Pain Management

Question 1

What areas of the brain are affected by pain?

Answer 1

LATERAL AREA of brain involved with sensory components of pain (location, intensity, quality) and the LIMBIC FOREBRAIN- involved with emotional and cognitive aspect of pain

Question 2

which drugs are used as first line agents in a PCA pump (patient- controlled analgesia)?

Answer 2

morphine or hydromorphone (schedule 2 drugs)

Question 3

which ROA may result in more sedation?

Answer 3

IV infusion

Question 4

which drugs can be administered rectally?

Answer 4

morphine and oxycodone

*morphine works faster

Question 5

What is the max. dosage for non-opioids such as Tylenol?

Answer 5

3000-4000 mgs/ day

Question 6

what class of drug is best choice for bone pain?

Answer 6

NSAIDs (but is not 1st choice after surgeries)

Question 7

which adjuvant drug should you consider using with neuralgias?

Answer 7

anti-depressants

Question 8

Which receptors do you block/activate to block pain?

Answer 8

block NMDA and AMPA receptors (which cause pain when stimulated by glutamate)

stimulate GABA and mu receptors (to cause analgesia)

Question 9

which adjuvant drugs block NMDA receptor and Ca2+ ch blockers?

Answer 9

pregabalin**
ketamine
amantadine

Question 10

which adjuvant drugs block AMPA, Na+ channel blockers?

Answer 10

gabapentin**
tegretol**
lidocaine, melixitine

Question 11

which drugs block glutamate?

Answer 11

gabapentin*

and clonidine

Question 12

which adjuvants are GABA agonists?

Answer 12

baclofen

benzos

Question 13

which adjuvatns are NE- reuptake inhibitors?

Answer 13

TCA **
tramadol
duloxetine

Question 14

which are your substance P inhibitors?

Answer 14

topical capsaicin

Question 15

What is STEP 1 of WHO step ladder?

Answer 15

non-opioid + adjuvant

Question 16

what is step 2 of WHO step ladder?

Answer 16

opioid + nonsteroidal + adjuvant (+ laxative)

Question 17

what are some step 2 opioids?

Answer 17

• codeine or tylenol with codeine
• hydrocodone or acetaminophen with hydrocordone
• oxycodone

Question 18

what is step 3 on WHO ladder?

Answer 18

opioid (morphine) + nonsteroidal + adjuvant

Question 19

for step 3 opioids, there is no ceiling effect to opioids.

Answer 19

true

Question 20

what are some step 3 opioids?

Answer 20

morphine
hydromorphone
methadone

Question 21

how often are fentanyl patches changed?

Answer 21

every 3 days

Question 22

what is the best for breakthrough pain? and why?(fastest form of pain relief)

Answer 22

transmucosal fentanyl-it is the only opioid that is lipophilic; all others are hydrophilic

Question 23

which drug may have addiction potential?

Answer 23

ultram - use in caution with patients on SSRI

Question 24

when are corticosteroids used as adjuvants?

Answer 24

• control headache
• N/V in cancer patients
• pain assoc with spinal tumors

Question 25

side effects of opioids?

Answer 25

• sedation or euphoria
• constipation
• respiratory depression
• nausea/vomiting

Question 26

which is the least potent?

Answer 26

codeine and hydrocodone- 0.15

*morphine- 1.0

Question 27

What does rule of 2s and 8s refer to?

Answer 27

(use of PCA pump)

• 2 refers to amt of analgesic in mgs or micrograms
• 8 refers to time in minutes for drug to reach max. concen in blood

Question 28

what is “lockout”

Answer 28

min. time in minutes btwn consecutive doses

Question 29

what is interval dose?

Answer 29

subsequent dosages

Question 30

if patient is not getting adequate control on pain pump, what do you do?

Answer 30

double dose every 8 min.

Question 31

what is the most potent narcotic?

Answer 31

sublimaze (fentanyl)- potency is 100