Flashcards in pain Deck (134)
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1
Oligoanesthesia- who is at risk
under-treatment of pain
• Peds, elderly, cognitive delay, psych pt’s, altered
2
Know three rule
• Know three drugs for each class and route
3 CCB for HTN
3 Medicines parenteral for pain
3 NSAIDS
3 Long Acting insulin
not everybody is the correct profile. the third medicine should always be "what if they are pregnant"
3
pain treatment is separate in what dx
• Pain treatment is separated in cancer and non-cancer pain
Cancer pain – don’t worry about addiction (just treat their pain which generally terrible pain)
4
Symptomatic vs. Mechanism approach
Treating the mechanism of pain is treating the nerve pathways/physiology of pain
5
Parenteral includes
IM SQ IV
6
onset of IM
easy, onset 10-20 min, lasts longer; stick is involved, not titrateable, results are unpredictable. Can give someone 8mg of morphine IM and they may not feel anything and want more.
7
IV advantages
what situations are pest
Fast onset, titrateable; stick, shorter duration, more side effects.
Good if: moderate/severe, NPO, or local pain control not possible. Best overall
8
advantages and disadvantages of PO
i. Easy, long duration; delayed onset, can’t give if vomiting, NPO or significant pain
9
Local infiltration/blocks advantages
i. Fast onset, lasts 1-4hrs*, good duration for procedures – lacs, abscess, foreign body, digital block, ring block, dental blocks
10
when would acetaminophen be used
• IV: 1g excellent; Oral: 1gm; Rectal in kids
• Great antipyretic, good analgesia
• Combine w/ NSAID’s, opiates - anything
• Good for most elderly/pregnant pt’s
11
when is acetaminophen CI
Avoid: liver FAILURE, big etoh
NOT liver disease
12
• NSAIDs are CI in
Over 65yo (but if youre going to give it, give the lowest dose), renal or GI issues, on ASA/coumadin, bleeding issues, pregnant, breastfeeding. Avoid Cox-2’s
13
NSAID dose
• Oral: Ibuprofen 600-800mg, Naprosyn 500mg, etc
800 NO significant benefit
14
can use NSAIDS with
Combo: APAP/NASIDs to treat acute pain
15
Ketorolac (Toradol®) what kind of drug is it
how is it administered
IM/IV 15-30mg (you will see 30 and 60 mg)
NSAIDS
16
Ketorolac (Toradol®) is best for
NSAIDS
Great: back pain, renal colic, muscles, burns, etc
17
Ketorolac (Toradol®) should be avoided in
Avoid:
Over 65yo (but if youre going to give it, give the lowest dose)
renal or GI issues
on ASA/coumadin
bleeding issues
pregnant
breastfeeding. Avoid Cox-2’s
18
what are the limitations with ketorolac
More not better. Give 1-2x max in ED. 5 days inpatient max
19
Benefits of Ketoralc over NSAIDs
sometimes better for acute pain
better for placebo of IM
20
Gabapentin (Neurontin®)
what are the other drugsin this class
dosed
nerve pain medication
Oral dosing only
Pregabalin, Duloxetine
21
Gabapentin can be used with
Gabapentin
combo with
NSAIDs/APAP for acute pain
but CAN'T DRIVEAFTER
22
Gabapentin typically given for
Neuropathic pain –
DM, fibromyalgia, post herpetic neuralgia, back pain
23
Tramadol (Ultram®)
• Synthetic, opiate-like activity
• Addiction/abuse potential
• . Not often used in ED for acute pain, not often rx’d
24
opiates are schedule
what are the indications
Opium-derived drugs: alkaloids, semisynthetic
. Parenteral are Schedule IV – pt specific order
iv. Indications: moderate – severe pain
25
Biggest ADE’s/concerns with opiates
i. Respiratory depression: all
ii. Hypotension; esp w/ Morphine
iii. Altered mental status, dizzy
iv. Nausea/vomiting common
v. ADE: flushing, rash, itching
vi. Constipation
vii. Tolerance/dependence/addiction
26
opiatesa are given with (3)
IV-pump up your blood pressure
antiemetics-keep you from barfing
antihistamines -reduce rash and flush
27
dosing or morphine
Dose 4-10mg IM/IV common
comes in 2's be mindful of this
order 2, 4, 6, 8 or 10
really don't use 2 or 10
because it comes in 2s DO NOT ORDER 5
8 is high
usually we giver 4 or 6
10mg is .1 fentanyl and 1.5 hydromorphone
onset is 10-15 minutes
28
morphine is CI in
hypotensive
USE ANOTHER DRUG
• AMS common; careful in resp dz, elderly, kids
29
Hydromorphone (Dilaudid®) dosing
Dose 0.5-1mg IV (0.5 novice, 1mg severe pain)
PO dose 1-2mg – good if no IV, can take PO
IM NOT so good
very slow onset
30
