ROGERS Flashcards
1
Q
what percent of americans have chronic pain
A
30%
2
Q
subjective questions to ask a pt about pain
A
PQRSTU
precipitating factors
quality of pain
region
severity
time related
impact on U
also what have you tried
3
Q
objective factors of pain
A
behavior changes
dilated pupils
paleness
sweating
tachycardia
tachypnea
4
Q
which pain scale is helpful in kids?
A
Wong-Baker
(faces)
5
Q
what is nociceptive pain
A
tissue
6
Q
what is neuropathic pain
A
nerve
7
Q
non-pharm options for pain
A
correct cause
exercise
acupuncture
massage
heat/ice
chiropractor
8
Q
treatment ladder step 1
A
non opioid
+/- adjuvant analgesic
9
Q
treatment ladder step 2
A
opioid for mild/mod pain
+ non opioid
+/- adjuvant analgesic
10
Q
treatment ladder step 3
A
opioid for mod/severe pain
+ non opioid
+/- adjuvant analgesic
11
Q
Tylenol dosage forms
A
tablet
capsule
chewable
liquid/gel
IV
suppository
12
Q
Tylenol dosing adults
A
325-1000 mg q4-6h
max: 3-4 g /day
13
Q
Tylenol dosing kids
A
10-15 mg/kg q4h
max: 75 mg/kg/day or 3-4 g
14
Q
Tylenol hepatotoxicity likely with what dose
A
> 10 g dose
15
Q
NSAID side effects
A
GI bleed
nephrotoxicity
fluid retention
increase in CV events
16
Q
when to avoid NSAIDs
A
liver disease
CKD
Beers
CV history
17
Q
counseling tip for NSAIDs
A
take with food
18
Q
aspirin
A
tablet
capsule
chewable
ec tablet
er capsule
suppository
19
Q
ASA dosing adult
A
325-1000 mg q4-6h
max: 4 g /day
20
Q
ASA in children
A
AVOID
21
Q
when to avoid ASA
A
children
pts on blood thinners
22
Q
what is Reyes syndrome
A
swelling in brain and liver
(when kids have a viral infection)
23
Q
ibuprofen dosage forms
A
tablet
capsule
chewable tablet
IV
suspension
24
Q
ibuprofen dosing adult
A
200-800 mg q6-8 h
max: 3200 mg /day
25
ibuprofen dosing kids
> 6 months
5-10 mg/kg q 4-6h
max: 40 mg/kg/day or 2400 mg
26
diclofenac dosage forms
tablet
capsule
IV
suppository
topical gel
topical solution
ophthalmic
patch
27
diclofenac dosing
50 mg PO q8h or 2-4g QID topically
28
naproxen dosage forms
tablet
capsule
DR/ER tablet
suspension
29
naproxen dosing
220-500 mg PO q6-12 h
max: 1000 mg/day
30
ketorolac dosage forms
tablet
IV/IM solution
nasal spray
ophthalmic
31
ketorolac dosing adults
15-30 mg IV q6h
10 mg PO q6h
31
ketorolac dosing kids
0.5 mg/kg/dose IM/IV q6h
32
maximum duration of ketorolac
5 days
33
when is oral dosing used with ketorolac
continuation of IV or SUBQ
34
celecoxib dosage forms
capsule
oral solution
35
celecoxib dosing
200 mg PO BID
36
gabapentin / pregabalin uses
fibromyalgia
neuropathies
post op pain
37
gabapentin doing and max dose
100-300 mg TID
3600 mg / day
38
pregabalin dose and max
75 mg BID
max: 600 mg
39
pregabalin is what schedule
IV
40
gabapentin is what schedule
not scheduled
41
pregabalin and gabapentin side effects
sedation
dizzy
42
gabapentin and pregabalin are ____ dosed
renally
43
venlafaxine max dose
225 mg /day
44
duloxetine max dose
60 mg/day
45
duloxetine renal considerations
avoid in CrCl < 30
46
side effects of nortriptyline and amitriptyline
anticholinergic
sedation
47
when to use amitryptiline and nortriptyline in fibromyalgia/neuropathy
last line
48
max of nortriptyline and amitriptyline dose
150 mg /day
49
when to use muscle relaxants
musculo skeletal pain / pulled muscle
50
muscle relaxant drugs
cyclobenzaprine
baclofen
methocarbamol
carisoprodol
tizanidine
51
muscle relaxants duration of use
< 3 weeks
52
which muscle relaxant has abuse potential
carisoprodol
schedule IV
53
cyclobenzaprine max
30 mg
54
baclofen max
80 mg
55
carisoprodol max
1050 max
56
methocarbamol max
8 g
57
tizanidine max
24 mg
58
carbemazepine max
1200
59
carbemazepine risk
hypersensitivity with HLA B 1502 allele
autoinduction of hepatic enzymes
60
topical agent for pain
lidocaine
61
lidocaine dosage forms
patch
injection
topical
62
what can happen with continuous use of lidocaine patch
tolerance
12 hour break between patch
63
Beers oral NSAID recommendation
avoid chronic and acute use unless needed to but with a PPI or misoprostol
64
Beers recommendation ketorolac and indomethacin
avoid
65
Beers recommendation carisoprodol, cyclobenzaprine, methocarbamol
avoid
66
Beers tizanadine and baclofen
don't avoid but substantial side effects
67
Beers reccomendation SNRI, TCA, carbamazepine
use with caution
68
Beers recommendations opioids and benzos together
avoid
69
Beers recommendations opioids and gaba/prega
avoid unless tapering off or swtiching to gaba
70
Beers recomendation two anticholinergics (like TCA and muscle relaxant)
avoid
71
Beers recommendation of CNS agents
avoid three or more CNS active drugs
72
best pain medications for elderly
tylenol
topical
SNRI
gaba
73
side effects muscle relaxants
anticholinergic
74
side effects venlafaxine/duloxetine
nausea, headache, sedation
75
weak opioid agonists
tramadol
codeine
76
signs of overdose
bradycardia
decreased respiratory rate
hypotension
pale
sedation
pinpoint pupils
77
signs of withdrawal
tachycardia
increased respiratory rate
hypertension
sweating
insomnia
dilated pupils
78
pts who should get naloxone
hx overdose
hx substance disorder
benzo use
higher opioid dosages
79
narcan dosing frequency
2-3 mins
80
who is codeine not recommended for
breastfeeding mothers
children <12
81
tramadol is ____ dosed
renal
82
tramadol risk
serotonin syndrome with other serotonin meds
83
codeine dosage forms
tablet
syrup`
84
tramadol dosage forms
tablet
capsule
solution
85
morphine dosage forms
tablet
capsule
solution
IV
suppository
86
hydromorphone dosage forms
tablet
oral solution
injection solution
suppository
87
hydrocodone dosage forms
tablet
oral solution
88
hydrocodone use with a 3A4 inhibitor will do what
increase concentration
89
oxyodone dosage forms
tablet
capsule
oral solution
90
which oxycodone formation is abuse deterrent
ER
91
fentanyl dosage forms
buccal
sublingual
lozenge
injectable sol
patch
92
fentanyl renal considerations
can use in impairment
93
who can use the noninjectible forms of fentanyl
opioid tolerant: 60 mg morphine daily for a week
94
swithcing between doses for fentanyl
not one to one between dosage forms
95
fentanyl patch duration
every 72 hours
96
methadone dosage forms
tablet
oral solution
injectible solution
97
which pain drug QTC prolong
methadone
98
which drug do we need to avoid with hx of seizures
tramadol
99
dilaudid
hydromorphone
100
duragesic
fentanyl
101
demerol
meperidine
102
which meds available in ER
tramadol
morphine
hydropmorphone
hydrocodone
oxycodone
103
naural opiates
codeine
morphine
104
synthetic opioids
fentanyl
methadone
miperidine
tramadol
105
if pt has allergy to natural or semi synthetic what can we give them?
synthetic
106
how much to reduce dose by when switching
25-50%
107
what type of opioid should be selected first?
IR, lowest effective dose
108
when should clinicains follow up with starting opioid therapu
1-4 weeks
109
what strength if not working should we taper opioids
>50 MME
110
how to taper if pt has taken opiods > 1 year
reduce by 10% per month
111
how to taper if pt has taken opioids for weeks to months
reduce by 10% per week
112
what to do once lowest dose has been obtained and we're tapering?
interval can be extended
113
frequency at which we can stop opioids?
once daily
114
who does 2014 chronic pain law apply to
>60 pills / month for 3+ months
>15 MME for 3+ months
transdermal patch 3+ months
ER med
115
7 day prescribing law
initial opioid rx for a patient cant be more than 7 day supply
unless: cancer, palliative care, substance abuse disorder, professional judgement
116
Inspect requirement
before prescribing opioid or benzo prescribers must check
no exceptions
on pain contract - check every 90
117
what does a pain contract do
if pt gets opioid from other prescriber than original will no longer write
118
what is OPEN and reccomendations
michican opioid prescribing engagement network
scheduled dosing of acetaminophen and ibuprofen
alternate tylenol 650 with ibuprofen 600 alternate every 3 hours for 3 days or until not needed
119
uses for patient controlled analgesia (PCA)
post-operative
pancreatitis
sickle cell crisis
120
first line low back pain
acetaminophen
NSAIDs
121
second line low back pain
SNRIs
TCAs
122
osteoarthritis first line
acetaminophen
oral/topical NSAIDs
123
osteoarthritis second line
intra articular hyaluronic acid
capsaicin
124
fibromyalgia FDA approved meds
pregabalin
duloxetine
125
fibromyalgia options not FDA approved
TCAs
gabapentin
venlafaxine
126
neuropathic pain first line
SNRIs
gaba/preg
127
neuropathic second line
TCAs
topical lidocaine
128
hospice meds
morphine IV under the tongue (pain)
lorazepam IV or SL (anxiety)
ondansetron ODT (nausea/vomit)
atropine drops/ scopalomine patch (secretions)
