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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

CI with dilaudid

Hypotension less – but still a concern; AMS

really high abuse potential