Term
| P, Q, R, S, T of Pain Assessment by JCAHO |
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Definition
P- palliative/provocative factors (what makes it better/worse)?
Q- quality (describe the pain)
R- radiation (where is the pain)
S- severity/intensity (how does the pain compare w/ other pain experienced)
T- temporal factors (does intensity change with time) |
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Term
| Four types of pain scales used commonly to rate pain |
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Definition
a) simple descriptive pain scale (none/mild/moderate, etc)
b) visual analog scale (no pain to worst pain, mark x)
c) numeric pain intensity (0-10)
d) Wong-Baker FACES Pain scale (0 happy face, 10 crying face) |
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Term
| chronic nonmalignant pain is described as lasting _____________ or beyond the healing period. |
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Definition
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Term
| nerve conduction rate in acute vs chronic pain |
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Definition
acute pain = rapid nerve conduction
chronic (malignant/nonmalignant) pain = slow nerve conduction |
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Term
World Health Organization (WHO) Analgesic Ladder:
Stage 1 |
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Definition
non-opioid agent, such as an NSAID or APAP
± adjuvant agent (anything used for a different purpose, such as antidepressants or seizure meds) |
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Term
World Health Organization (WHO) Analgesic Ladder:
Stage 2
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Definition
Mild to moderate pain;
Opioid for mild/moderate pain
± non-opioid
± adjuvant |
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Term
World Health Organization (WHO) Analgesic Ladder:
Stage 3 |
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Definition
opioid for moderate to severe pain
± non-opioid
± adjuvant |
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Term
| What are the first-line agents for mild to moderate pain? |
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Definition
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Term
for 75+, the first line for pain management is...
(per the American Geriatrics Society Pain Management Guidelines) |
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Definition
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Term
| Tolerance is defined as... |
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Definition
| A state of adaption in which exposure to a drug induces changes that result in a diminution of 1+ of the drug's effects over time. |
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Term
| Addiction is defined as... |
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Definition
| A primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. |
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Term
| Pseudoaddication is reflective that the patient is... |
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Definition
| NOT receiving adequate pain control. |
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Term
| A patient who has _________ ___________ on an opioid will have a specific withdrawal syndrome if the drug is stopped abruptly or if the dose is rapidly reduced. |
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Definition
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Term
| APAP max single dose reduction from _____ to _______ |
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Definition
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Term
| APAP max daily dose reduced from ________ to ________ |
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Definition
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Term
| A ceiling effect is only seen with... |
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Definition
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Term
3 types of opioid receptors
(ranked in order of strongest to weakest) |
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Definition
strongest: mu (μ)
#2: kappa (κ)
#3: delta (δ)
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Term
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Definition
mu=
analgesia, respiratory depression,
euphoria, miosis
reduced gastric motility, physical dependence |
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Term
SE's of opioids:
Kappa (5)
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Definition
| analgesia, sedation, dysphoria, miosis, and diuresis |
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Term
SE's of opiods:
Delta (2) |
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Definition
| analgesia, respiratory depression |
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Term
| strong full (opioid) agonists produce maximal response when binding to what receptors? |
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Definition
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Term
Long-acting opioids (full agonists):
4 morphine options and dosing frequencies |
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Definition
1/2: MS Contin (CR) & Oramorph SR, q8h-q12h
3: Kadian q12h-q24h
4: Avinza q24h (biphasic delivery)
3/4 can open and sprinkle
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Term
| Oxycodone (OxyContin CR)-- dosing frequency |
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Definition
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Term
| Oxymorphone (Opana ER)-- counseling pts, pts it's most effective in |
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Definition
do not consume with alcohol
cancer pts switching from long-acting morphine or oxycodone |
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Term
Methadone (Dolophine)--
two indications, dosing frequencies, DOA vs half-life |
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Definition
heroin indication-- once daily
pain-- 3-4x's daily
elimination half-life 8-59h, DOA 4-8h
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Term
| Fentanyl (Duragenic Transdermal Patches)-- DOA, dosing, and time til depot formation |
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Definition
DOA: 72h
Dosing: 25mcg patch deliver 25mcg/hour
12h to depot formation |
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Term
| Meperidine (Demerol)-- _____-acting agent, should not be used for longer than _________ |
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Definition
short-acting agent;
48 hours |
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Term
| Hydromorphone (Palladone ER versus Exalgo ER)- dosing |
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Definition
Palladone ER removed from market.
Exalgo ER-- once daily |
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Term
| Proper disposal of Fentanyl patches |
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Definition
| folding sitcky sides together & flushing down the toilet |
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Term
Why should Meperidine (Demerol) not be used chronically?
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Definition
| toxic metabolite (normeperidine) can accumulate with repeated dosing |
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Term
Hydromorphone (Dilaudid):
______-acting, dosing frequency |
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Definition
| short acting, dosed every 3-4 hours |
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Term
| Morphine/Naltrexone (Embeda)-- role of Naltrexone |
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Definition
| Naltrexone is an opioid antagonist designed to limit abuse |
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Term
To determine dose of immedaite release opioid:
the total daily dose of the long-acting opioid should be calculated and the IR should be dosed as ___-___% of the long acting dose. |
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Definition
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Term
| Short-acting opioids usually dosed how often? |
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Definition
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Term
Fentanyl (Actiq Oral Transmucosal Fentanyl) IR--
1) consumption time
2) time to peak effect
3) a 2nd lozenge can be used how long after the 1st dose
4) initial/max doses |
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Definition
1) consumption time- 15 minutes
2) peak effect in 5-10 minutes
3) 2nd lozenge 15 minutes after 1st
4) 200mcg initial/ 1600 mcg max |
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Term
Fentanyl (Fentora Effervescent Buccal Tablet):
1) how its absorbed
2) initial dose, length til 2nd dose
3) max dose |
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Definition
1) 50% from buccal mucosa, 50% swallowed with saliva
2) initial 100mcg, another 100mcg 30 minutes later
3) max= 800 mcg |
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Term
Fentanyl (Onsolis Buccal Film)--
time to dissolve
elapsed time prior to next dose
(initial/max dose) |
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Definition
15-30 minutes to dissolve,
at least 2 h til next dose
(i: 200mcg, max: 1200 mcg) |
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Term
Fentanyl (Abstral Sublingual tablets)--
1) time to dissolve
2) max/min dose
3) elapsed time prior to next dose |
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Definition
1) 10 seconds to dissolve
2) initial: 100mcg, max: 800mcg
3) 2h to next dose |
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