you refer children to physician after use of ibuprofen?
- fever/pain lasts > 3 days | - no improvement in 24 hrs
43
Side effects for ibuprofen:
- GI upset - fluid retention/edema - dizziness - bleeding
44
Interactions w/ ibuprofen:
- warfarin - lithium - methotrexate - alcohol - NSAIDs/steroids
45
Precautions of ibuprofen:
- NSAID allergy - cardiovascular disease - pregnancy - GI ulcers/bleeding - geriatric - undiagnosed migraines
46
One should discontinue ibuprofen if...
- fever lasts > 3 days - pain > 10 days - alcohol use is >3 drinks/day
47
200 mg of Naproxen base is the same as...
220 mg naproxen sodium
48
Adult dosage for naproxen:
200 mg Q8-12 H - can take as much as 400 mg for initial dose - take with food
49
Max dosage of naproxen per day:
600 mg
50
Max dosage of naproxen per dose:
400 mg
51
Pediatric ( > 12) dosage for naproxen:
same as adult - 200 mg Q8-12 H - can take as much as 400 mg for initial dose - take with food
52
Onset of action for naproxen:
1 hr
53
Duration of action for naproxen:
7-12 hr
54
Side effects of naproxen:
- GI upset - Fluid retention/edema - dizziness - bleeding
55
Precautions of naproxen:
- NSAID allergy - cardiovascular disease - pregnancy - GI ulcers/bleeding - geriatric - undiagnosed migraines
56
One should stop taking naproxen if...
- fever > 3 days - pain > 10 days - alcohol use is > 3 drinks a day
57
NSAID label warning:
- stomach bleeding risk factors
58
People at a higher risk for stomach bleeding risk factors:
- > 60 YO - history of stomach ulcers - take blood thinners, steroids, other NSAIDs - > 3 alcoholic drinks/day - taking it longer than directed
59
Cardiovascular concerns w/ NSAIDs:
- increased risk of myocardial infarct, heart failure, hypertension, stroke - hypothesized mechanisms (usually dose dependent)
60
Examples of high risk patients that should avoid NSAIDs:
- previous myocardial infarct - hyperlipidemia - hypertension - diabetes - other macrovascular disease
61
Types of headaches:
- primary - secondary - episodic: occasional - chronic: very often - tension - migraine - sinus
62
When do you refer a patient with headaches based on descriptions?
- severe head pain - fever/signs of infection - symptoms of migraine without diagnosis of migraine - headache for 10 days
63
When do you refer a patient with headaches based on health status?
- last trimester of pregnancy - < 8 YO - history of liver disease - > 3 alcoholic drinks/day - secondary headache
64
Nonpharmacologic ways to treat headaches:
- relaxation - hot/cold application - exercise - hydration - regular sleep cycles - avoiding food triggers
65
Pharmacologic ways to treat headaches:
- acetaminophen - ibuprofen - naproxen
66
OTC analgesic use for headaches:
- 3 days per week | - want to prevent medication overuse headaches
67
What medication should a 79 YO use for a headache that lasts 5 days?
Tylenol/acetaminophen
68
What medication should a 79 YO use for a headache that lasts 13 days?
None, he has to see a MD first
69
What medication should a 64 YO w/ severe cardiovascular disease use for a headache?
Tylenol/acetaminophen
70
Where can you measure for a fever?
- rectal - oral - axillary - temporal - tympanic
71
What counts as a fever when measured rectally?
> 100.4 F
72
What counts as a fever when measured orally?
> 99.5 F
73
What counts as a fever when measured axillary?
>99.35 F
74
What counts as a fever when measured temporally?
- 0-2 months: > 100.7 F - 3-47 months: > 100.3 F - > 4 years: > 100.1 F
75
What counts as a fever when measured tympanically?
> 100.7
76
A fever is usually indicative of...
an underlying illness
77
Goal of fever treatment is...
alleviate discomfort vs. goal temperature
78
How to treat fever?
- APAP | - NSAIDs
79
APAP and NSAIDs reach peak temperature lowering at...
2 hours
80
Nonpharmacologic ways to reduce fever:
- bathing not recommended for fevers < 104 F - lightweight clothing - remove blankets - drink enough fluids
81
For children, fluid intake to reduce fever should be increased by...
30-60 mL/hour
82
For adults, fluid intake to reduce fever should be...
60-120 mL/hour
83
If patient with fever also has diarrhea, they should avoid...
excessive fruit juice or sports drinks
84
Refer the patient w/ fever to the MD when temperature is...
- > 3 month w/ rectal temp of > 104 F | - < 3 month w/ rectal temp of > 100.1 F
85
Refer the patient w/ fever to the MD when there are impairments such as...
- breathing concerns - immune function - CNS damage/injury
86
Refer the patient w/ fever to the MD when they've had a fever for more than...
- < 2 YO: > 24 hours | - > 2 YO: > 3 days
87
Refer the child patient w/ fever to the MD when...
- rash/spots occur - excessively sleepy, irritable - dehydrated - history of febrile seizures
88
5 YO has temporal temp of 102 F w/ stuffy nose. What do you advise mom to do?
- keep him hydrated - see Dr after 3 days - can give ibuprofen/APAP
89
If 5 YO has temporal temp of 102 F w/ stuffy nose can't eat b/c of upset stomach, what med can he take?
motrin/tylenol
90
Menstrual cycle typically starts in what ages?
11 to 14.5 YO
91
Dysmenorrhea:
6-12 months following menarche | - impacts teens until early 20s
92
Menstrual pain is continuous w/...
spasmodic cramping in lower mid abdominal region | - radiates to back and aches extends down thighs
93
Self care of menstrual pain is appropriate for...
- healthy young women - presentation consistent w/ dysmenorrhea - not sexually active
94
When to refer patients w/ dysmenorrhea:
- prolonged/severe bleeding - history of PID, infertility, endometriosis - IUD - GI disease
95
Treatment of dysmenorrhea:
- NSAIDs - APAP - BC
96
When to take NSAIDS and APAP for dysmenorrhea?
at start of menses - if adequate pain control then start 1-2 days prior - take on schedule for 2-3 days
97
Nonpharmacologic ways to treat dysmenorrhea:
- heating pads - Omega fatty acids - vitamin D3 (600 IU/day) - regular exercise - avoid cigarette smoke
98
Why do patients prefer topical analgesics vs PO analgesics?
can put on spot that hurts
99
Indication for capsaicin:
temporary relief of minor pain associated w/ muscles and joints
100
MOA of capsaicin:
desensitization of sensory axons resulting in pain signal inhibition - occurs by depletion of substance P and prevention of additional accumulation
101
Capsaicin adult dose:
- apply to affected areas TID or QID - need to use at least TID - benefits occur in 2-4 weeks
102
Capsaicin patch dose:
apply patch to affected area for up to 8 hours per application - max 5 days use
103
Side effects of capsaicin:
- erythema (redness) | - pain
104
Capsaicin precautions/warnings:
- may cause burns (1st-3rd degree) | - seek medical attention if blister, swelling, or pain at site
105
Interactions w/ capsaicin:
- minor
106
Counseling for capsaicin:
- avoid eyes/mucouse membranes - apply to intact skin - transient burning may occur and disappears after several days - stop use and contact HCP if redness or irritation occurs
107
Administration for capsaicin in dosage forms of gel, cream, liquid, lotion:
- wear gloves | - wash hands w/ soap and water after application
108
Administration for capsaicin topical patch:
- apply to clean and dry affected area - remove backing film - do not use 1 H before or after bathing - avoid heating pads - remove after 8 hours
109
Indication of methyl salicylate and menthol:
temporary relief of minor aches and pains of muscle joints
110
MOA of methyl salicylate and menthol:
- counter irritant (methyl) and local salicylate analgesic effect (methyl salicylate)
111
When you hear methyl salicylate, think about...
NSAIDs and aspirin
112
Adult dosage of methyl salicylate and menthol:
- balm, cream, foam, spray, stick | - apply to affected area TID or QID per day
113
Adult dosage of methyl salicylate and menthol patches:
- dose dependent - MS 10% and menthol 1.5%: 1 patch no more than QID and remove after 8 hours - MS 10% and menthol 3%: 1 patch no more than 12 H with max of 1 patch per application (max 2 patches/24 hours for 3 days)
114
Side effects of methyl salicylate and menthol:
topical irritation | - not as bad as capsaicin
115
Counseling for methyl salicylate and menthol:
- topical, external use only on intact skin - wash applied area prior to bandaging, covering, etc - avoid heating pads
116
Max dosaging for methyl salicylate and menthol:
- max 3 days for patch | - max 7 days for gels, ointments, etc
117
Warnings/precautions of methyl salicylate and menthol:
- avoid if allergic to NSAIDs, salicylates, menthol - can cause burns - seek medical attention if blister, swelling or pain at site
118
Warnings/precautions of methyl salicylate and menthol patch:
- same as topical ones plus the ones below - GI issues (ulcers, reflux, stomach pain) - cardiac conditions - anticoagulants - geriatric - remove prior to MRI b/c has aluminum
119
Indication for trolamine:
relief of pain or muscular aches, rheumatism, neuralgia, sprains, arthritis on intact skin
120
MOA for trolamine:
local salicylate action in muscle/affected area | - systemic absorption considerations
121
Adult dose for trolamine:
- apply to affected area prn TID or QID | - no odor
122
Side effects of trolamine:
- confusion - drowsiness - nausea - vomiting - diarrhea - local skin irritation
123
Precatuion/warning of trolamine:
avoid irritated skin/eyes
124
Counseling for trolamine:
- wash hands after application - contact HCP if pain persists or worsens w/in 7 days - may wrap area loosely - watch for signs and symptoms of bleeding