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26 Cards in this Set
- Front
- Back
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Somatic Pain:
Superficial laceration or burn, IM injections, OM |
Sharp, stabbing, localized
Typically responds to tx: APAP, cold packs, steroids, local anesthetics, opioids, NSAID’s, tactile stimulation |
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Visceral Pain:
Periosteum joints, muscles, sickle cell, appendicitis, renal stones |
General ache or pressure, can be sharp. Typically deeper innervation.
Typically responds to tx: Corticosteroids, NSAID’s, opioids, intraspinal local anesthetics |
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Neuropathic Pain:
Trigeminal, post-traumatic neuralgia, peripheral neuropathy, amputations |
Radiating or specific location w/burning, prickling, tingling, lancinating or shock-like in peripheral or central locations
Typically responds to tx: Anticonvulsants, corticosteroids, neural blockade, NSAID’s, opioids, TCA’s |
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Non-pharmacological pain mgmt
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(hot/cold packs, immobilization, massage, relaxation/biofeedback, etc.)
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Opiods
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Morphine, hydromorphone, fentanyl, meperidine, oxycodone, propoxyphene, hydrocodone
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Local anesthetic
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Lidocaine
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Epidural blocks
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Ropivicaine, bupivicaine
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Anticonvulsants
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Gabapentin, pregabalin
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Perioperative pain management
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NSAIDs, APAP, Cox-2 inhibitors, regional block with local anesthetic, patient controlled anesthetic
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Patient controlled anesthetic (PCAs)
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Max bolus dosing has a 1 or 4 hour lockout period
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Ketorolac used for
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moderate to severe pain
Don't use for more than 5 days or in renal dysfunction |
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APAP, ASA, NSAID’s, COX-2 Inhibitors, Corticosteroids, Anticonvulsants
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have significant opioid dose-sparing properties. Dec. opioid ADE’s
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Opiods
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use after you've tried NSAIDs, APAP, ASA, or Cox-2.
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Opiod of choice
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Morphine
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Hydromorphone
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Good alternative for morphine-intolerant patients or in patient that developed tolerance to other opioids
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Fentanyl—
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Good alternative for morphine-intolerant patients; Good for patients w/renal dysfunction; Short DOA
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Nalbuphine—
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Unreliable provision of adequate analgesia for moderate to severe pain (analgesic ceiling effect); Should be avoided in chronic or cancer pain
Can cause acute w/d response in patients who are chronically receiving mu-agonists |
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Meperidine
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Not considered 1st line opiate
Must follow dosing limitations Must not use in impaired renal or hepatic dysfunction, hx of seizures or head trauma, elderly Must be monitored for signs/symptoms of CNS excitation |
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Avoid morphine when
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SCr > 2 mg/dL
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Meperidine use limited to
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Treatment of post-op shivering
Prevention/treatment of rigors (from platelets or drugs) One-time pre-procedural conscious sedation for adults Anaphylactoid reactions to other opioids Unmanageable ADR’s to other opioids |
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Meperidine
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Pure opioid agonist; Binds to mu receptor & promotes analgesia & respiratory depression in CNS; Decreases gastric, biliary & pancreatic secretion, induces vasodilation
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Meperidine Contraindications
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MAOI’s, head injury, unstable/untreated thyroid condition, renal dysfunction, hepatic dysfunction, hx of seizures, elderly, infants
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Meperidine adverse drug effects
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N/V, dizziness, lightheadedness, hypotension, seizures, resp. depression
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Morphine
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Pure opioid agonist; Binds to mu receptor & promotes analgesia & respiratory depression in CNS; Decreases gastric, biliary & pancreatic secretion, induces vasodilation
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Morphine ADE's
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Peripheral edema, pruritis, rash, N/V/D/C, dizziness, resp. depression, sedation
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Morphine drug interactions
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MAOI’s (resp. depression), muscle relaxants, BZD’s, barbiturates (resp. depression & additive CNS effects)
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