Pain mgmt therapy pt 1 Flashcards
(70 cards)
What is the max dose of Hydrocodone / APAP (Norco)?
1) One to two tablets (10 / 325 mg) PO Q 4-6° (not to exceed 12 tablets per day due to APAP)
2) Most people would only take one tablet four times per day as max
T/F: There’s no max dose of morphine
True
List the max doses of Tramadol
IR: 50 – 100 mg PO Q 4-6° (max of 400 mg / day)
ER: 100 mg PO Qday (max of 300 mg / day)
What’s the max dose of each opioid?
Mostly a patient-specific question
Be conservative with acute pain
Cancer & hospice patients may require very high doses
1) List 2 types of adaptive pain
2) List 2 types of maladaptive or pathologic pain
1) Nociceptive or Inflammatory
2) Neuropathic or Centralized
Pain further classified as _______, ________, or _________ pain
acute, chronic or cancer
List 3 groups of Endogenous Opioid Peptides
1) Endorphins
2) Enkephalins
3) Dynorphins
List the 3 types of G-Protein Coupled Opiate Receptors
1) Miu (u)
2) K
3) Delta (o)
Which two G-Protein Coupled Opiate Receptors are assoc with resp depression and miosis?
Miu (u) and K (less resp)
Which G-Protein Coupled Opiate Receptor has the most classic Sx?
Miu (u)
Gaba has a ____________ feedback on brain
negative
Opioid prescriptions:
1) May not exceed _____-days
2) No refills for _______– partial fills may occur – Rx is good for one year
3) Max of five refills for CV-CIII over 180-days – examples include what?
1) 30
2) CII
3) Tylenol #3/#4, Ultram, or Suboxone
T/F: One exemption to the E-prescribing mandate is that the Rx may be issued when the prescriber determines that e-Rx would delay pt from getting Rx in a timely manner
True
1) Women can be charged with a ______________ if they illegally use narcotics during pregnancy and if the baby is harmed as a result
2) Providers who make the diagnosis of neonatal abstinence syndrome must report cases to the _________________
1) misdemeanor
2) Department of Health
Any prescribers of opioids, benzodiazepines, barbiturates or carisoprodol, either alone, concurrently, or sequentially with any other opioids, benzodiazepines, barbiturates, or carisoprodol to patients who are in chronic, long-term drug therapy for ninety (90) days or longer ________ consider mandatory urine drug testing.
shall
-Legally, the word “shall” = “you will do this”
Must prescribe opioid overdose / reversal if prescribing opioid and:
(1) The prescription dosage for the patient is _____________ equivalents of an opioid medication per day;
(2) An opioid medication is prescribed concurrently with a prescription for a ________________
1) 50 or more morphine milligram
2) benzodiazepine
Non-pharmacologic Therapies for pain mgmt include what 5 things?
1) Exercise
2) Physical therapy
3) Diet: Anti-inflammatory or Elimination
4) Weight loss
5) Electroanalgesia: application of electrical stimulation to various areas that range from noninvasive to highly invasive
Electroanalgesia: List 3 examples from least to most invasive
1) Noninvasive: transcutaneous electrical nerve stimulation (TENS) – CAN BE OTC
2) Minimally invasive: percutaneous electrical nerve stimulation (PENS)
3) Highly invasive: spinal cord stimulation (SCS)
CDC Guidelines (2022):
1) ________________ opioids are preferred over CR/LA opioid formulations when starting therapy.
2) Use the lowest effective dose of opioid possible (e.g, 5-10 MME/ day). Use caution at any dosage, and carefully reassess evidence of benefit versus risk when exceeding _______ MME/day and avoid increasing dose _______ MME/day without careful justification.
1) Immediate-release
2) ≥50; ≥90
Opioid analgesia should be used for the shortest duration possible. In most cases, ______ days is sufficient for acute pain. More than 7 days will rarely be required for most acute pain indications.
3
Careful evaluation of opioid overdose risk should be assessed frequently, and naloxone co-prescribed at opioid doses of________MME/day or when patients are exposed to concurrent opioid analgesia and ____________.
≥50; benzodiazepines
T/F: Concurrent prescribing of opioid analgesics and benzodiazepines should be avoided when possible.
True
When _________________ is recognized or suspected, clinicians should offer evidence-based treatment such as medication-assisted therapy (i.e., methadone or buprenorphine/naloxone) in combination with behavioral therapies.
Opioid Use Disorder
Are NSAIDS or APAP preferred for osteoarthritis & chronic back pain?
NSAIDs
