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Pain Management Flashcards

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1
Q

Drug Choices for PCA Pumps

A

Morphine
Fentanyl
Dilaudid

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2
Q

Other Pain Management Options for Inpatients

A

Toradol IM/IV
Morphine IM/IV
Dilaudid IM/IV
Demerol/Phenergen IM

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3
Q

Acute Pain Management of Post-Operative Pain

A

Narcotic + non-narcotic medication

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4
Q

Points of Pain Contracts

A

Pain med- amount- time period
Drug testing
Providers (primary & secondary)
Ancillary Services

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5
Q

Ancillary Services for Chronic Pain

A 
Behavioral health
Biofeedback
PT
OT
Hypnosis
Osteopathic manipulation
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6
Q

Most Commonly Prescribed Narcotics

A 
Codeine
Hydrocodone
Oxycodone
Tramadol
Hydromorphone (Dilaudid)
Meperidine (Demerol)
Fentanyl
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7
Q

What are narcotics commonly in combination with?

A

Acetaminophen (APAP)

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8
Q

Use of Schedule I Drugs

A

Illegal
Restricted to research
No accepted medical use

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9
Q

Examples of Schedule I Drugs

A 
Hallucinogens
Heroin
Peyote
Coca
Psilocybin mushrooms
Marijuana
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10
Q

Schedule II Regulations

A

Requires prescription
30 days of medication with no refills
Psychological or physical dependence
Verbal orders not allowed

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11
Q

Examples of Schedule II Drugs

A 
Codeine
Hydrocodone
Hydromorphone
Morphine
Cocaine
Fentanyl
Methadone
Meperidine
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12
Q

Schedule III Regulations

A

Requires a prescription
Moderate abuse potential
Max: 5 refills
Verbal orders allowed

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13
Q

Examples of Schedule III Drugs

A 
Benzphetamine
Clortemine
Ketamine
Pentobarbital
Secobarbital
Sulfomethane
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14
Q

Schedule IV Regulationss

A

Requires a prescription
Low abuse potential
Max of 5 refills
Verbal orders allowed

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15
Q

Examples of Schedule IV Drugs

A 
Alprazolam
Barbital
Clonazepam
Lorazepam
Midazolam
Phenobarbital
Diazepam
Tramadol
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16
Q

Schedule V Drug Regulations

A

OTC with restrictions or requires a prescription

Low abuse potential

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17
Q

Examples of Schedule V Drugs

A

Robitussin AC
Lyrica
Lomotil
Potiga

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18
Q

Codeine/APAP

A 
Opioid agonist
Used as antitussive as well
Schedule II
Good for pediatric patients
Cost: $15 for 30 tabs
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19
Q

Hydrocodone

A

Opioid agonist
Many combo formulations (with APAP)
Schedule II
Cost: $55 for 30 tabs

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20
Q

Examples of Hydrocodone Variations

A

Lorcet (10/650)
Vicodin (5/500)
Norco (5/325, 7.5/325, 10/325)
Lortab (5/500, 7.5/500, 10/500)

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21
Q

Oxycodone

A

Combo drug or not
Opioid agonist
Schedule II
Cost: $100 for 30 tabs

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22
Q

Examples of Oxycodone

A

Percocet (combo)

OxyContin

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23
Q

Tramadol (Ultram)

A

Binds to opioid receptors & inhibits norepinephrine/serotonin reuptake
Schedule IV
Cost: $60 for 30 tabs

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24
Q

APAP Combo of Tramadol

A

Ultracet

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25
Hydromorphone (Dilaudid)
``` Opioid agonist High abuse potential Highly sedative Taper to D/C Schedule II Cost: $30 for 20 tabs ```
26
Meperidine (Demerol)
``` Opioid agonist Very sedative Seizure risk over time & dose Avoid abrupt cessation Schedule II Cost: $30 for 20 tabs ```
27
SE of Meperidine (Demerol)
N/V
28
Fentanyl (Duragesic)
``` Chronic pain Opioid tolerant patients Major abuse potential Responsible patients or caregiver to administer Schedule II Cost: $100 for 5 patches ```
29
How long does a fentanyl patch last?
3 days
30
NSAIDS
Good for orthopedics Anti-inflammatory Caution: concomitant anti-coagulation Slow fracture healing
31
Warnings of NSAIDs
CV risk GI bleeding Kidney risk
32
MOA of Acetic Acid Group
Inhibit cyclooxygenase, reducing prostaglandin & thromboxane synthesis
33
Examples of Medications in Acetic Acid Group
Diclofenac Etodolac Indomethacin Ketorolac
34
What is the acetic acid group of medications effective of treating?
Arthritis associated pain
35
Examples of Propionic Acids
Naproxen | Ibuprofen
36
MOA of Propionic Acids
COX 1 and COX 2 inhibitor | Mess with prostaglandins
37
SE of Propionic Acids
GI issues | Kidney issues
38
COX2 Inhibitor
Celebrex
39
Contraindication of COX2 Inhibitors
Sulfa allergy
40
Oral Steroids
Medrol-dose pack
41
Injectable Steroids
Triamcinalone (Kenalog) Celestone (betamethasone) Depo-medrol (methylprenisolone)
42
Aim of Muscle Relaxants
Produce a decrease in muscle tone and involuntary movement without loss of voluntary motor function or consciousness
43
MOA of Muscle Relaxants
Alters the balance of synaptic excitation and inhibition of motor neuron receives
44
Indications of Muscle Relaxants
Acute, painful musculoskeletal conditions of local origin Adjunct to rest and PT Relief of acute painful musculoskeletal conditions which include muscle spasm secondary to trauma, radiculopathy, musculoskeletal strain or sprain, herniated intervertebral disc & muscle spasm of OA
45
Muscle Relaxant Effects
CNS depressants | Well absorbed with quick effects
46
When should you be cautious when prescribing muscle relaxants?
Renal insufficiency Hepatic insufficiency Elderly
47
SE of Long Term Use of Muscle Relaxants
``` Leukopenia Thrombocytopenia Hemolytic anemia Bleeding agranulocytosis Withdrawal ```
48
How are muscle relaxants commonly used with for abusive purposes?
Alcohol | Opioids
49
What populations are muscle relaxants not recommended in?
Pregnancy | Children
50
Guidelines for Muscle Relaxants
Muscle relaxant + analgesic agent preferred Most effective therapy: drugs + PT SE: drowsiness, HA, dizziness, blurred vision, dry mouth NSAIDs where pain predominates Diazepam should be considered in anxiety ridden patients
51
Possible Mode of Action of Carisoprodol (Soma)
Doesn't directly relax muscles | MOA may be related to sedative properties
52
Length of Time to Use Carisoprodol (Soma)
Not longer than 10-14 days
53
SE of Carisoprodol (Soma)
``` Drowsiness, dizziness Vertigo, ataxia N/V Hiccups Epigastric distress Tremor, agitation Headache, insomnia Tachycardia Postural hypotension Facial flushing ```
54
Contraindications of Carisoprodol (Soma)
Porphyria: inherited porphobilinogen deaminase mutation
55
Precautions with Carisoprodol (Soma)
Seizures
56
MOA of Cyclobenzaprine (Flexeril)
Relieves skeletal muscle spasm of local origin without interfering with muscle function
57
Contraindications of Cyclobenzaprine (Flexeril)
Concurrent use with MAOIs Acute phase of MI Arrhythmias Heart block
58
SE of Cyclobenzaprine (Flexeril)
``` Drowsiness Dry mouth Fatigue Headache Constipation Abdominal pain Acid regard Dizziness Nausea ```
59
Use of Diazepam (Valium)
Centrally acting skeletal muscle relaxant
60
MOA of Diazepam (Valium)
Depresses muscle excitability indirectly by potentiating the effects of synaptic inhibition medication by GABA
61
MOA of Methocarbamol (Robaxin)
CNS depression | No direct action on contractile mechanism of striated muscle
62
What medication is good for the elderly, fall risk individuals, or individuals with mental status issues?
Methocarbamol (Robaxin)
63
Other Muscle Relaxant Medications
Metaxalone (Skelaxin) Tizanidine (Zanaflex) Baclofen (Lioresal)
64
What is the most common use for Tizanidine (Zanaflex)?
Chronic muscle issues
65
What is Baclofen (Lioresal) used for?
Treat spasms associated with spinal cord injuries
66
Order off Pharmacologic Medications for Ortho Pain
``` NSAIDs Muscle relaxants Narcotics Steroids TCA's GABA analog (gabapentin, valproic acid) OTC: glucosamine, omega 3's ```
67
Non-Pharmacologic Treatment of Ortho Pain
``` Ice/heat Patient handouts on stretches/exercises Consider PT/OT Consider plain films then MRI Osteopathic manipulation or chiropractor Behavioral health for chronic pain Biofeedback, hypnosis, or anti-inflammatory diet Splint, bracing, or immobilization ```
68
Treatment of Grade I Ankle Sprains
NSAIDS
69
Treatment of Grade II-III Ankle Sprains
NSAIDs during the day | Narcotic at night to sleep
70
SE of Vicodin
``` Constipation Shallow breathing, slow heartbeat Feeling light-headed, fainting Confusion, fear, unusual thoughts or behavior Seizure (convulsions) Problems with urination Nausea Epigastric pain Itching Loss of appetite Dark urine Clay colored stools Jaundice ```
71
Define Fibromyalgia
Widespread musculoskeletal pain accompanied by fatigue, sleep, memory & mood issues
72
Risk Factors for Fibromyalgia
Genetics Rheumatic diseases Physical, emotional, or sexual trauma
73
Classes of Medications to Treat Fibromyalgia
Pain relievers Antidepressants Anti-seizure drugs
74
Pain Relievers in Fibromyalgia
``` OTC Acetaminophen (Tylenol) Ibuprofen (Motrin, Advil) Naproxen (Aleve) Tramadol (Ultram) ```
75
Antidepressants in Fibromyalgia
Amitriptyline (noc for sleeping) | Duloxetine (Cymbalta)
76
Alternative to Amitriptyline for Fibromyalgia
Cyclobenzaprine (Flexeril)
77
Anticonvulsants in Fibromyalgia
Gabapentin | Pregabalin
78
What is combination treatment in fibromyalgia directed at reducing?
Chronic widespread pain Fatigue Insomnia Cognitive dysfunction
79
What is reflex sympathetic dystrophy characterized by?
Severe pain Swelling Limited ROM Skin changes
80
Inciting Events for Reflex Sympathetic Dystrophy
Soft tissue injury Fractures MI CVA
81
Medications for Reflex Sympathetic Dystrophy
``` Capsaicin cream Prednisone NSAIDs Propranolol Terzosin Prazosin Opioids: severe pain ```
82
Characteristics of Drug Seeking Behavior
Requests for early refills Multisourcing Intoxicated behaviors Pressuring behaviors
83
"Reasons" for Requesting for Early Refills
``` "I took too many" "Lost the prescription" "Washed it with the laundry" "Spilled it in the toilet" "Pharmacist shorted the count" "My sorry ass brother-in-law stole them" ```
84
Multi sourcing and Drug Seeking Behavior
Visiting multiple physicians Recruiting surrogates to obtain meds Purchasing drugs from illicit drug dealers or over the internet
85
Intoxicated Behaviors and Drug Seeking Behavior
Slurred or disinhibited calls to the office Presenting to pharmacies under the influence ED visits for repeated falls, other traumatic injuries, accidental overdose
86
Pressuring Behaviors and Drug Seeking Behavior
Begging or pleading Excessive compliments Breaching boundaries Threats of harm to self or others

Ortho (22 decks)

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