Pain Management Flashcards

Question

Buprenorphine & BUtorphanol uses and how they work

Answer 1

Buprenorphine - a partial opioid agonist: used for opioid withdrawal - has a celing effect - produces a submx. pain relief response but good for lower abuse potential Butorphanol - opiod agonist and anagonists - antagonist at one receptor, agonist at other - used for migraines: but addictive properties

Answer 2

Opioid Antagonists - reverse the effect of the opioid by binding, but not stimulating the receptor - **can cause and percipiate withdrawal if given with opioids** Naloxone - **the antidote!!** = for overdoses - mayneed multiple doses to get effect - IV/IM gives 0.4-2mg = can give dose every 2-3 minutes - if no repsonse afte 10 mg = consider other reason for respiratory depression - intranasal: gives 4-8mg = give doses every 2-3 minutes alternating nostrils Naltrexone - used for chornic maitenence for reducing craving of opioid

Answer 3

MOA: NMDA receptor antagonist - analgesic effect - anesthetic effect ADR - CNS depression - respiratory depression - dependence - emergency reactions: psychotic breaks - increases HR and BP

Answer 4

Age: older age = more sensitive to opioids History - use: if SE to med previously, probably happen again - abuse: know if they have ever and maye choose something else Renal - always check: active metabolites: **morphne and meperidine** - best choices for bad kidneys:**methadone, fentanyl** Liver - **all opioids cleared by liver** : will accumulate if bad liver ADR - true allergy is rare:see if its just intoleratnce (itchy!! N?V) - if TRUE morphine allergy: can use **methadone or fentanyl**

Answer 5

N/V: can be transient - highest risk and most intense is with codine Ithcy - with the naturals: morphine and codine - due to histamine release - **less with fentanyl and methadone** = synthetics Sedation - **CANNOT LEADLLY DRIVE OR OPERATE MACHINERY** - tolerance can occur Constipation - WILL Occur: give them a **stimulant lax.**: sinner or bisacodol - there will not be tolerance to this - can give a stool softener: PEG (miralax) Respiratory Depression - tolerance within 1 week - highest risk with higher doses AMS - can have delirum

Answer 6

BP - risk of hypotension (IV mostly) - watch orthostasis HR - Bradycardia QT - QT-c prolongation with **methadone** - get baseline EKG and EKG during treatment Physical Dependence - after using, stopping drug will produce a withdrawal effect if not tapered Tolerance - overtime, there is a dimished effect Substance use Disorder - keep an eye out, using ONLY for pain! - dont be afraid to ask

Answer 7

**withdrawal from opioids is awful, but not fatal** Symptoms - nausea - sweating - anxiety - agitation - muscle cramping - tachycardia - HTN - insomnia - diarrhea - yawn and sneeze

Answer 8

Acute Pain - **non-opioid meds are as effective as opioids for ACUTE PAIN** - maximize non-opioid medication and nonpharm first - discuss all ADR and benefits with pt. Acute Pain: Severe Trauma - may consider using opioid: lowest dose and **PRN** - always properly educate pt. on risks and ADR - should be a trial use, not put on and never taken off

Answer 9

Subacute and Chronic Pain - maximize non-opioid medications first: these are preferrred!!! if starting an opioid - have exist stragety: "try 4 months, then stop if the pain does not respond at all"

Answer 10

Starting Opioids IR - always start with **immerdiate release ALWAYS starts first** - never treat acute pain with long acting meds - **METHADONE IS NEVER A FIRST LINE** or fentynal Always start with the LOWEST EFFECTIVE DOSE - espeically for naive pt. to opioids - usually 5-10 MME mrphine milligram equ. - at 50 MME: te risk of death from opioid ADR doubles - there must always be a documented response/benefit

Answer 11

for those on opioid therapy: always weight risk v benefit before changing doses - if benefit > risk = continue - if risk > benefit = d/c and taper

Answer 12

Rx. - for acute pain = only rx. the quantity needed for expected amount of pain (usually a few days) Acute Pain - always reevaluate the need **every 2 weeks** if continuing a dose > 1 month = this may need to consider the use of chronic opioids and transition from acute for subacute-chronic - reevalulate **1-4 weeks after starting** for those on chronic opioids - need to **reasses every 3 months** PERALS offer naloxone as rx with opioid mental health treatment ask about drug and alcohol use always revied info in PDMP: before every rx written **consider doing tox screening to asses for perscribed and non-rx. substances** = test ANNUALLY *caution benzo and opioid co-rx.* = increased respiratory drive always help taper and assist in derx. process

Answer 13

demand dosing: with lockout continuous infucion with demand dosing good for cognitively with it pr. and those post-op or with sickle cell

Answer 14

assess pain (scale 1-10) and controlled pain to help get idea about increase/decrease dosing determine TDD by adding ER and IR together, dosing an damount taken per day (not what they're rx. but what they take) convert to same opioid: TDD divided by doses = new amt. and find closest strength dose that is comes in conver to new opioid: TDD then equipotent dosing to find new (via chart) - if changing to NEW opioid: need to decrease dose by 30% (so multiple by .75) IR dosing is given Q4H - this will be 10-20% of TT (so .1 -0.2 of TTD) then find the closes dosage form - try to keep IR and ER same type of med **if using < 3 doses of rescue - pain is well controlled if using > 3 doses of resuce - pain uncontrolled** always add HOURS to rx.

Answer 15

Neuropathic: nervous sytem pain GAbapentin (First Line) - start at bedtime - SE: sedation, weight gain and edema Pregabalin (if gabapentin not working) - controlled substance Second Lines TCAs - avoid in eldery - start low and titrate up need 6-8wk. Duloxeint/venlafaxine (SNRI) - sexual dysfunction **risk of Serotinin syndrome with TCA and SNRI** Lidocaine Patch - used for **localized pain** - can be used in combo with other meds - only 12 hours - caution: class 1 antiarrythmic

Answer 16

Bone Pain NSAIDs = if tolerable corticosteroids bisphosphonates use with other agents to get max. pain releif

Pain Management Flashcards

(40 cards)