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Flashcards in Pharmacology Deck (48):
1

Goal of Peri-Operative Pain Management

Have the patient comfortable when they awaken from anesthesia

2

SE of Peri-Operative Pain

Thromboembolic complications
Pulmonary complications
Increased length of hospitalization
Hospital readmission for further pain management
Needless suffering
Impairment of QOL
Development of chronic pain
Respiratory depression
Brain injury
Neurologic injury
Sedation
Circulatory depression
N/V
Pruritis
Urinary retention
Impairment of bowel function

3

What must we always document?

Pain intensity
Effects of pain therapy
SE caused by therapy

4

Factors to Consider When Approaching a Patient with Pain

Type of surgery
Expected severity of postoperative pain
Underlying medical conditions
Risk:benefit ratio for the available techniques
Patient's preferences
Patient's previous experience with pain

5

How to Prepare the Patient Medication Wise for Surgery

Adjust/continue meds that may provoke withdrawal symptoms
Reduce anxiety & pain
Patient & family education

6

Patient & Family Education Prior to Surgery

Addiction
Adverse effects of meds
Optimal use of PCA pump

7

Perioperative Techniques for Pain Management

Central regional opioids analgesia
Patient controlled analgesia with systemic opioids
Peripheral regional analgesia

8

Epidural Administration of analgesia

Injection outside of the dura
Can be placed anywhere along the spine

9

Intrathecal/spinal Administration of Anesthesia

Injection through the dura directly into the SAF

10

Benefits of Central Regional Opioid Analgesia

Improved pain relief when preincisional morphine is administered

11

Risks of Central Regional Opioid Analgesia

Increased pruritus
Increase urinary retention post up

12

How long can a single dose of intrathecal morphine provide pain relief for?

18-24 hours

13

When is a PCA indicated?

Moderate to severe post op pain

14

Benefits of PCA Pumps

Decreased delay in patient access to pain medication
Decreased likelihood of overdose

15

When is a PCA pump discontinued?

When the patient can take oral medications

16

What medications can be given via a PCA pump?

Fentanyl
Hydromorphone
Morphine

17

Multiple Techniques for Pain Management

2+ drugs by different mechanisms
Opioid + NSAIDs
Central + regional meds

18

Peripheral Regional Techniques

Peripheral nerve blocks
Intra-articular blocks
Infiltration of incisions

19

When should a nerve block be performed?

Pre-operative

20

Patients at Risk for Inadequate Pain Control

Pediatrics
Geriatrics
Critically ill
Cognitively impaired
Others with difficulty communicating

21

3 Most Common IV Analgesics

Morphine
Hydromorphone (Dilaudid)
Fentanyl

22

How must opioids be given when postoperative?

IV
In a highly supervised environment

23

Where are all opioids metabolized?

Through the liver

24

Morphine

Rapid onset
Peak: 1-2 hours
Duration: 4-5 hours
IV 1-3 mg Q 5 minutes

25

SE of Morphine

Sedation
Respiratory depression
Hypoxemia

26

Renal Insufficiency & Morphine

Active metabolites may accumulate
Neurotoxicities: myoclonus, confusion, coma, death

27

Relative Contraindication of Morphine

Severe renal disease

28

Hydromorphone (Dilaudid)

Onset: 30 minutes
4-6 times more potent than morphine
0.2-1 mg q 2-3 hours

29

Fentanyl

100 times more potent than morphine
More lipid soluble than morphine
Rapid onset
Improved penetration of blood-brain barrier
Shorter duration of action

30

When is fentanyl used?

Moderate pain
Moderate to severe pain
Pain control in ventilated patients

31

When is meperidine (demorol) indicated?

Short term management of acute pain

32

Contraindications of Meperidine (Demarol)

MAOIs

33

SE of Meperidine (Demorol)

Lowers seizure threshold
Dysphoric effect

34

General Opioid SE

Somnolence
Depression of respiratory drive
Hypotension
Urinary retention
N/V
Slowing of GI transit
Histamine release

35

Signs of Histamine Release from Opioids

Flushing
Tachycardia
Hypotension
Pruritus
Bronchospasm

36

Oral Opioids for Post-Operation

Oxycodone
Hydrocodone
Hydropmorphone
Morphine

37

Most Common Oxycodone Medication

Oxycodone/acetaminophen (Percocet)

38

Most Common Hydrocodone Medication

Hydrocodone/acetaminophen (Lortab or Vicodin or Norco)

39

Short Acting Opioids

Fentanyl

40

Moderate Action Opioids

Morphine
Codeine
Hydropmorphone
Oxycodone

41

Medications that are Safer in Renal Impairment

Hydromorphone
Oxycodone
Fentanyl

42

Opioid Reversal Agent

Naloxone (Narcan)

43

MOA of Naloxone (Narcan)

Reversal of respiratory depression

44

Non-Opioid Adjunctive Medications

NSAIDs
Ketamine
Lidocaine
Magnesium
IV acetaminophen

45

Why is ketamine use limited?

Hallucinations

46

What does ketamine reduce?

Hyperalgesia
Opioid tolerance

47

Contraindication of Acetaminophen

Hepatic failure

48

When is lidocaine most effective?

After major abdominal surgery