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Therapeutics III > Pain - Block 2 > Flashcards

Pain - Block 2 Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

  • Overall, pain is very subjective
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2
Q

What are the factors that affect pain?

A
  1. Biological
  2. Psychological
  3. Social
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3
Q

What are the duration classification of pain?

A
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4
Q

What are the classifications of the type of pain?

A
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5
Q

What is adaptive pain?

A

Physiologic: Stimulated by temperature extremes, mechanical trauma, or chemical irritation

Protective: Designed to protect the body from actual or potential tissue injury

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6
Q

What is the physiological process of adaptive pain?

A
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7
Q

What are the types of somatic pain?

A

Superficial: skin, SC, mucous membranes (localized, sharp, pricking, throbbing, burning)
Deep: muscles, tendons, joints, bones (dull, aching, less well localized)

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8
Q

What is visceral pain?

A

Due to a disease process or abnormal function involving an internal organ or its covering

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9
Q

What are the types of visceral pain?

A
  1. True localized visceral pain
  2. Localized parietal pain
  3. Referred visceral pain
  4. Referred parietal pain
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10
Q

What are the presentation of visceral pain?

A

Dull, diffuse, and usually midline; frequently associated with abnormal autonomic activity causing nausea, vomiting, sweating, and changes in blood pressure and heart rate

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11
Q

What are the presentations of parietal pain?

A

Sharp and often described as a stabbing sensation that is either localized to the area around the organ or referred to a distant site

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12
Q

What is and the presentation of maladaptive pain?

A

Pathophysiologic & harmful: episodic or conituous pain, (burning, tingling, shock-like, or shooting), hyperalgesia, allodynia

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13
Q

What are the types of maladaptive pain?

A

Neuropathic
CNS
Central

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14
Q

What is neuropathic pain?

A

Damage or abnormal functioning of the peripheral nervous system (PNS)

Ex: Postherpetic neuralgia, painful diabetic neuropathy, trigeminal neuralgia, phantom limb, or chemotherapy-induced neuropathy

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15
Q

What is CNS pain?

A

Damage or abnormal functioning of the CNS

Ex: Ischemic stroke, spinal cord injury, or multiple sclerosis (MS)

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16
Q

What is central pain?

A

No nerve injury or inflammation exists, but a centrally mediated disturbance in pain processing within the CNS

Ex: Fibromyalgia, irritable bowel syndrome (IBS), temporomandibular joint disorder, and myofascial pain syndrome

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17
Q

What are the screening tools for PAIN?

A
  1. SCHOLAR-MAC
  2. OLD-CARTS
  3. SOCRATES
  4. PQRST
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18
Q

What is used to assess the full body for pain?

A

Melzack Pain Questionaire

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19
Q

What are the types of severity indices?

A
  1. Verbal Pain INtensity Scale
  2. Visual analogue scale
  3. 0-10 numeric pain intensity scale
  4. Wong-baker faces pain rating scale
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20
Q

What are examples of non-verbal screeening tools?

A

FLACC scale (Face, Legs, Activity, Cry, Consolability)

  1. Guarding
  2. Increased vitals
  3. Increased respiratory rate
  4. Facial expressions
  5. Movement/activity
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21
Q

What is the difference between acute and chronic pain?

A
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22
Q

What are the tx goals for acute pain?

A

Pain relief to help patients attain functional goal

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23
Q

What is the tx goals for chronic pain?

A
  1. Improve functioning
  2. Decrease pain
  3. Reduced med use
  4. Improve QoL
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24
Q

What are the components of multimodal pain managment?

A
  1. Medications (Opioid and Non-opioid)
  2. Restorative tx
  3. Interventional procedures
  4. Behavioral health approaches
  5. Complementary and intregrative health
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25
Q

What are the requirements for selecting non-pharm?

A
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26
Q

What are types of restorative therapies?

A

Therapeutic exercise (PT/OT)
Transcutaneous electric nerve stimulation (TENS)
Massage therapy
Traction
Cold and heat
Therapeutic ultrasound
Bracing

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27
Q

What is the difference between PT and OT

A

PT: focuses on an area of dysfunction
OT: Improves ADL functioning

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28
Q

What are the types of behavioral health approaches?

A
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29
Q

What are the types of Complementary & Integrative Health?

A
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30
Q

What are the pharmacologic approaches to pain?

A
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31
Q

COnsiderations for selecting a pain med?

A

1.Severity and duration
2.Frequency
3. Comorbidity
4. Frequency
5. Concomitatn med
6. Allergies

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32
Q

Classes of pain meds?

A
  1. NSAIDs
  2. APAP
  3. Opioid
  4. ANticonvulsants
  5. Antidepressants
  6. Musculoskeletal Agents
  7. Topical
  8. Emerging
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33
Q

Acetaminophen

MOA, Dosing, Considerations

A

MOA: antipyretic and analgesic
Dosing:
* Adult: 325-1000 mg Q4-6H PRN (Max: 3 g)
* Children: 10-15 mg/kg Q4-6H PRN (Max: 75mg/kg/d)

Consideration: hepatic metabolism, alcohol

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34
Q

What is the antidote for APAP?

A

NAC: to shift pathway to non-hepato tox

35
Q

NSAIDs

MOA, PK, ADR, COnsideration

A

MOA: Antipyretic, analgesic, anti-inflammatory
PK: High F, High PPB, absorption as active drugs (except sulindac and nabumetone -> hepatic conversion)
ADR: CV thrombotic events (except aspirin), GI bleeding, ulcerations, and perforations
Considerations: CV hx, kidney function, preganancy status

36
Q

How do you reduce GI risk from NSAIDs?

A
  1. Take the lowest dose possible and only when needed
  2. Misoprostol QID (reduce ulcer rate and GI complications)
  3. PPI or full dose H2RA QD
  4. COX2 selective
37
Q

Who are CI from taking NSAIDs?

A

Active ischemic HD, cerebrovascular dx, mod-severe heart failure

38
Q

What NSAID has the less of a CV risk?

A

Naproxen

39
Q

What are the renal effects of NSAIDs?

A
  1. Acute renal insufficiency
  2. Sodium retention
  3. Acute interstitial nephritis
  4. Renal papillary necrosis
  5. Accelerated chronic kidney disease

NSAIDs inhibt compensatory vasodilation

40
Q

What are the DDI fo NSAIDs?

A

Lithium, warfarin, agents that increase bleeding risk, AntiHTN, diuretics, ACEI, b-blockers

41
Q

What are the coxib DDI?

A

Metabolized by CYP2C9
- Inducers: rifampin, carbamazepine, and phenytoin
- Inhibitors: fluconazole, fenofibrate, Bactrim

Inhibits CYP2D6
Celebrex is a sulfonamide -> allergies

`

42
Q

What are the meds used for maladaptive pain?

A

Anticonvulsants:
1. Carbamazepine, Oxcarbazepine
2. Gabapentin, Pregabalin
3. Lamotrigine
4. Topiramate

43
Q

Why are antidepressants used for pain?

A

Decrease 5-HT and NE

44
Q

What are the meds used for neuropathic pain?

A

TCA:
* Amitriptyline
* Imipramine
* Nortriptyline (less anticholinergic effects)
* Desipramine (less anticholinergic effects)

SSRI:
* Duloxetine
* Milnacipran
* Venlafaxine

45
Q

What is the difference between spasm and spasticity?

A

Spasm: Involuntary contractions of the muscle
Spasticity: upper motor neuron disorder

46
Q

What are the sx and causes of spasms?

A

Sx: jerks, twitches, cramps
Causes: musculoskeletal pain, fibromyalgia, sciatica (peripharl conditions)

47
Q

What are the sx and causes of spasticity?

A

Sx: stiffness, hypertonicity, and hyperreflexia
Causes: MS, CP, spinal cord or brain injury, post-stroke syndrome (central conditions)

48
Q

What are you antispasmodics?

A
  1. Carisoprodol
  2. Chlorzoxazone
  3. Cyclobenzaprine
  4. Methocarbamol
  5. Metaxalone
  6. Orphenadrine
49
Q

What are you antispasticity?

A

Baclofen
Dantrolene

50
Q

Types of topical NSAIDs?

A

Diclofenac

51
Q

Types of local anesthetics? What has the longest DOA?

A

Lidocaine, benzocaine, and pramocaine; bupivacaine (liposomal)
* Decrease discharges in superficial somatic nerves and cause numbness on the skin surface

52
Q

ADRs of local anesthetics?

A

LAST:
* CNS: excitation and depression
* Cardiac effects

53
Q

MOA of rubefacients? Types?

A

Produce redness; methyl salicylate

54
Q

Counterirritants that produce cooling effects?

A

Camphor, menthol

55
Q

Counterirritants that cause vasodilation?

A

Methyl nicotinate

56
Q

Counterirritants that irritate without redness?

A

Capsaicin

57
Q

What counterirritant is used for chronic pain?

A

Capsacin -> ↓ Substance P

58
Q

Types of opioids?

A
59
Q

Common ADRs of opioids?

A

N/V (transient)
Constipation
Dependence
Tolerance
Pruritus

60
Q

What is the standard opioids are compared to?

A

Morphine

61
Q

What are common full mu agonists?

A
  1. Morphine
  2. Hydromorphone
  3. Codeine
  4. Oxycodone
  5. Hydrocodone
  6. Fentanyl
  7. Metadone
62
Q

What is the CI with morphine?

A

CrCl <30 mL/min

63
Q

Does fentanyl require dosing adjustments?

A

Renal and hepatic adj with patch

64
Q

How is methadone unique compared to other full µ agonists?

A

Can be used for neuropathic pain because it is an NMDA receptor antagonist, kappa/delta opioid receptor agonist, seratonin/NE reuptake inhibitor

ADR: QTc prolongation

Requires titration in 5-7 day increments cause of long t1/2

65
Q

Opioid conversion

A
66
Q

What the counseling points for topical fentanyl?

A
  1. Apply to flat surface (chest, back - cognitive impaired, flank, upper arm)
  2. Excess hair may be clipped but not shaved
  3. Don’t cut
  4. Change Q72H and rotate site
  5. May tape edges, but don’t wrap
  6. Don’t expose to excessive heat
  7. Fold and flush after use
  8. Wash hands thoroughly
67
Q

What are the types of opiod antagonists?

A
  1. Butorphanol and nalbuphine (psychomimetic responses)
  2. Buprenorphine
  3. Buprenorphine/Naloxone
68
Q

What is Nalbuphine used for?

A

MOR agonist-associated pruritis

69
Q

What is suboxone used for?

A

Opioid use disorder

70
Q

What are examples of central acting opiods?

A

Tramadol
Tepentadol

71
Q

ADR of central acting opioids?

A

Sz, hyponatremia, hypoglycemia with tramadol

72
Q

Types of opioid antagonists?

A
  1. Naloxone (Narcan), nalmefene (Opvee) - reversal agents
  2. Naltrexone (Vivitrol) -> w/ buproprion for weight loss
  3. Naloxegol (Movantik), naldemedine (Symproic), methylnatrexone (Relistor), Linaclotide (Linzess) - Peripheral acting used for opioid induced constipation
73
Q

What is opioid tolerance?

A

Reduction of med effect over time as a result of exposure to the agent

74
Q

What is hyperalgesia?

A

Increased sensitivity to pain

75
Q

What is physical dependence?

A

An abstinence syndrome following admin of an antagonist med or abrupt dose reduction or discontinuation

76
Q

What are the types of emerging therapies?

A

Ketamine
Cannabis

77
Q

What are neurosurgical procedures for pain management?

A
78
Q

What is the treatment for acute pain?

A

Nonopioid therapies are just as effective as opioids

3-7 days supply of opioids is recommends with close follow-up

79
Q

What is PCA?

A

Patient controlled analgesia: IV opioids utilized with basal-bolus conceptr
* Button should only be pushed by the patient

80
Q

What the guideline to prescribing opioids for chrronic pain?

A
81
Q

What do we use to determine if patients should recieve chronic opioid alalgesia?

A

DIRE score
* 7-13: not suitable
* 14-21: suitable

82
Q

What are the steps to develop an opioid regimen?

A
83
Q

What should opioid tapering look like?

A

Taper slow enough to minimize sx and signs of withdrawal
Short duration: Decrease of 10% of the original dose per week or slower -> 30% of the original dose is reached -> weekly decrease of approximately 10% of the remaining dose

Long duration: Longer durations (e.g., for ≥1 year) of opioid use -> tapers of 10% per month or slower -> approximately 30% of the original dose is reached -> weekly decrease of approximately 10% of the remaining dose

Therapeutics III (40 decks)

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