Pharmacology
One medication from each class of laxative: stimulant, detergent/surfactant, lubricant, PAMORA
Stimulant: senna, bisacodyl
Osmotic: PEG, lactulose, magnesium citrate, magnesium hydroxide
Detergent/surfactant: docusate
PAMORA: naldemedine, naloxegol, methylnaltrexone
These are two common side effects shared by opioids
What are sedation, constipation, respiratory depression, nausea
T/F: All patients experience pain similarly and can be rated on the same scale
Pain is inherently subjective and can differ significantly between individuals. While there are scales available to rate pain, at similar levels of pain behaviors might vary markedly between individuals and patient self-report remains the primary basis
The original opioid
What is morphine
Drugs to use with caution or dose adjust in renal insufficiency
What are NSAIDs, hydromorphone, oxycodone, gabapentin, pregabalin, and morphine
Duloxetine and venlafaxine work on these neurotransmitters
What are norepinephrine and serotonin
Risk factors for the development of persistent pain
What are poorly controlled, high-intensity pain, acute pain, preoperative pain or anxiety, long-term opioid use, long ICU stay, and major surgery
Three non-opioid options for neuropathic pain management
What are gabapentin, pregabalin, amitriptyline, duloxetine, venlafaxine, lamotrigine, oxcarbazepine, and botulinum toxin
The duration of action of a fentanyl patch
What is 72 hours
The toxic metabolite of acetaminophen and its treatment
The shortest to longest half-life of buprenorphine, fentanyl, oxycodone, methadone, morphine, hydromorphone
What is fentanyl, hydromorphone, morphine, oxycodone, buprenorphine, methadone
These are two topical pain management medications that have poor systemic absorption
What are lidocaine patches, diclofenac, capsaicin, menthol, and methyl salicylate
Two validated pain intensity assessment scales
Wong-Baker FACES
Behavioral Pain Scale (BPS)
Critical Care Pain Observation Tool (CPOT)
Numerical Rating Scale (NRS)
Verbal Rating Scale (VRS)
COMFORT scale
Brief Pain Inventory (BPI)
McGill Pain Questionnaire (MPQ)
The generally recommended strategy for patients on buprenorphine outpatient treatment with acute pain
What is continue the buprenorphine by splitting the daily dose into q6-8 hour dosing and maximizing non-opioid pain management
CYP3A4
What are buprenorphine, fentanyl, and methadone
Ketamine acts on these receptors
NMDA, mu/delta/kappa opioid, serotonin
The maximum recommended dose of acetaminophen and the maximum recommended dose in hepatic failure (short term vs long term)
What is 4g/day, 3g/day, and 2g/day
Three management strategies for hyperalgesia
What are reducing opioid doses, interrupting infusions, multimodal agent use, and rotating analgesic agents
An oral mu receptor antagonist
What is naltrexone
Glucuronidation
What are hydromorphone, morphine, and acetaminophen
The pain management dosing for IV ketorolac
What is 15-30 mg IV once or every 6 hours for up to 5 days
Three criteria of the Rome IV definition for OIC
New or worsening symptoms of constipation plus > 2 of the following > 25% of the time:
straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction/blockage, manual maneuvers to facilitate and < 3 spontaneous bowel movements per week
Two physiological mechanisms by which patients with critical illness may experience opioid tolerance
α1-acid glycoprotein binding, increased TNF-a mediated P-gp efflux, proinflammatory activation of NMDA receptors, reduction of nociception by inhibitory pathways, sympathetic activity activating spinal cord DAMP, systemic inflammation leading to neuroinflammation
The recommended dose reduction when converting opioids by MME
What is 25-50%
CYP2D6
What are oxycodone, duloxetine, venlafaxine, and amitriptyline