Chronic Pain/Pallative care

true or false: symptoms can occur without relation to noxious stimuli

True

goals of tx of chronic pain

functional status

decrease pain perception 

reduce use of medications as able 

improve QOL

What does OLDCARTS stand for

onset, location, duration, character, aggravating factors, relieving factors, timing and severity

what does SOCRATES stand for

site, onset, characteristics, radiation, associated symptoms, timing, exacerbating factors, severity

what are examples of adjunctive agents/co-analgesics for neuropathic pain

• antidepressants

• anticonvulsants

• corticosteroids 

• anti-spasmodic

• sleep aid

• anxiolytics

what are some side effects someone on TCAs can experience

Anti-SLUD, cardiac adverse events

what are some side effects someone on SNRIs can experiene

serotonin syndrome, HTN

what is a key side effect someone one venlafaxine may experience

QT prolongation

what are some non pharm interventions for patients experiencing chronic pain

PT/OT

acupuncture, chiropractic, massage

TENS/PENS

surgical interventions (kyphoplasty)

what opioid would you give someone who is opioid naive?

IR, short acting

key phrase to remember when dosing opioids

start low and go slow

tramadol interacts with what CYP450 enzymes

2D6 activity

tramadol dosing IR

25-100mg PO Q4-6 PRN (max 400mg/day)

tramadol dosing ER

100mg/day with max of 300mg/day

oral long acting opioids for chronic pain

MS contin

oxycontin

this drug has activity at mu and NMDA recepetors

methadone

this drug is highly lipophilic, does not require renal adjustment and is available as oral solution and the tablet can be crushed

methadone

what should you monitor with methadone

EKG with QT baseline, day 30 then annual

risk of arrhythmia

how often should you replace fentanyl patch

Q72 hours

when can you only replace Q48 hours

if tolerating Q72 and pain recurs at end of interval

with fentanyl patches, titrate dose no faster than every ____-____ days

3-6 days

what should the patient do with the PO long acting med when placing first patch on

take last dose of PO long-acting med

what should patient do with PO long acting med when taking patch off

Give half of the first long acting PO med at 12-18 hour later

what should you never do with the fentanyl patch

cut it

strengths of morphine IR tabs

15, 30mg

strength of MS Contin

15, 30, 60, 100, 200mg

strength of oxycodone IR tabs

5, 10,15,20,30mg

strength of Oxycontin

10, 20, 40, 80mg

hydromorphone strength

2, 4, 8mg

fentanyl patch strengths

12.5, 25, 50, 75, 100mg

Define PCA

patient controlled analgesia

when is PCA used

for institutionalized patients needing IV therapy

PCA is a _____ not a piece of equipment

process

what is a side effect of opioids that does not delevop tolerance

constipation

example of bowel regimen

stool softener + stimulant

how to manage unrelieved constipation

methylnaltrexone

methylnaltrexone strength is non-cancer patients

PO 450mg QD or SubQ 12mg daily

dosing of methylnaltrexone in patient <38kg

0.15mg/kg

dosing of methylnaltrexone in patient 38-62kg

8mg

dosing of methylnaltrexone in patient 62-144kg

12mg

dosing of methylnaltrexone in patient >114kg

0.15mg/kg

CDC recommendation for having naloxone while on opioids 

50 or greater morphine mg equivalent per day or if concurrent benzodiazepine

true or false: it is okay to restart your opioid after its been a while since you last took one

false

true or false: palliative care is not the same as hospice

true

who can qualify for palliative care

cancer, AIDS, HF, COPD, ALS, any terminal illness