Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Palliative Care > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Define pain

A

an unpleasant sensory and emotional experience normally associated with tissue damage or described in terms of such damage

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

What is nociceptive pain?

A

pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors

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

What are the main features of visceral pain?

A

Diffuse, difficult to locate
Can be referred from a distant structure
May be a/w nausea and vomiting
Dull, deep, gnawing, sickening, crampy, colicky, pressure, tightness

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

What leads to visceral pain?

A

Visceral structures are highly sensitive to stretch, ischemia and inflammation
Internal organs, deep tumor masses

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

Deep somatic pain quality?

A

Dull, aching, throbbing

poorly localized

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

What structures are involved in deep somatic pain?

A

Bones, joints, ligaments, organ capsules, pleura, peritoneum

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

Superficial somatic pain quality?

A

Sharp, well-defined and clearly located

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

What structures are involved in superficial somatic pain?

A

Skin, subcut tissues, mucosa

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

Define neuropathic pain

A

pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. Occurs in distribution of nerve or dermatome

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

Neuropathic pain quality

A

Quality: burning, episodic shooting or electric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define parasthesia

A

abnormal sensation, whether spontaneous or evoked e.g. pins and needles

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

What is wind up or sensitisation?

A

as the pain response continues, the nerves feeds back to dorsal column and NMDA receptors and the pain somehow becomes amplified
- Lowered threshold of nerve activation/ pain threshold after injury

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

What is breakthrough pain?

A

sudden onset, usually short periods of time, between regular disease of analgesia

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

What is incident pain?

A

type of breakthrough pain that you can relate to incident - exacerbated by movement or activity e.g. weight bearing, coughing, wound dressings. Common with bony mets

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

What is the WHO analgesic ladder?

A

WHO analgesic ladder is used for cancer, palliative and chronic pain

Step 1of the ladder is for mild pain. Non-opioid analgesics such as paracetamol or NSAIDs are used. This may be used in conjunction with adjuvant agents such as antidepressants, anticonvulsants, antiemetics and laxatives.

Step 2is employed for persisting or worsening pain. A weak opioid such as codeine or tramadol is added to step 1.

Step 3is for severe pain. Strong opioid analgesia e.g. morphine, oxycodone or fentanyl replaces the weak opioid in step 2. The dose is titrated according to response. Non-opioid analgesics +/- adjuvants may be continued.

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

NSAIDs should consider an individuals risks of…?

A

individuals GI, CV and renal risk

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

Celecoxib (selective COX 2 inhibitor) has what risk?

A

High in CV risk, but low GI risk

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

What is the maximum dose of paracetamol?

A

4g in 24 hours

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

What are the common side effects of opioids that are transient?

A
  • Sedation, nausea and vomiting are usually transient (only lasts a few days)
20
Q

What re the common adverse effects of opioids that are persistent?

A
  • Constipation persists, regular laxatives should be prescribed with opioids
  • Opioids may cause confusion particularly in those with dementia - older patients with cognitive impairment are more prone to CNS adverse effects
  • Opioids increase the risk of falls
21
Q

Oral morphine starting dose in opioid naive patient

A

Start at 2.5 - 5mg morphine oral IR and then titrate up

22
Q

Oxycodone starting dose in opioid naive

A

2.5-5mg oral IR and then titrate up

23
Q

What is the breakthrough dose calculation?

A

1/6 of last 24 hours for each dose

24
Q

Once 24 hour dose has been established what should happen?

A
  • Once the 24 hour dose has been established, the patient can be transferred to a more convenient controlled release formulation, usually given as half the 24 hour dose administered 12 hourly
  • The choice between oral and transdermal is based on tolerability, adherence and patient preference
  • Breakthrough pain should still be treated with immediate use morphine or oxycodone
25
Q

For severe acute pain, what dose of IV morphine should be started?

A

2.5mg - 5mg morphine IV

Review response in 5-15 minutes, and titrate according to response

26
Q

Oral morphine conversion to SC morphine

A

Oral morphine to SC - must divide by 3 (i.e. 30 mg oral = 10mg SC)

27
Q

What is MS contin?

A

Morphine controlled release

BD (12 hourly dosing)

28
Q

What is Oxycontin?

A

Oxycodone controlled release

BD (12 hourly dosing)

29
Q

What is Jurnista?

A

Hydromorphone modified released OD (24 hourly dosing)

30
Q

What is Durogesic?

A

Fentanyl patch (3 days release)

31
Q

What is Norspan?

A

Buprenophine patch (7 days release)

32
Q

What is Targin?

A

Oxycodone CR and Naloxone

33
Q

What is the purpose of Targin?

A

reduces opioid induced constipation

34
Q

What is the limitation of Targin?

A
  • Naloxone does not relieve constipation induced by opioids

- Naloxone cannot be metabolised by the liver in people with liver disease therefore its opioid effects are insufficient

35
Q

Tramadol should never used with what medications?

A

Tramadol should not be used in combination with other serotonin active medications such as SSRIs - serotonin syndrome

36
Q

When is buprenorphine patch indicated?

A

The 7 day patch is suitable for moderate to severe chronic pain, but is not suitable for the management of acute pain.
* weaker patch than fentanyl

37
Q

When should a fentanyl patch not be used?

A
  • should not be commenced in opioid naive patients (it is a potent analgesic)
  • acute pain
38
Q

What are the steps in treating neuropathic pain?

A
  1. Paracetamol, codeine and NSAIDs, topical lignocaine
  2. Followed by adjuvant:
    ○ TAC: amitriptyline
    ○ Antiepileptic agents: pregabilin, gabapentin
    ○ SNRIs: venlafaxine, duloxetine
  3. If not effective, consider stronger opioid
39
Q

What neuropathic pain medication is best for diabetic peripheral neuropathy?

A

SNRI: venlafaxine or duloxetine

40
Q

What are the recommendations for opioids in patients with renal failure/dialysis patients?

A

AVOID: morphine and codeine - metabolites accumulate and can cause resp depression and sedation.
CAUTION: hydromorphone or oxycodone
SAFE: methadone and fentanyl/sufentanil

41
Q

What opioid should be avoided in poor liver function?

A

Targin - naloxone component cannot be metabolised

42
Q

What analgesics are NMDA antagonists?

A

Methadone and ketamine

They reduces sensitisation/wind up.

43
Q

What is the onset of a long acting opioid and how long does it last for?

A

Long action: onset 2-3 hours, last 8 hours (hence why BD)

44
Q

What is the onset of a short acting opioid and how long does it last for?

A

Short action: onset 15 minutes, last app 2 hours

45
Q

What is the most common adjuvant for opioid?

A

Pregabilin: it is most used as it is the least toxic

46
Q

What is the first line opioid for chronic pain?

A

Targin - due to naloxone component. Cannot get higher doses than 40mg therefore not for acute pain. Naloxone cannot work at higher doses. Swap to oxycontin afterwards.

47
Q

Sufentanyl is ___x fentanyl ____ x morphine

A

Sufentanyl is 10x fentanyl 100 x morphine

Palliative Care (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions